Legal issues in nursing

Nursing Management

1. LEGAL ISSUES IN NURSING R.RUPPAMERCY M.Sc Nursing II year DR.MGR Educational & Research Institute

2. CONTENTS Introduction History Terminologies Types of law Purposes Legal rights and responsibilities Liability and its types L egal issues in nursing Medico legal issues Journal reference Legal safeguards in nursing practice

3. INTRODUCTION The legal aspects of nursing have an impact on the manner in which care is delivered to patients by nurses. Legal concerns shape the environment in which nursing is practiced and determine how documents are kept or shared. Ultimately, nurses and the nursing care they provide are judged based on a legal definition for the standard of care for nurses.  As a nurse, it has become an important necessity to be aware of the legal aspects associated with caring and helping people in the health industry today because nursing covers a wide range of disciplines and health-care issues that are always changing and at the forefront of what guides this career path.

4. HISTORY The American Civil War (1861–1865) had a profound effect on the development of the nursing and medical professions and in many ways laid the foundation for modern nursing. In the beginning, nurse volunteers were inexperienced, untrained, and disorganized in 1867 .

5. In 1868 , just three years after the end of the Civil War, Samuel Gross, president of the American Medical Association, strongly endorsed the formation of training schools for nurses ( Egenes , 2009 ). in 1873 , the first educational programs for nurses in the United States were established in New York. The period from 1863 to 1893 was distinctly a pioneering period . The immediate problem was not to build a finished educational structure, but to clear the ground, to provide decent conditions for both patients and nurses, and to lay the foundation for an adequate nursing service.

6. As the nineteenth century drew to a close, nurses themselves, along with many women’s organizations and their leaders, lobbied for nurse registration. By 1900, between 400 and 800 nurse training schools were operating in the US and both support for and opposition to the regulation of nursing practice was strong. Although a vocal proponent for improvements in education and working conditions, an aging Florence Nightingale famously opposed nurse registration.

7. Despite fierce opposition, In 1902 members of the newly formed New York Nurses Association met at the Rochester City Hospital to discuss the establishment of the nation’s first nurse practice act . In 1903 , North Carolina passed the first “permissive” registration law for nurses. Permissive licensure allowed nurses who met certain standards (such as graduating from a nursing school and passing a comprehensive exam) to work as a nurse but did not allow the use of the title “registered nurse .” The First Registration and Practice Acts:

8. NURSE PRACTICE ACT N urse P ractice A ct , signed into law by the governor on March 2, 1903 , read in part: At meetings it shall be their duty to examine all applicants for license as registered nurse, of good moral character, in the elements of anatomy and physiology, in medical, surgical, obstetrical and practical nursing, invalid cookery and household hygiene, and if on such examination they be found competent to grant each applicant a license authorizing her or him to register, as hereinafter provided, and to use the title “Registered Nurse” signified by the letters R.N. The said Board of Examiners may in its discretion, issue license without examination to such applicants as shall furnish evidence of competency entirely satisfactory to them. Each applicant before receiving license, shall pay a fee of $5.00, which shall be used for defraying the expenses of the Board

9. By , 1921, 48 states followed North Carolina’s pursuit the practice of professional nursing licensure . These laws all changed during the Great Depression states started to become more lenient and lacked the reinforcement of nurse licensure. Many uneducated nurses were working with the sick just for pay. This created a competition for positions within the work field between the educated and the uneducated. By the help of the ANA in 1940 it became a mandated law that all nurses must be licensed to practice the nursing profession.

10. TERMINOLOGIES LAW Rules of conduct, established and enforced by authority, which prohibit extremes in behavior so that one can live without fear for oneself or one’s property. Sullivan and Decker,2001 Law is a system of rights and obligations which the state enforces. --Green Nursing law: A rule of conduct, executive orders, regulations and legal precedents which protects the individuals and the community affected by the nursing services.

11. Contd.. Legal : Established by or founded upon law or official or accepted rules Legal system: A legal system is a procedure or process for interpreting and enforcing the law . Legal issues: Legal issues in nursing are those in which a person lead to face legal problems in which nurse face problem when not meeting proper patient care.

