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Flashcards in Legal Issues Deck (36)
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Nurses' Legal Responsibility

obligation to practice and direct the practice of others under the nurse's supervision so that harm or injury to the client is prevented and the standards of care are maintained


"ignorance of the law"

not a defensible position in a lawsuit ot trial


Standard of Care

-knowledge and skill that an ordinary, reasonably prudent nurse would possess and exercise in the same or similar circumstances

-determined by the testimony of an "expert" witness



-defines the legal scope of practice of professional nursing

-varies state to state

-delineates standards for the competent use of the nursing process


Ultimate purpose of the NPA

-protect the public from practitioners who are less than competent

-legalizes the nurse's role as a patient advocate



-assert that every person is responsible for the wrong or injury done to another as result of carelessness


Personal liability

-requires nurse to assume responsiblity for patient harm or injury that is a result of negligent acts

-nurse cannot be relieved of liability by another professional such as a physician or nurse manager


Personal liability with floating and cross training

-in no case is a nurse permitted to render services if the requisite knowledge to act competently is lacking

-nurses have a legal duty to refuse specific tasks that they cannot perform safely and competently but should consider negotiation and compromise with the supervisor


Personal Liability fo r the CN

CNs have been held negligent for issues surrounding:

-triage of staff and equipment
-supervision of subordinates
-delegation of patient care tasks
-reporting of team member performance deficits in any supe
-supporting or invoking the chain of command process when indicated


RNs functioning in the orle of CN or in any supervisory capacity should review the following...

-detailed job description, including responsibilities when asked to supervise in an unfamiliar area or floor

-job descriptions for team members

-formal period of training and mentoring in the role

-validated proof of competencies

-guidelines for personal patient care assignments

-chain of command


Nurse managers and administrators held liable for...

-inadequate training
-failure to periodically re-eval staff competencies
-failure to discipline or terminate unsafe workers
-negligence in developing appropriate policies and procedures
-failure to uphold institutional licensing laws and state and federal statutes


Defenses against claims of vicarious liability

-borrowed servant and "captain of the ship" doctrines

-employer also may be liable for negligent conduct of nurses within the scope of their employment

-based on the legal principle of respondeat superior (let the masster answer)--adequate numbers of qualified nursing staff


Corporate liability

-HC corporation can be held to a specified standard of care

-HC facilities have been found coporately liable for failing to have adequate numbers of qualified nursing staff

-TJC has developed standards related to orientation, training, and education of agency staff


Reducing Legal Liability: Risk management systems

-track incidents and accidents in the facility

-assist in the development of policies and procedures to improve practice

-provide knowledge about federal and state laws, licensing laws, and HC case law



-acts of omission or commission

-if negligent acts committed in your capacity as a professional, it is considered malpractice


Statutes of limitations in malpractice cases

-differs from state to state

-establishes time limits within which a person may initiate a lawsuit

-in florida the statute of limitations for medical malpractic is two years from when the patient or family member or guardian either knew or should have known with the exercise of reasonable diligence, that the injury has occured


Major Categories of Negligence

-failure to assess, monitor , and/or rescue

-failure to follow standards of care

-failure to act as a patient advocate

-failure to use equipment in a reasonable manner

-failure to communicate

-failure to document


Transparency and Disclosure of Error

-telling the patient and family about the mistake results in less severe ramifications for clinicians and facilities

-in 2001, TJC established a safety standard requiring institutions to have a process in place to disclose unanticipated outcomes to patients


Incident Reports

-patient/family member complaint

-medication error

-medical device malfunction

-any one is injured or a potential for injury

-unexpected patient outcomes


Why an incident report?

-jog your memory
-trigger a rapid response from admin
-to facilitate decisions about restitution (lost or damaged belongings)


What to include in incident report

-concentrate on the facts
-describe what you saw/heard, etc
-put second hand info in quotes and clearly identify the source
-include full names of those involved, witnesses, etc
-what you did about it? notify MD?


What to exclude in incident report

-exclude your opinion, finger-pointing and conjecture

-do not draw conclusions or make assumptions of blame

-chart clinical observations in the chart

-make no mention of the incident report in the patient's chart

-incident report are not part of the patient's record



-investigates reports of negligence, incompetence, drug use mental or physical illness that prevents nurse from practicing safely

-may suspend license for any of the above for fraud, deceit in the practice of nursing conviction of or pleading guilt of a felony or crime of moral turpitude


Who determines eligibility to sit for NCLEX?


-law states that student can be educated by may not be able to sit for NCLEX and get license

-considers any jurisdiction including juvenile acts

-regardess of adjudication

-entering a plea of nolo contendere


Sources of Complaints

-AHCA surveyors
-TJC surveyors
-malpractice allegations
-law enforcement
-employer, co-workers, patients and their family


Grounds of Discipline

-unprofessional conduct
-failure to practice with reasonable skill and safety
-criminal conduct
-filing a false report, reapplication and or fraud
-failure to notify BON of a criminal charge within 30 days


Unprofessional conduct

-inaccurate recording
-misappropriating supplies or equipment
-leaving assignment without reporting to another licensed person
-practice with a delinquent license
-acts of negligence
-submitting false CE records
-doesn't matter if patient was harmed or not
-you wear two hats; employee and licensee


Failure to Meet Standards

-falsifying documentation
-administering meds or providing care in a negligent manner
-misappropriating drugs
-violating confidentiality
-engaging in fraud
-impersonating another licensed practitioner
-influencing a patient for exploitation
-taking drugs for self without perscription and or being impaired while caring for patients
-practicing beyond scope
-providing false or incorrect information to employer
-violating BON order to enter into a license proceeding


Investigation Process

-complaint filed
-notice mailed, have 20 days to respond
-general investigation performed
-probable cause panel
-case either dismissed or advanced
-written response
-file review
-supplementary reponse


Disciplinary actions

-letter of guidance
-suspension of license for a period of time
-revocation of license
-payment of court costs
-restrict practice
-of additional CE or College courses
-community service