Legal Aspects Of Nursing Practice - NURS 2300 State Boards O

Legal Aspects Of Nursing Practicenurs 2300state Boards Of Nursing P

Legal Aspects of Nursing Practice NURS 2300 State Boards of Nursing ïµ Purpose of licensing: ïµ To protect the public health, safety, and welfare of the people (not nurses!) ïµ All states have a mandatory licensure law for the practice of nursing to safeguard the public. ïµ Thus, only licensed nurses – RN or LVN/LPN – can practice nursing. 2 Nurse Practice Act Objectives of NPA: ïµ Defines the practice of professional nursing ïµ Sets the minimum educational qualifications and other requirements for licensure ïµ Determines the legal titles and abbreviations nurses may use ïµ Provides for disciplinary action of licensees for certain causes In many states, NPA is a statutory law affecting nursing practice within the bounds of the state. ïµ Nursing Practice Act – defines and controls nursing ïµ g_practice_act_pdfs/npa2013.pdf 2017 by Elsevier Inc.

All rights reserved. 3 Composition of the Board of Nursing (BON) Members appointed by the Governor with advice and consent of senate (13 Members) 1 APN; 2 RNs; 3 LVNs; 1 Nurse Faculty LVN Program; 1 Nurse Faculty ADN; 1 Nurse Faculty BSN; 4 Public Members State Boards of Nursing and Nursing Education ïµ The state boards of nursing have the authority to set and enforce minimum criteria for nursing education criteria. ïµ An applicant for licensure must graduate from a state- approved nursing education program. 2017 by Elsevier Inc. All rights reserved. 5 National Council of Licensure Examination for Registered Nurses (NCLEX- RN) ïµ The licensure exam is updated regularly and tests critical thinking and nursing competence in all phases of the nursing process. ïµ Computerized adaptive testing ïµ Minimum: 75 Maximum: 145 ïµ Duration: 5 hours ïµ How does computerized adaptive testing work? Video: The Next Generation NCLEX Uses Computer Adaptive Testing ( CAT) | NCSBN 2017 by Elsevier Inc. All rights reserved. 6 Licensure by Endorsement ïµ Endorsement – the RN may practice in different states without having to take another licensing exam ïµ Requirements: ïµ Proof of licensure in another state ïµ Licensure fee ïµ 7 Nurse Licensure Compact: A Mutual Recognition Model of Licensure ïµ As of January, 2018- eNLC is now in place ïµ ïµ Each state that wishes to participate in the compact must pass legislation enabling the board of nursing to enter into the interstate NLC. ïµ 8 State Boards of Nursing and Sanctions ïµ The state boards of nursing has the power to sanction a nurse for performing professional functions that are dangerous to the patient or general public. ïµ Probation ïµ Suspension ïµ Revocation Most common reason for disciplining nurses: Practicing while under the influence of alcohol or drugs (diverted from workplace).

2017 by Elsevier Inc. All rights reserved. 9 Legal Risks in Professional Nursing Practice ïµ Malpractice occurs when a professional fails to act as a reasonably prudent professional would have acted under the same circumstances. ïµ Malpractice may occur by ïµ Commission – doing something that should not have been done ïµ Omission – failing to do things that should have been done 10 Legal Risks in Professional Nursing Practice Four Elements of a Cause of Action for Negligence 1. The professional (nurse) has assumed the duty of care (responsibility for the patient’s care; Lunsford Case) 2. The professional (nurse) breached the duty of care by failing to meet the standard of care. 3. The failure of the professional (nurse) to meet the standard of care was the proximate cause of the injury. 4. The injury is proved. 2017 by Elsevier Inc.

All rights reserved. 11 Delegation and Malpractice ïµ Professional nurses may delegate independent nursing activities (as well as medical functions that have been delegated to them) to other nursing personnel. ïµ State nurse practice acts do not give LPNs or LVNs the authority to delegate. 2017 by Elsevier Inc. All rights reserved. 12 Delegation and Malpractice ïµ Professional RNs retain accountability for acts delegated to another person. ïµ RN is responsible for determining that the delegated person (delegatee) is competent to perform the delegated act. ïµ The delegatee is responsible for carrying out the delegated act safely. ïµ The professional nurse remains legally liable, however, for the nursing acts delegated to others unless the delegatee is also a licensed professional whose scope includes the assigned act. 2017 by Elsevier Inc. All rights reserved. 13 Delegation and Ethical Implications ANA Code of Ethics for Nurses Provision 4.4: Delegation of Nurse Activities (2015) The nurse must make reasonable efforts to assess individual competence when assigning selected components of nursing care to other healthcare workers. This assessment involves evaluating the knowledge, skills, and experience of the individual to whom the care is assigned, the complexity of the assigned tasks, and the health status of the patient. Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate tasks.

