LEGAL AND ETHICAL ISSUES IN NURSING

INTRODUCTION
Many key legal concepts are important for nurses to understand.
As nursing practice evolves, these fluid concepts are refined and
changed. The legal concepts are apply to all areas of nursing
practice and are not restricted to any specific segment.
Safe nursing practice includes an understanding of the legal
boundaries with in which nurse practice. As with all aspects of
nursing, an understanding of the implications of the law supports
critical thinking on the nurse part. Nurses need to understand the
law to protect themselves from liability and to protect their
clients rights.
DEFINITIONS OF LAW
The law is the body of principles recognized and applied by
the state and the administration of justice
Salmaind
The law constitutes body of principles recognized or enforced
by public and regular tribunals has the administration of
justice
Pound
The law is a system of rights and obligations which the state
enforces
Green
Ordinarily the term law means a body of rules to guide
human action
Wilson

TYPES OF LAW
The law divided into two types
a) CIVIL LAW:-It includes rules and regulations that specify the
required course of action to be followed by an individual in
business and social relationships with others.
It is concerned with relationship among people and the protection
of persons rights. The damages for civil laws involve the payment
of money, unlike criminal laws, which sometimes result in
imprisonment.
b) CRIMINAL LAW:- It defines offences that affect public
welfare and security and impose penalties. It is concerned
with relationship between individuals and governments and
with acts that threaten society and its order. A felony is a
crime of serious nature that carried a penalty of
imprisonment for greater than one year or death.
SOURCES AND VALUES OF LAW IN NURSING
The legal guidelines that nurses follow come from statutory law,
regulatory law and common law.
Elected legislature bodies such as state legislatures and U.S.
congress create statutory law or constitutional law.
An example of state statures is the nurses practice acts found
in all 50 states. These nurse practice acts describe and define
the legal boundaries of nursing practice with in each state.
Regulatory law or administered law reflects decisions made
by administrative bodies such as state boards of nursing
when they pass rules and regulations.
Common law results from judicial decisions made in courts
when individual legal cases are decided.

E.g. include informed consent and the clients right to refuse

treatment. It is a body of legal principles that has evolved
from court decisions.
As a professional nurse you need to understand the legal limits
influencing your practice. Thus along with good judgment and
sound decision making, ensures your clients receive safe and
appropriate nursing care.
It differentiates nursing practice from the practice of other
health care professions. It also describes and protects the rights
of clients and nurses.
Most of the nursing activities are characterized by intimate
touching, critical judgment, skillful manipulation and protective
vigilance. Consequently nursing practice is regulated by laws that
protect patients against deliberate to inadvertent injury by a
nurse.
Nurses who give competent care, based on their education need
not worry about malpractice law suit. Now many clients are
knowledgeable about their rights related to their health and
illness, so, nurse should take it as a challenge to become
advocate for clients.
CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE
TORTS:- A tort is a civil wrong made against a person or property.
Classification for torts include intentional, quasi-intentional or
unintentional.
Intentional torts:- Are willful acts that violate anothers rights
as assault, battery and false imprisonment.
Quasi intentional torts:- Are acts where intent is lacking but
violational action and direct causation occur. Such as found
with invasion of privacy and defamation of character.
Unintentional tort:- Which includes negligence or mal
practice

INTENTIONAL TORTS
a) ASSAULT:- Assault is any intentional threat to bring about
harmful or offensive contact. No actual contact is necessary.
The law protects clients who are afraid of harmful contact.
E.g. It is an assault for a nurse to threaten to give a client an
injection or to threaten to restrain a client for an X-ray
procedure when the client has refused consent.
b)
BATTERY:- Battery is any intentional touching without
consent. The contact can be harmful to the client and cause an
injury or it can be merely offensive to the clients personal
dignity.

A battery always includes an assault, in e.g. of a nurse

threatening to give a client an injection without the clients
consent if the nurse actually gives the injection it is battery.
b) False imprisonment:- The tort of false imprisonment occurs
with unjustified restraining of a person without legal warrant.
Fore.g. this occurs when nurses restrain a client in a
bounded area to keep the person from freedom.
QUASI INTENTIONAL TORTS:a) Invasion of privacy: - The tort of invasion of privacy protects
the childs right to be free from unwanted intrusion into his
or her private affairs.
For.e.g. in a classic case, reporters published photographs of a
female client in her hospital room without her consent. Courts
upheld a claim for invasion of privacy. This case is an example
of intrusion or publication of private.
Another form of invasion of privacy is the release of a clients
medical information without the clients consent.for.e.g.