12. TYPES OF LAW PUBLIC LAWS PRIVATE LAW OR CIVIL LAWS - CONSTITUTIONAL LAW - CRIMINAL LAW - ADMINISTRATIVE LAW - TORTS - CONTRACT LAW

13. PUBLIC LAW PUBLIC LAW: It refers to the body of law that deals with the relationship between individuals and the government and the government agencies. CONSTITUITIONAL LAW: Fundamental law written or unwritten, that establishes the character of government by defining the basic principle to which a society must conform. CRIMINAL LAW: Prevent harm to society and provides punishment for crimes. ADMINISTRATIVE LAW: When a state legislature passes a statute, an administrative agency is given authority to create rules & regulations to enforce the statutory laws.

14. PRIVATE LAW OR CIVIL LAW The body of the law that deals with relationship among private individuals. CONTRACT LAW: Legally binding exchange of promises or agreement between parties that the law will enforced. TORT LAW: It defines and enforces duties and rights among private individuals that are not based on the contractual agreement. Tort is a legal wrong committed against a person, his or her rights or property, intentional, willfully committed without just cause. A tort can be: Denial of a person’s legal right Failure to comply with a public duty Failure to perform a private duty that’s results in harm to another.

15. PURPOSES SAFEGUARDING THE PUBLIC The public safety is guaranteed The individual is secure to the event of sickness or disability with no fear of anxiety of being cared for by a competent person. It protects the patients /clients against deliberate injury by a nurse. SAFEGUARDING THE NURSE It protects the nurses also against the legal action if she renders right care. Good rapport

16. LEGAL RIGHTS AS A NURSE Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice . Nurses have the right to a work in an environment that supports and facilitates ethical practice , in accordance with the Code of Ethics for Nurses with Interpretive Statements. Nurses have the right to a work environment that is safe for themselves and for their patients.   Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.   Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities .  Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.  

17. LEGAL RESPONSIBILITIES OF A NURSE Be responsible for his or her own acts. Protect the rights & safety of patients. Witness, but not obtain, informed consent for procedures. Document & communicate information regarding client care. Refuse to carry out orders that the nurse believes to be harmful to the client. Perform acts allowed by the nurse’s state nurse practice act. Reveal client’s confidential information only to appropriate persons Perform acts for which the nurse is qualified either by education or experience. Witness a will. Restraint clients only in emergencies to prevent injury to self or others

18. WHAT ARE THE LEGAL RIGHTS OF A PATIENT? Right to considerate and respectful care. Right to information on diagnosis, treatment and medicines. Right to obtain all the relevant information about the professionals involved in the patient care. Right to expect that all the communications and records pertaining to his/her case be treated as confidential Right to every consideration of his/her privacy concerning his/her medical care programme . Right to expect prompt treatment in an emergency Right to refuse to participate in human experimentation, research, project affecting his/her care or treatment. Right to get copies of medical records Right to know what hospital rules and regulations apply to him/her as a patient and the facilities obtainable to the patient Right to get details of the bill. Right to seek second opinion about his/her disease,treatment , etc .

19. LIABILITY Liability is anything that is hindrance, or puts individuals at a disadvantage In law, a legal liability is a situation in which a person is liable and is therefore responsible to pay compensation for any damage incurred.

20. TYPES OF LIABILITY IN NURSING PERSONAL LIABILITY: Each professional is responsible for his or her own actions SUPERVISOR LIABILITY: Supervisors are responsible for the actions of those working under their directions EMPLOYER LIABILITY: Employers can be held responsible for actions committed by employers

21. LEGAL ISSUES IN NURSING UNINTENTIONAL TORT INTENTIONAL TORT QUASI-INTENTIONAL TORT

22. INTENTIONAL TORT Deliberate actions in which the intent is to cause injury to a person or property. BATTERY: Purposely touching or applying force on other persons or things related to the person without his consent with the intention to harm the person is known as a battery . EG. Actually punching the person is considered as a battery.  The battery is often considered as trespass to a person, so it is divided into two types: Criminal Battery - intention to kill a person.  Civil Battery- NO intention to kill a person. 