Employer policies or directives do not relieve the nurse of responsibility for making judgments about the delegation and assignment of nursing care tasks (p. 2). 2017 by Elsevier Inc. All rights reserved. 14 FIVE MOST FREQUENT ALLEGATIONS 1.

Failure to ensure patient safety 2. Improper treatment or performance of treatment 3. Failure to monitor and report 4. Medication errors 5. Failure to follow facility’s policy and procedure Malpractice vs Peer Review ïµMalpractice-Actual injury, Money for compensation, Courts-judges & juries, Statute of limitations ïµPeer Review-Patient exposed to unnecessary risk of harm, license restrictions, peer review committees and the BON, No Statute of Limitations Peer Review ïµ Enacted in 1987 as part of the Professional Nursing Quality Assurance Act ïµ Organizations with 10 or more RNs required to have peer review procedure Peer Review 1.

RN is reviewed at employer (hospital) 2. Complaint is received by BON 3. Informal Hearing at BON 4. Agreed Order/ No agreement 5. Formal Charges filed at State Office of Administrative Hearings 6.

Formal Hearing/Admin. Law Judge 7. State Court Peer Review ïµ The fact of the discipline remains on the RN’s/LVN’s record and is public information National Data Bank ïµ The names of all disciplined nurses are sent to the National Practitioner’s Data Bank and the information is available to all nursing licensing boards ïµ mplaints_disciplinary_action.asp Avoiding Malpractice ïµ Maintain open, honest, respectful relationships and communication with patients and family members. ïµ Patients are less likely to sue if they feel that a nurse has been caring and professional. ïµ Don't offer opinions when a patient asks what you think is wrong with him-you may be accused of making a medical diagnosis. ïµ Don't criticize health care providers or their actions when you are with patients. ïµ Maintain confidentiality in the health care setting.

Avoiding Malpractice ïµ Maintain competence in your specialty area of practice. ïµ Attend relevant continuing education classes. ïµ Attend relevant hospital in-service programs. ïµ Expand your knowledge and technical skills. Avoiding Malpractice ïµ Know legal principles and incorporate them into everyday practice. ïµ Keep up to date on your state's nurse practice act. ïµ Keep up to date on hospital policies and procedures. ïµ Practice within the bounds of professional licensure. ïµ Perform only the nursing skills allowed within your scope of practice and that you are competent to perform. Avoiding Malpractice ïµ Know your strengths and weaknesses. Don't accept a clinical assignment you don't feel competent to perform. ïµ Evaluate your assignment with your supervisor ïµ Accept only those duties you can perform competently ïµ Document all nursing care accurately. ïµ When documenting care on the patient's chart, use the FACT mnemonic: be f actual, a ccurate, c omplete, and timely.

Informed Consent Three Major Conditions of Informed Consent 1. Consent must be given voluntarily. 2. Consent must be given by an individual with the capacity and competence to understand. 3.

The patient must be given enough information. 25 Informed Consent and the Role of the Nurse ïµ Unless primary providers, nurses collaborate with the primary provider. ïµ A nurse may witness a patient’s signing but is not responsible for explaining the proposed treatment. ïµ The nurse is not responsible for evaluating whether the physician has truly explained the significant risks, benefits, and alternative treatments. ïµ The nurse is responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to change consent, and communicating the patient’s need for further information to the primary provider. 26 Confidentiality Confidentiality – legal and ethical concern.

Protection of private information gathered about a patient during provision of care. ïµ The Code of Ethics for Nurses Provision 3.1 states that: ïµ “…the nurse has a duty to maintain confidentiality of all patient information, both personal and clinical in the work setting and off duty in all venues, including social media and any other means of communication  Nurses are responsible for providing accurate, relevant data to members of the health care team and others who have a need to know†(ANA, 2015). 27 Health Insurance Portability and Accountability Act (HIPAA) of 1996 ïµ What does this mean for nurses? ïµ What are the consequences? ïµ Case studies 28 Confidentiality and Social Media ïµ NCSBN (2011): A Nurse’s Guide to the Use of Social Media ïµ Confidentiality and HIPAA regulations place significant limitations on the content of nurses’ social media activities and comments. ïµ NCSBN identified six common myths and misunderstanding regarding social media. ïµ Video: 2017 by Elsevier Inc.