Respect the wish nit to inform the clients family of a

terminal illness.
b) Defamation of character:- Defamation of character is the
publication of false statements that result in damage to a
persons reputation.
The statements must be published with malice in the case of a
public official or public figure. Malice means that the person
publishing the information knows it is false and publishes it any
way or publishes it with reckless disregard as to the truth.
UN INTENTIONAL TORTS
a) Negligence: - Negligence is conduct that falls below a
slandered of care. The law established the slandered of care
for the protection of others against great risk of harm.
For e.g. if a driver of a bus acts reasonably in failing to stop at a
stop sign, it is negligence. It is also defined as exposure of
another persons property to unreasonable risk of injury.
Common negligent acts are: Failure to assess and or monitor, including making a
nursing diagnosis.
Failure to use proper equipment to monitor the client
Failure to document the followings.
Failure to follow orders.
Failure to follow the six rights of medication
administration.
Failure to ensure client safety, especially those who have
a history of falling, are heavily sedated have
disequilibrium problems, mentally impaired, getup in the
night and are uncooperative.
Failure to follow policies and procedures.
Failure to properly delegate and supervise.

Malpractice: Isa type of negligence and often referred to as

professional negligence or carelessness by a professional person.
It concerns professional actions and in the failure of person with
professional education and skills to act ina reasonable and
prudent manner.
Failure to monitor clients response to treatment.
Failure to communicate change in status to other care
provider.
IN children wards falling of children from beds common, i.e.
there should be evidence that client suffered due to lack of
forsebility by the nurse.e.g. failures to ensure minimum
standards are met.
Failure to provide patient education
SOME OTHER ISSUES ARE
1) INFORMED CONSENT:- who performs a procedure on client
without informed consent may be found civilly liable for
committing battery. A patients consent must be obtained
before any medical, surgical or nursing treatment is
administered. The patients consent is his or her
authorization for another to touch him or her for the purpose
of care and treatment.
The required information that must be included in the informed
consent are as follow: An explanation of the treatment procedure to be
performed and the expected results of the treatment
procedure.
Description of the risk involved
Benefits that are likely to result because of the treatment
Statement that may withdraw his/her consent at any time.

A signed consent form is required for all routine treatments,

hazards procedures such as surgery, some treatment
programmes such as chemotherapy and research.
If you consider the children are developing decisional capacity
then they would be increasingly involved in making health care
treatment decisions based on their ability to comprehend
situations and the factors involved in informed consent.
2) DOCUMENTATION:- health care records for each client should
provide a complete and accurate representation of all care
delivered to the client, including diagnostic tests and rheir
results, physical procedures, assessment of condition and
any therapy ordered and received.
While maintaining the recordsAccuracy -: a clients record must
never be falsified entries should be dated, timed and written in
sequence as events occur.
If an error is written it is marked through with a single line,
and the word error written and initiated; do not erase or
obliterate the error.
Completeness-it is important to record all nursing and health
care interventions and their outcomes.
Nursing charting should be objective with factual data
Documentation must be legible and permanent.
3) ABORTION ISSUES:- In 1973 in the case of Roe.v.wade the
U.S. supreme court ruled that there is a fundamental right to
privacy, which includes a womans decision to have an
abortion.
During the second trimester, the state has an interest in
protecting maternal health and the state enforces regulating
regarding the person performing the abortion facility.

By the third trimester, when the fetus becomes viable, the

states interest is to protect the fetus, so the state therefore
prohibits abortion except when necessary to save the mother.
4) NURSING STUDENTS:- Nursing students are liable if their
actions cause harm to clients. If a student harm a client as a
direct result of his or her actions or lack of action, the
student, instructor, hospital or health care facility and
university or educational institution generally share the
liability for the incorrect action.
Nursing students should never be assigned to perform tasks
for which they are unprepared, and instructors should
carefully supervise them as they learn new skills.
Faculty members are usually responsible for instructing and
observing student, but in some situations staff nurses
serving as preceptors share these responsibilities.
5) ABANDONMENT AND ASSIGNMENT ISSUES:1) SHORT STAFFING: - during nursing shortages of staff
downsizing periods, the issue of inadequate staffing occurs.
Legal problems occur if there are not enough nurses to
provide competent care or nurses work excessive overtime.
If nurses are assigned to care for more clients than is
reasonable, they need to bring this information to the attention
of the nursing supervisor. Do not walk out when staffing
inadequate, because this constitutes abandonment.
2) FLOATING:- Nurses are sometimes required to float from
the area in which they normally practice to other nursing
units based on census load client acuities.
In one case a nurse in obstetrics was assigned to an
emergency department. A client entered the emergency
department and complained of chest pain. The client
received an incorrect dosage of lidocaine by the obstetrical
nurse and died after suffering irreversible brain damage and
cardiac arrest.