23. ASSAULT: The assault is generally an attempt to harm someone else which also includes threats against other people. So, assault is a planned attempt to violently harm another person.  EG. Trying to punch a person is an assault FALSE IMPRISONMENT: It is intentionally restraining another person without any legal right to do so.

24. QUASI - INTENTIONAL A wrongful act based on speech committed by a person or entity against another person or entity that causes economic harm or damage to reputation DEFAMATION: Defamation is the issuance of a false statement about another person’s reputation which causes that person to suffer harm. SLANDER LIBEL

25. Fraud : Fraud is a crime or offence of  deliberately deceiving another in order to damage another – to obtain property or services. EG. Trying to obtain a higher position by giving incorrect information to the prospective employer.

26. INVASION OF PRIVACY: Invasion of privacy is the unjustifiable intrusion into the personal life of another without consent. The four most common types of invasion of privacy torts are as follows: Appropriation of Name or Likeness Intrusion Upon Seclusion False Light Public Disclosure of Private Facts

27. UNINTENTIONAL TORT A wrong occurring to another person leading to injury even though it was not intended. Negligence and malpractice are examples of unintentional torts. NEGLIGENCE: Negligence is an individual to do something that a reasonable prudent person would do or the commission of the act in particular circumstances in standard of care to which a nurse is legally bound, would not do under similar circumstances.

28. Karimnagar : In yet another incident of apathy, an old age man suffering from coronavirus died after falling down from the hospital's bed. The man was admitted to district headquarters hospital in Telangana's Karimnagar . The aged man was surviving on the oxygen cylinder and had a breathing issue. When nobody attended him after he fell down from bed, his breathing worsened. As a result of which the oxygen supply stopped and the man died. Other patients who witnessed the man's condition raised an alarm among hospital workers, but nobody came forward for help.

29. COMMON NEGLIGENCE Failure to use aseptic technique where required. Leaving a foreign object in a patient’s body during surgery Failing to protect an infirm patient from failing, falls resulting injuries to patients. Administering wrong medicine to a patient. Administering a care in such a manner that a patient suffers injury, eg . Improper handling of hot water bag, burns to clients.

30. MALPRACTICE Malpractice occurs when an improper, injurious or faulty treatment of a client that results in illness or injury. Eg . Failure to perform proper assessment Failure to take appropriate precautions Failing to report another’s mistake Failure to follow a physician’s orders Delaying patient care Incorrectly performing a procedure, or trying to perform a procedure without training Documentation error Failure to get informed patient consent.

31. 6 ELEMENTS TO PROVE MALPRACTICE 1. DUTY: The nurse must have a relationship with the client that involves providing care and following an acceptable standard. 2. Breach of duty: standard of care that is expected in the specific situation but that the nurse did not observe. 3. foreseeability: a link must exist between the nurse’s act and the injury occurred. 4. causation: it must be proven that harm occurred as a direct result of nurse’s failure to follow the standard of care. 5. Harm or injury: The client must demonstrate some type of harm or injury( physical, financial or emotional) 6. Damages: if malpractice caused the injury, the nurse is held liable for damages that may be compensated.

32. JOURNAL ARTICLE TITLE: Malpractice an Updated Concept Analysis and Nursing Implication in Developing Countries AUTHOR: Eyad Abu Al- Haijaa RN,MSN,CPHQ,CHRM1 , Omar Ayaad RN,PHD(c)2 , Muna Al- Refaay RN,BSN 3 , Tareq Al- Refaay NAME OF THE JOURNAL: IOSR Journal of Nursing and Health Science Volume 7, Issue 1 ( Jan.- Feb . 2018) PP 81-85

33. ABSTRACT Malpractice crisis is one of the emerging challenges of the current healthcare system. Therefore, nurses are required to understand what malpractice is and develop or adopt effective strategies to prevent its occurrences. This paper aimed to update the baseline knowledge of the concept of malpractice using Walker and Avant (2011) eight steps concept analysis method and to guide nurses' practice in developing countries with regards to safe nursing practice. It was found that the concept of malpractice is related to professions and professionals, characterized by unintentional misconduct and resulting in injury and harm. The most common factors leading to nursing malpractice were improper communication, documentation, patient assessment, use of equipment, and deviation from standards of nursing practice, as well as lack of patient advocacy role . Nursing administrators play an important role in preventing the incidences of malpractice by forecasting proper plan of actions to prevent the occurrences of malpractice.