All rights reserved. 29 Social Media Do's ïµ Nurses should talk about themselves, the nursing profession, their family, hobbies, and interest ïµ Never talk about patients or identifiable coworkers ïµ Avoid identifying your employer on your social media profiles ïµ Don’t post anything online that you wouldn’t say in front of your boss or human resources ïµ Uplift the nursing profession Social Media Don'ts ïµ Don’t use the employer’s internet to post on social media sites--just don’t post to social media while at work ïµ Realize that nothing online is ever really anonymous ïµ Become keenly aware of your employer’s social media policies ïµ Don’t identify your employer on your personal profiles ïµ Don’t do anything you would be embarrassed to say to your mother, your clergy, your boss, or a potential employer ïµ Don’t do anything that could degrade or embarrass your profession

Paper For Above instruction

The legal aspects of nursing practice are fundamental in safeguarding both the public and the profession. These legal considerations encompass the regulatory frameworks established by state Boards of Nursing, the Nurse Practice Acts (NPAs), licensure procedures, and disciplinary actions. The primary purpose of licensing is to protect the public's health, safety, and welfare by ensuring that only qualified individuals serve as registered nurses (RNs) or licensed practical/vocational nurses (LPNs/LVNs). The Nurse Practice Act delineates the scope of practice, educational requirements, legal titles, and mechanisms for disciplinary measures. State Boards of Nursing (BON) play a critical role in setting educational standards, issuing licenses, and imposing sanctions such as probation, suspension, or revocation when a nurse violates legal or ethical standards.

The licensure process typically involves passing the NCLEX-RN exam, which evaluates critical thinking and nursing competence through computerized adaptive testing. Additionally, licensure can be achieved via endorsement, allowing nurses licensed in one state to practice in another with proper documentation. The Nurse Licensure Compact (eNLC), established in 2018, facilitates mutual recognition of licensure across participating states, promoting interstate practice and mobility. However, sanctions for unethical or unsafe practices are enforced by BON, which holds the authority to discipline nurses and maintain public safety.

Legal risks inherent in nursing practice include malpractice and peer review. Malpractice entails a failure to act as a reasonably prudent professional would under similar circumstances, either through commissions (doing something wrong) or omissions (failing to do something necessary). The four elements of negligence—duty, breach, causation, and injury—must be proven in court for a malpractice claim. Nurses bear accountability for delegated acts; although they can delegate tasks, they remain liable for ensuring competence and safety. Ethical guidelines, such as the ANA Code of Ethics (Provision 4.4), emphasize assessing individual competence and practicing within scope of practice.

Frequent allegations against nurses involve patient safety failures, improper treatment, medication errors, and failure to follow policies. Both malpractice and peer review processes serve as mechanisms for addressing these issues, with peer review being a confidential, organizational process aimed at quality improvement without statutes of limitations. The National Practitioner Data Bank records disciplinary actions, which are accessible to licensing boards and can impact a nurse’s license and professional reputation.

Preventing malpractice requires effective communication, documentation, competence, and adherence to legal principles. Nurses should maintain honest relationships with patients, avoid unauthorized opinions, and respect confidentiality in all settings, including on social media platforms. Informed consent is a vital ethical and legal component requiring voluntary agreement, capacity, and full disclosure of information. Nurses often witness consent but do not explain treatments; instead, they ensure the consent process's validity and communicate patient needs for further information to primary providers.

Privacy and confidentiality are protected under laws such as HIPAA, which restrict sharing identifiable patient information. Nurses must be cautious about social media activities, avoiding discussions of patients or workplace specifics, and aligning online behavior with organizational policies. Violations can lead to legal consequences, professional discipline, and damage to reputation. Upholding legal and ethical standards in nursing ensures accountability, promotes trust, and sustains the integrity of the profession.

References

• American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements.
• National Council of State Boards of Nursing. (2017). NCLEX-RN Examination Candidate Bulletin.
• National Council of State Boards of Nursing. (2019). Nurse Licensure Compact (eNLC) Legislation & Implementation.
• Giddens, J. (2018). Concepts for Nursing Practice. Pearson.
• Black, J. M., & Hawks, J. H. (2019). Medical-Surgical Nursing: Clinical Reasoning in Practice. Saunders.
• U.S. Department of Health and Human Services. (1996). Health Insurance Portability and Accountability Act (HIPAA).
• Davies, B. (2014). Legal and Ethical Issues in Nursing. Cengage Learning.
• Spencer, R. F. (2015). Legal Aspects of Nursing. Elsevier.
• American Nurses Association. (2016). Policy Statement: Nurse practice acts and licensure.
• Kaplan, L., & Eichelberger, D. (2020). Ethical and Legal Issues in Nursing. Elsevier.