 The nurse who float need to inform the supervisor of any

lack of experience in caring for the type of clients on the
nursing unit.
Before accepting employment, find out the institutions
policies regarding floating and have an understanding as to
what is expected.
3) QUALITY ASSURANCE:- quality assurance is a program
adopted by an institution that is designed to promote the
best possible care. These systems include ongoing education
of staff, evaluation of staff performance on a routine
schedule, and an audit of selected activities on a regular
basis.
4) RISK MANAGEMENT:Risk management is usually related
to quality assurance and may overlap functions; however it
is designed to identify problems and to evaluate and correct
problems to decrease the possibility of financial loss to the
institution or individual.
In a system of risk management, an incident report is field
describing the error. After the report is completed it is
analyzed by a risk manager who looks for possible trends
within a nursing unit or the entire institution.
LEGAL ISSUES IN SPECIALITY PRACTICE AREAS
1) Maternal and infant nursing
2) Child health nursing
3) Medical surgical nursing
4) Psychiatric nursing
5) Community health nursing
MATERNAL AND INFANT NURSING: - many legal issues are
involved in the care of the mother and her infant. Generally the
causes of lawsuits for malpractice in this area may be divided into
two categories who handling the mother and child. Lawsuits
brought against physicians/doctors and nurses differ.

The common causes for law suits against nurses will include:1) Problems of medication:- e. g. nurse are often involved in the
administration of oxytocin for the augmentation of labour, so
have to follow the principles of drug administration.
2) Failure in adequate client monitoring:- nurses are expected
to monitor their clients at appropriate time intervals that
depend upon the clients condition. Labour and delivery pose
a unique monitoring challenge, in that there are two clients
to monitor the mother and baby.
Nurses have legal responsibilities regarding fetal monitoring
during labour
3) Failure to adequately assess the clients:- Nurses in all
specialty areas must maintain the higher level of assessment
skills.
4) Abortions: - Abortion is one of the emotionally charged
issues confronting nurses. Nurses can not be forced to
participate in procedures they find morally offensive. Nurses
have right to refuse to assist with abortions. She can assist
with abortion if it is performed under MTP act.
5) Nursing care of newborn:- There are certain legal
requirements in providing nursing car of newborns , such as
properly identifying the infant-mother pair as soon as
possible with finger prints, foot prints and wrist bands or
obtaining blood samples. Resuscitation equipment must be
in the delivery room.
CHILD HEALTH NURSING( PAEDIATRIC NURSING):- Pediatric
nurses responsible for preventing children, in their care, from
accidentally harming themselves. Cribs which sometimes have
a restraining device over the top are designed to keep infants
and toddlers from climbing out of bed and injuring themselves.

All poisoning substances and sharp objects should be kept out

of the reach of children. Children should be kept under constant
surveillance to minimize opportunities for accidental harm.
MEDICAL SURGICAL NURSING:- Nurses are responsible for
performing all procedures correctly and exercising professional
judgment. As they carry out doctors orders and duties not
ordered, but for which they have authority.
Some common acts of negligence in medical surgical nursing
as follows:a) Over looked sponges, instruments needles in the operation
theatre. It is a responsibility of the nurse to count the
sponges, instruments needles before closure of the abdomen
or any cavity.
b) Burns the professional nurse is required to know the cause
and effect of any heat application so, as to avoid burns.
c) Injury due to administration of wrong medicine, wrong
dosage and wrong concentration. Administration of medicine
without prescription by the concerned authority, mixing up
of poisonous and non poisonous drug in cupboard leading to
error.
d) Assault and battery:- failure to take the informed consent of
the patient prior to any procedure, treatment, investigation
or operation.
e) Maintenance of records and reports:- failure to maintain
accurate record and reports or removing a position of record
may also make the nurse liable
PSYCHIATRIC NURSING:- A psychiatric nurse should be
sufficiently acquainted with the legal aspects of psychiatry so,
that she/ he can be aware of patients rights.
As a psychiatric nurse should know that whether the patient
admitted by informal admission, voluntary admission or
involuntary admission by the police or parents .While

