Legal Aspects of Nursing

Dr. Yousef Jaradat

Spring 2023
 Objectives
• Describe general legal concepts applied to nursing
• Recognize nurses’ legal responsibilities with selected aspects of
nsg practice
• Describe legal roles of nurses
• Describe the purpose &essential elements of informed consent.
• Discuss the impaired nurse &available diversion or peer
assistance programs.
• Discriminate bet negligence and malpractice.
• Delineate the elements of malpractice.
• Compare -contrast intentional torts and unintentional torts
• Describe laws &strategies that protect the nurse from litigation.
• Discuss legal responsibilities of nursing students.
 Nurse Practice Acts (NPA)

• Define and describe “scope of nursing

practice”
• Control practice through licensing

Where can you find our country

Nurse Practice Act? State of Palestine
 Credentialing
 Medical credentialing verifies that nurses, doctors are properly
trained, certified and have the required professional experience to
provide healthcare services to pts. It’s a crucial aspect of
maintaining high standards of safety in the medical profession.

 Maintaining competence in nursing practice

 Licensure
 Certification
 Accreditation ‫ شهادة‬-‫ترخيص‬-
 ‫اعتماد اكاديمي‬
 Licensure Models

• State-based
• Separate license required for each state!
• Challenged by changes in health care delivery
 Certification
• A practice validating- an individual has met
minimum standards of competence in a specialty
area.
 Standards of care

• Internal standards • External standards (National)

• Job description • NPA

• Educational level • Professional organizations

• Expertise • Nsg specialty-practice

organizations
• Institutional policies
• Other organizations
and procedures guidelines (MOH, MOE)
 Legal Aspects of Nursing Practice
“legal responsibilities”

• Informed consent (IC)

• Delegation
• Violence, abuse, neglect
• Controlled substances
• Impaired nurse
• Death and related issues!
 Informed Consent

• Purpose
o Provides client with complete information prior to
obtaining agreement by client to accept a course of
treatment or procedure
– The IC is the record of the IC, not the IC itself
 IC
• Types

I. Express consent ‫موافقة صريحة‬

• Oral or written (more invasive) agreement

II. Implied consent ‫ضمنية‬

• Individual’s nonverbal behavior indicates agreement
• Medical emergency when a person cannot express content
because of physical condition.
 IC
• Essential elements
• Must be voluntary -No coercion/force/fear of disapproval
• Must be given by client/individual with capacity to understand
• Must be given enough information to be the ultimate decision maker

Discussion- Arab world? Illiterate?

 Illiteracy in the Arab world (1 out of 3 in Arab world illiterate, half of the
women); only 63% of adult Arab population can read and write with
understanding. Literacy is the highest in Jordan 98%, Palestine 96.67%,
and Qatar 97.76%, and lowest in Egypt 75.84%, Mauritania 52.12%, South
Sudan 31.98%, Yemen 69.96%
https://wisevoter.com/country-rankings/literacy-rate-by-country/#denmark
 IC

 Exceptions (who cannot provide IC):

• A minor, person 18 yrs or younger

• The unconscious or person injured in such as way that they are
unable to consent
• A mentally ill person judged by professionals to be incompetent
 A parent, legal guardian, or representative provides or refuses
consent for these individuals
 IC
• Consider problem of illiteracy, language barriers
• Consent must be read to the client or an interpreter appropriately
used to be certain client understands
• Nurses Role:
 Nurse witness the signature but not explain the procedure.
 Assess client’s understanding, identify misconceptions
 The nurse signature confirm that:
• Client gave consent voluntarily
• Signature is authentic ‫أصلي‬
• Client appears competent
• Client have the right to refuse after signature
 Delegation
“The process for a nurse to direct another person to perform nursing
tasks and activities” [National Council of State Boards of Nursing (NCSBN)]
“The transfer of responsibility for the performance of an activity from
one person to another while retaining accountability for the
outcome” [American Nurses Association (ANA), 1997]
• The nurse’s authority to delegate is based on laws &regulations.,
nurses must be familiar with their NPA.
• Nurses must know their own scope of practice, also the scope of
practice of the Unlicensed Assistive Person (UAP,) which may vary
depending on a facility’s policies and procedures.
 The Impaired Nurse
• Inability to perform essential job functions due to:
Chemical dependency on drugs
Alcoholism
Mental illness
• Nurse promotes, advocates for, and strives to protect
the health, safety, and rights of the patient.
• Nurses need to advocate for their colleagues who
have substance abuse
(Code of Ethics for Nurses, ANA 2010)
 Advanced health care directives
• Allow persons to specify aspects of care they wish to receive if unable to make decisions
• Patient Self-Determination Act
– Recognize advance directives
– Ask clients if they have advance directives
– Providing educational material

