LEGAL ISSUE IN CCN

Introduction
 Law is the result of the minimum level of shared values or ethics of a community of people. Law and
ethics are related.
 Nurses may act in ways that are legal but not ethical. Both law and ethics are related to politics.
 Law means a body of rules to guide human action
Definition of Law
 Laws are “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”. (By Sullivan and Decker, 2001)
 It is a rule or standard of human conduct established & enforced by authority, society, or custom.
 It is established for the welfare of society (Kozier & Erb 2004).
Standards of Care
Definition:
 The legal guidelines for nursing practice. Standards of care are the skills and learning commonly
possessed by members of a profession.
Purpose of standards of care is to protect the consumer
 These standards are used to evaluate the quality of care nurses provides
 And therefore become the guidelines for nursing practice
Standards of Practice
 All nurses are responsible for knowing provisions of the State Practice Act and the regulatory law
passed by the State Board of Nursing
 All nurses are required to know the policies and procedures of the hospital in which they work.
 The same standards must apply to all nurses and they must not conflict with other guidelines or laws.
Law in Critical Care
 Legal issues involving critical care are of increasing concern to the nurse because the number of
malpractice suits that name or involve nurses is increasing.
 There are three areas of the law that affect critical care nursing practice:

Administrative Law
 When a state legislator passes a statute (act),
 An administrative agency is given the authority to create rules and regulations to enforce the statutory
laws.
 Nurse Practice Act (NPA)
o Defines practice of nursing
o Requires nursing licensure
o Establishes standards for nursing schools
o Delegates enforcement powers to a state agency
State Board of Nursing
  If a citizen feels that he or she has not received reasonable nursing care, the citizen may contact the
state agency and file a complaint against the nurse or nurses involved in the care.
 The state is then responsible for conducting an investigation to determine whether the patient’s claim
has merit.
 The state agency has the right to temporarily suspend a nurse’s license immediately for acts the
agency believes dangerous to the welfare of the general public.
Health Insurance Portability and Accountability Act
Act enacted by Congress in response to concerns about security of electronic health records.
Critical Care Nurses, according to HIPPA, need to
 Verify who can have access to patient information before sharing it
 The patient has right to make the decision.
 Must communicate this right to the patient
 Use of passwords and careful use of computers out of view of public
Criminal Law
 In criminal cases, the local, state, or federal government fi les a lawsuit against an individual.
 Criminal offenses, which are extremely rare in nursing situations, include criminal assault and
battery, negligent homicide, and murder.
 The legal responsibility of the registered nurse in critical care settings does not differ from that of the
registered nurse in any work setting.
Civil Law
Civil law is private law.
 In civil cases, one private party files a lawsuit against another.
 One specific area of civil law, tort law.
 Examples: of torts include: negligence, malpractice, assault, and battery.
Torts
 Assault: saying or doing something that will make a person genuinely fear that he or she will be
touched without consent (threat).
 Battery: unconsented touching of a person, or anything he or she is wearing or holding, or anything that
is attached to him or her, without the person’s permission; does not have to cause injury.

Definitions of Terms
 Litigation: the process of taking legal action
 Plaintiff: a person who brings a case against another in a court of law.
 Defendant: The defendant in a lawsuit is the person against whom the action is brought, by the
plaintiff.
 Deposition: a witness's sworn out-of-court testimony. It is used to gather information as part of the
discovery process. The witness being deposed is called the "deponent."
Common Legal Issues in Critical care
 Negligence (breach of duty) The most common lawsuits against nurses and their employers are based on
the legal concept of malpractice, known as negligence by a professional.
 In a malpractice suit, the plaintiff has to show that some type of injury or harm occurred as a result of
the nurse’s actions or inaction.
 Malpractice: Malpractice law requires that there be a causal relationship between the conduct of the
nurse and the injury to the patient, and that the injury that the patient experienced must be reasonably
anticipated.

Elements of Malpractice
 Duty
 Breach of Duty
 Damages
 Causation

Duty
 Legal relationship between two or more parties
 Contractual relationship between the patient and the health care facility
 Duty of individual nurse confirmed by the nurse’s name in the patient’s records
 A nurse has a duty to provide reasonable care within established standard of care.
Breach of Duty
 After the establishment of duty, the plaintiff must show the nurse violated that duty.
 Negligence is determined by comparing the nurse’s conduct with established standard of care (SOC).
 If the nurse fails to have met the SOC, he or she has violated his or her duty to the patient.
 Negligence can be “ordinary” or “gross.”
o Gross negligence indicates the nurse willfully and consciously ignored a known risk of harm for the
patient.
Causation
 Malpractice law requires a causal relationship between the nurse’s breach of SOC and injury to the
patient.
 The plaintiff has to show the injury or harm occurred as a result of the nurse’s action or inaction.
 “Proximate cause” has to be established.