discharging the patient understand that whether the discharge

is conditional, absolute, judicial discharge or discharge on
parole.
HOME HEALTH CARE NURSING/ COMMUNITY NURSE:home
health care is a rapidly expanding field of practice for nurses, Not
only for clients discharged from the hospital with more complex
short term technology care needs.
With the changing dynamics in acute health care, where clients
are sent home to recover more quickly, pressure rise for those
who provide home health nursing, home health agencies should
develop clear policies and procedures for care provided and
establish risk management programs to identify and correct
possible problems.
LEGAL SAFEGUARDS IN NURSING PRACTICE:
Licensure:
All nurses who are in nursing practice have to possess a valid
licensure, issued by the respective state nursing council/ Indian
nursing council.
Hence the purpose of the professional licensure on the one hand
is to secure and safety the benefits which come from the services
at a highly skilled group and other hand to protect society from
those who are not highly skilled yet professional.
Good Samaritan laws:
In response to health professionals fear of malpractice claims,
most states good Samaritan laws that exempt doctors and nurses
from liability when they render first aid during emergency.
Good rapport:
Developing good rapport with the client is very important to
prevent malpractice.

The ability to develop good rapport with clients is dependent on

the nurses having good interpersonal communication skills. E.g.
listening.
Standards of care:
All professional practicing in the medical field are held to certain
standards when administering care. Standards of care come from
several sources including laws, organizational standards and
institutional policies and procedures.
Standing orders:
Although a nurse may not legally diagnose illness or prescribe
treatment, she or he may offer assessing patients condition, apply
standing orders or treatment guidelines that have been
established.
Contracts:
A contract is a written or oral agreement between two people in
which goods or services are exchanged.
Treating a patient without obtaining proper consent can lead to a
charge of assault or battery.
Consent for operation and other procedures:
Any investigation or treatment of a serious nature or an
operation, in which an anesthetic is used, requires written consent
of the patient. A patient may give his own consent if he is full age,
i.e. has attained the age of 18 years of age.
Correct identity:
The nurse or the midwife has the great responsibility to make sure
that all babies born in hospital are correctly labeled at birth and
ensure that at no time they are placed in the wrong cot or
handled to the wrong mother.

Counting sponge, instrument and needles:

Nurse s advocate that sponge instrument and needle counts be
performed for all surgical procedures taking place in the operation
theatre.
During operation the scrubbed nurse must check the number of
all instruments, needles, swabs and packs or her trolleys and as
the operation proceeds.
The misuse of drug act:
The act aims at checking the unlawful use of the drugs liable to
produce dependence or cause harm if misused.

Accidents or injury:
If a patient sustains injury while in hospital he may bring an action
against the hospital authority or against a person to whom he
attributes the injury.
Advance directives:
Advance directives provide a means for individuals to make their
decisions clear while they are still competent about their health
care treatment they desire in the future.
Advance directives clearly provide information about clients
health treatments choices to ensure respect for that individuals
autonomy.
Advance directives should be placed in the clients medical record
preferably always in the same place in each clients chart.
Although legally nurses cannot act according to a clients advance
directive without a physicians order, if a physician orders a
treatment, the nurse is subject to legal liability for providing
treatment.

Professional confidence:
Guarding the confidence of the patient is in a ethical duty of the
medical and nursing professions. No confidential information
should be divulged to relatives or friends, nor should details of the
patients documentation.
Physicians orders:Physicians are responsible for directing medical treatment and
nurses are obligated to follow physicians orders for medical
treatment unless they believe that the orders are in error and
would cause harm to the client.
Physicians orders should be written, oral are not recommended
because of increased possibility of error.