• The types of advance health care directives are the living will and the health care
proxy or surrogate
- The living: Specific instructions about what medical treatment the client chooses to
omit or refuse (e.g., ventilatory support) in the event that client is unable to make
decisions.
- The health care proxy, (A durable power of attorney for health care) is a certified or
witnessed statement appointing someone else (e.g., a relative, trusted friend) to
manage treatment decisions when client is unable to do so.
 Do-Not-Resuscitate, DNR

• Order is generally written when client wishes for no

resuscitation
• Values and choices given highest priority
• DNR explicitly discussed with client, family, and designated
decision maker, and health care team
• DNR clearly documented, reviewed, updated
• Other care should not be withdrawn
 Crimes

• An act committed in violation of public (criminal)

law
• Punishable by a fine or imprisonment
• Does not have to be intended in order to be a crime
– Example: accidentally administering an additional and
lethal dose of a narcotic to relieve discomfort
 Negligence

• Misconduct or practice that is below the standard

expected of an ordinary, reasonable, and prudent
person

• Places another person at risk for harm

• Gross negligence
– Extreme lack of knowledge, decision making, or skill
that should have been known that put others at risk
for harm
 Malpractice
• Negligence that occurred while the person was performing as a
professional
– Applies to physicians, dentists, lawyers, nurses
• Measures to prevent malpractice:

• Check and recheck medications-medication error

• Check side rails before leaving a client-client safety
• Do not ignore a clients complaint-failure to observe and take
appropriate action
• Right client…… identity
 Intentional Torts ‫أضرارمتعمدة‬

• Assault‫ اعتداء‬: Attempt or threat to touch unjustifiably

• Battery ‫ ضرب‬: Willful ‫ لمس‬touching that may or may not

cause harm

• False imprisonment ‫سجن خاطئ‬

• Invasion of privacy
 Unprofessional conduct
• Incompetence or gross negligence
• Conviction for practicing without a license
• Falsification ‫ تزوير‬of client’s records
• Illegally obtaining, using, or possessing controlled substances
• Need to retain professional boundaries
• Violation of professional ethical codes
• Breach of confidentiality
• Fraud
• Refusing to care for clients of specific socioeconomic or cultural
origins
 Legal Protection in Nursing Practice
 Carrying out a physicians order
• Nurses should analyze procedures &medications ordered by the
physician
• Seek clarification for ambiguous or erroneous orders

• Categories nurses should question to protect themselves:

 Question any order a client questions
 Question any order if the client’s condition changed
 Question & record verbal order to avoid miscommunication.
 Question any order that is illegible, unclear, or incomplete.
 CONT
 Providing competent nsg care
• Provide care within the legal boundaries
• Be familiar with job description-experience & education
match the Job description.
• Care to protect clients from harm
• Anticipate sources for injury
• Educate clients about hazards
• Implement measures to prevent injury
• Client’s need to be assessed and monitored appropriately
• Communicate with client’s with sincere concern
 CONT
 Documentation

• Medical chart is a legal document

• Provide accurate and complete documentation of the
nursing care provided
• Failure to document can constitute negligence
• Insufficient or inaccurate assessments can hinder proper
diagnosis and treatment causing harm to client.
 CONT
 Incident Reports

• Agency record of an incident or unusual occurrence (also called

unusual occurrence report)
• Why TO report incidents??

 Make all the facts available to agency personnel

 Contribute to statistical data about incidents
 Help health personnel prevent future incidents

• Filed according to agency policy

 Information included on incident reports
• Identify client by name, initials, hospital or identification number
• Name, Date, time, place of the incident
• Description of the facts of the incident (no conclusions or blame)
• Incorporation of the client’s account of the incident in quotes
• Identification of all witnesses
• Identification of any equipment by number and any medication by
name and dosage.
 Legal responsibilities of students

• Responsible for own action, and liable for their own acts of negligence
• Function within scope of education, job description and NPA
• Follow procedures and policies
• Ask for additional help or supervision in situations they feel inadequately
prepared
• Comply with the polices and definitions of responsibility supplied by the
school of nursing.
Discussion