Damages
 The intent of malpractice law is to make the injured party “whole.”
 Most courts award monetary “damages” to compensate the plaintiff for their injuries
 Economic damages
 Noneconomic damages
o Pain and suffering
o Many states place limits on the amount of monetary awards.
Common Cases in Critical Care Legal Negligence of Nurse
 Failure to document procedure or activities.
 Follow an appropriate standard of care,
 Failure to use equipment in a responsible manner.
 Failure to communicate with the patient and his/her family.
 Failure to assess and monitor a patient
 Failure to act as a patient advocate
Legal Malpractice in Nursing
 Delegation.
 Early discharge.
 Nursing shortage.
 Advances in technology.
 Increased autonomy and responsibility.
 Better-informed consumers.
 Expanded legal definitions of liability.
Vicarious Liability
 Vicarious liability means to hold someone responsible for the actions of another.
 Includes
o Respondent superior
o Corporate liability Negligent
o Rule of personal liability
Respondent Superior
 “Let the master answer for the sins of the servant.”
 Hospitals are held liable for the negligence of their employees.
 Applies when hospital employees act within their scope of employment
 Does not apply in situations involving temporary personnel or typically to physicians
Corporate Liability
 Corporate liability occurs when a hospital is found liable for its own unreasonable conduct.
 Example: If it is found that a unit is chronically understaffed and a patient suffers an injury as a result of
short staffing, the hospital can be held accountable.
o Corporate liability may also apply in “floating” situations. Floating nurses not competent in area
they are floated to.
o If the nurse does not possess the knowledge and skills required of a critical care nurse, he or she
should not be providing critical care.

Negligence Supervision
 Negligence supervision is claimed when a supervisor fails to reasonably supervise people under his or
her direction.
 Example:
o A nurse being floated to an ICU but is not skilled or trained in ICU is delegated invasive
procedures by the charge nurse.
o Charge nurse may be found liable if an injury occurred to the patient.
Rule of Personal Liability
 Physicians used to be considered the “captain of the ship.”
o Nurses were expected to follow any order.
 Now practice under a legal concept called “rule of personal liability”
 Nurses are responsible for making sound decisions by virtue of their own specialized education, training,
and experience.
o Do not follow orders the nurse deems unsafe
o Seek clarification or follow the chain of command
Independent Nursing Judgment
 Questionable medical order
 Policy statements should exist in hospitals that indicate the manner of resolving the issue of
“questionable” medical order.
o An order that is wrong can harm the patient.
o Initially clarification of order
o Clear chain of command
Importance of Law to the Nurse
 Nurses have more responsibility
 Increased numbers of Advanced Practice Nurses
 Law is there to assist in the decision-making process involved in nursing practice
 Law is there for the protection of nursing practice
 Law is there for the identification of the risk of liability www.google.com
Functions of Law in Nursing
 It provides a framework for establishing which nursing actions in the care of clients are legal
 It differentiates the nurse’s responsibilities from those of other health professionals
 It helps establish the boundaries of independent nursing action
 It assist in maintaining a standard of nursing practice by making nurses accountable under the law
(Kozier & Erb 2004).
Legal Basis for Nursing
 Nurse Practice Act
 Standards of Care

Nurse Practice Act

 Protects the public by legally defining and describing the scope of nursing practice.
 State nurse practice act also legally control nursing practice through licensing requirements. e.g. advance
practice nurse license (Kozier & Erb 2004).

Five Legal Responsibilities of the Registered Nurse

 The registered nurse is legally responsible for:
 Performing only those functions for which he or she has been prepared by education and experience.
 Performing those functions competently.
 Delegating responsibility only to personnel whose competence has been evaluated and found acceptable.
 Taking appropriate measures as indicated by observations of the patient.
 Being familiar with the employing agency’s policies.
References
 Morton. G.P & Fontain. K.D., (2013)., Essentials of Critical Care Nursing. A Holistic Approach.
Lippincott Williams & Wilkins.
 Kozier. B.,Erb. G., Berman. A., & Snyder. S. ( 2004). Fundamentals of Nursing: Concepts, Process &
Practice. (7th ed). Prentice Hall. New Jersey.
 www.google.com