34. EIGHT STEPS CONCEPT ANALYSIS METHOD

35. RESULT The concept of this analysis was malpractice. The concept was chosen because of its related importance to patient safety, nursing profession, nurses and health care organization. Malpractice may lead to catastrophic end to the patients, nurses, health care organizations and the healthcare system.

36. TITLE: Legal Awareness and Responsibilities of Nursing Staff in Administration of Patient Care in A Trust Hospital AUTHOR: Hemanth kumar,2012 METHOD: An open ended questionnaire was prepared to assess the level of legal awareness among the nursing staff. The GNM and ANM nursing staff deployed at the nursing home and general wards only were randomly screened and specialty nurses were exempted. Results:  The knowledge on various legal provisions, as was applicable to nursing, across all categories of nurses which were under review, was found to be poor. The nursing staff had poor knowledge on patients’ rights and also on their legal obligations towards patients. The GNM nurses fared better than ANM nurses. However, 46.67 % of nurses were found to be aware about cases of omission or commission. Conclusion:  This study substantiated the fact that nurses had poor knowledge on the law that governed their profession and that in days to come, it would become increasingly difficult for them to avoid law suits which were prepared against them, unless remedial actions were taken.

37. FIVE LEGAL ISSUES IN NURSING: DOCUMENT REPORT IT OR TORT IT YOU ARE DOSING WHAT? RIGHTS TO PRIVACY SIGNATURES ARE GOLDEN

38. MEDICO LEGAL CASES Medico legal situation is defined as where there is an allegation or suspicion of causes attributing to body injury or danger to life. It needs immediate attention to avoid the loss of important and vital sign that are helpful in confirming the underlying cause.   Medico — Legal case (M.L.C.) A medico legal case is a patient who is admitted to the hospital with some unnatural pathology and has to be taken care of in concurrence with the police and/or court

39. TYPES Types of clients which are categorized as MLC in a hospital are . Road traffic accidents. Injuries inflicted during brawls/fights, shooting, bomb blasts etc . Suicide . Burns . Poisoning . Rape victim. Assault .

40. NURSES ROLE IN A MEDICO-LEGAL CASE Obtain complete history from patient or significant others Inform the police officer /constable on duty in the hospital and the CMO. When it is made a MLC, then record it on the patient's case sheet with red ink at right hand top corner. Do not give any statement about patient's condition to police, magistrate or media. Only a doctor has to give information. When a patient has to be discharged, inform the CMO only. After clearance from them, he/she can be discharged. If a MLC patient absconds, inform the CM0 and the treating doctor immediately Document the care given to patients timely, accurately and duly sign the nurse’s notes. Records and all the documents pertaining to patient should be handled with care , during the stay in the hospital. They must be kept safely and should be handed over to the authorized person as designated by the hospital authority. Incase death of a MLC; the body is not to be handed over to the relatives . It needs to be accurately labeled and sent to the mortuary. CMO and/ or police officer should be informed simultaneously. Appropriately authority must be informed.

41. LEGAL SAFEGUARDS IN NURSING PRACTICE Licensure Good Samaritan law Good rapport Correct identity Standards of care Standing orders Consent for operation & other procedures Counting sponge, instrument and needle Documentation Patient’s property reporting

42. QUESTIONS…???????

43. TAKE A QUIZ… Which was the first law passed in nursing? The First Registration and Practice Acts What are the purposes of law in nursing ? Safeguarding the public and safeguarding the nurse What are the types of liability ? Personal, supervisor and employer What does this picture mean ?

44. THANK YOU……