LEGAL RESPONSIBILITES OF NURSE:

a) Responsibility of appointing and assigning:
Nursing administrators are expected to be aware of legal
restrictions affecting personnel appointment and assignment.
The nurse administrators have responsibility for staffing and
supervising nursing units to ensure safe effective patient care.
b) Responsibility in quality control:
The nursing administrator and the authority of the agency at all
levels have a legal obligation to ensure nursing care quality.
Quality control of nursing service imposes a duty to observe
report and correct the incompetence of any patient care
provider.
c) Responsibility for equipment:

To protect patients and employees from injury, a nurse

manager must ensure that all patient care equipment are fully
functional and the defective patient equipment is promptly
repaired and replaced.
Expected to provide instructions in proper care and storage of
patient care equipment, Nurse also have duty to refuse to use
equipment known to be faulty.
d) Responsibility for observation and reporting:
Nurses have a legal duty to observe patients frequently and
report findings that have diagnostic or treatment value.
The nurse has a duty to record and report observations of
patients promptly, so, that the physician can base treatment
decision on up to date information.
The nurse has a duty to report improper medical care through
appropriate channels in order to protect patients form doctors
negligence.
e) Responsibility to protect public:
The nurse has a legal duty to protect the public from injury by
dangerous patients. The manager must ensure that nursing
personnel follow the procedures to alert community members
to the presence of a patentiallly dangerous patient.
f) Responsibility for record keeping and reporting
Nurses have legal responsibility for accurately reporting and
recording patients conditions, treatments and responses to
care. In medical record is an information source document that
should be used to plan care, evaluate care, allocate costs,
educate personnel, research care measures.
Patients medical record is essential to proper care and it is the
property of the health care agency

f) Responsibility for death and dying

Nurses must be aware at legal definition of death caused they
must document all events that, when the patient is in their
care. In addition, documenting all events, surrounding death,
nurses have other specific legal duties which include, treat a
diseased person with dignity. A competent adult can legally
give consent to denote specific organs and nurses may serve
as an witness to this decision.
SUMMARY AND CONCLUSION:Professional nurse must understand the legal limits influencing
their daily practice. Nurse must understand the law to protect
their clients rights. Nurses need not fear the law but rather
should view the information that follows as the foundation for
understanding what is expected by our society from
professional nursing care providers. The purposes for legal
knowledge for nurse are to help the nurses to understand that
they do have legal responsibilities in nursing practice

BIBLIOGRAPHY
BT
Basavanthappa.
The
text
book
of
Nursing
st
Administration : 1 edition, jaypee brother publications ;
2007, New Delhi: page no- 476-500
Mary chairalla . The text book of the legal and professional
status of nursing ; Elsevier publications , China: 2007 page
no- 263- 265
Potter Perry. The text book of fundamentals of nursing , 7 th
edition; 2009 Elsevier publications , India; page no-326330
Grace deloughecy. Issues and trendsin nursing; 3 rd edition
1991. Mosby publications: page no- 390-408
http:// nursing informatics.com / visible nurse

MAMATA COLLEGE OF NURSING- KHAMMAM

SUBJECT:
TOPIC: GUIDE:

NURSING MANAGEMENT
LEGAL AND ETHICAL ISSUES IN NURSING
Mrs. I.V.MAMATHA
VICE PRINCIPAL

PRESENTED BY:

G.KAVITHA
M.S.C (N) II YEAR
DATE

TIME:

MASTER PLAN
1) INTRODUCTION
2) DEFINITIONS OF LAW
3) SOUSES OF LAW
4) VALUES OF LAW IN NURSING
5) CIVIL LAW AND COMMON LAW ISSUES IN NURSING PRACTICE
6) LEGAL ISSUES IN SPECIALITY PRACTICE AREAS
7) LEGAL SAFE GAURDS IN NURSING PRACTICE
8) LEGAL RESPONSIBILITIES OF NURSE
BIBLIOGRAPHY
BT

Basavanthappa.

The

text

book

of

Nursing

Administration : 1st edition, jaypee brother publications ;

2007, New Delhi: page no- 476-500
Mary chairalla. The text book of the legal and professional
status of nursing ; Elsevier publications , China: 2007 page
no- 263- 265
Potter Perry. The text book of fundamentals of nursing , 7 th
edition; 2009 Elsevier publications , India; page no-326330
Grace Deloughesy. Issues and trendsin nursing; 3 rd edition
1991. Mosby publications: page no- 390-408
http:// nursing informatics.com / visible nurse
http://studyon legal issues

SEMINAR ON

LEGAL AND ETHICAL ISSUES

IN NURSING

SUBMITTED TO: -

Mrs.I.V. MAMATHA

VICE PRINCIPAL
MAMATA COLLEGE OF NURSING.

SUBMITTED BY:

G.KAVITHA
M.S.C (N) II YEAR