Davis Advantage Basic Nursing, 3e

Chapter 39
Legal Accountability

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 Laws
 Established to protect society
 Nursing practice guided by legal principles
 Purpose of laws
• Protect patients/society.
• Define scope of nursing practice.
• Identify minimum level of care to be provided.

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 Liability Versus Malpractice
 Liability
 Malpractice

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 Sources of Law
 U.S. Constitution
 Federal and state legislatures
 Administrative agencies
 Courts

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 Federal Laws Guiding Nursing Practice
 Bill of Rights
 Health Insurance Portability and Accountability
Act (HIPAA)
 Emergency Medical Treatment and Active
Labor Act
 Health Information Technology for Economic
and Clinical Health (HITECH)
 Patient Self-Determination Act (PSDA)
 Americans with Disabilities Act (ADA)
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 ClickerCheck
On admission to the hospital, the patient indicates
they would like information about making a living
will. The nurse informs the patient that the hospital
does not have a process in place to facilitate this.
Which legal requirement is the hospital out
of compliance with?
A. Health Insurance Portability and Accountability Act
B. Emergency Medical Treatment and Active Labor Act
C. Americans with Disabilities Act
D. Patient Self-Determination Act

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 ClickerCheck (continued_1)

Correct Answer: D

The Patient Self-Determination Act requires

healthcare agencies to provide information to
patients about formulating advance directives.
A living will is a type of advance directive.

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 State Laws Guiding Nursing Practice
 Mandatory reporting laws
• Communicable disease
• Abuse
 Good Samaritan laws
• Differ by state
 Nurse practice acts
• Credentialing
• Licensing
• Discipline

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 Other Guidelines for Nursing Practice
 Institutional polices and procedures
 Nursing codes of ethics
 Patient care partnership
 ANA Nurses’ Bill of Rights

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 ClickerCheck
A 15-year-old male comes to the clinic seeking treatment
for “a problem.” The nursing history reveals the patient
may have a sexually transmitted infection (STI). Which is
the most appropriate initial response by the nurse?
A. “I will need a list of all the people with whom you have
had relations.”
B. “Have you told your parents about this situation?”
C. “Let’s discuss how you feel about this situation.”
D. “You will need to practice safe sex. Let’s discuss how to
use condoms.”

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 ClickerCheck (continued_1)
Correct Answer: C
The nurse must establish a caring and trusting
relationship with the patient. Discussing the
patient’s feelings will provide insight into his
knowledge base and readiness to learn. Because
this is a communicable disease, the patient can
receive treatment. In addition, the nurse must
adhere to the mandatory reporting guidelines
and report the STI. The nurse’s focus is ensuring
the patient receives the appropriate treatment.
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 Standards of Practice
 Standard of care
• What a reasonable and prudent nurse would do in
the same or a similar scenario
 Derived from
• Nurse practice acts (NPAs)
• Professional organizations
• The Joint Commission

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 ClickerCheck

There are no legal consequences for nurses

who do not follow the ANA Standards of
Professional Performance as these are
not laws.
A. True
B. False

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 ClickerCheck (continued_1)

Correct Answer: B

The ANA Standards of Care are one “group” of

professional nursing standards that define what
a reasonable and prudent nurse would do in a
practice environment. In a court of law, a nurse
could be found guilty of negligence for failing
to do what a reasonable and prudent nurse
would do.

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 Criminal Law
 Federal or state government prosecutes
 Offense against society
 Can lead to a fine, imprisonment, or death
• Misdemeanor
‒ Minor crime; DUI
• Felony
‒ Homicide

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 Civil Law
 Allows for resolution of dispute between
private parties
 May result in monetary compensation
 Plaintiff: Person bringing suit
 Defendant: Person being sued

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 Types of Civil Law
 Contract law
• Dealing with agreements between individuals
• Explicit or implicit
 Tort law
• Dealing with duties and rights among individuals
• Involves claims for damages

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 Torts and Nursing Practice
 Quasi-intentional torts
• Defamation of character
‒ False communication to a third person
• Slander
‒ Oral defamatory statements
• Libel
‒ Written defamatory statements

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 Torts and Nursing Practice (continued_1)
 Intentional torts
• Assault and battery
‒ Performing a procedure without consent
• False imprisonment
‒ Restraining a patient against their will
• Invasion of privacy
‒ Breach of confidentiality
• Fraud
‒ Failing to provide essential information for
informed consent

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 ClickerCheck
Trina, an RN on the nursing unit, states to the student
nurse, “I see you are working with Beth today. Make
sure you watch your patient carefully because I think
Beth is one of our worst nurses. She also hides her
medication errors.” The student knows that, if untrue,
this statement could be considered:
A. Libel
B. Slander
C. Fraud
D. Invasion of privacy

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 ClickerCheck (continued_1)

Correct Answer: B

The nurse has made an oral statement to

another person reflecting only her opinion that
may cause harm to her colleague’s reputation.

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 Torts and Nursing Practice (continued_2)
 Negligence
• Failure to perform as a reasonable, prudent
person would
• Failure to follow standards of practice
• No intent to harm is present.

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 Torts and Nursing Practice (continued_3)
 Malpractice
 Professional form of negligence
 Four elements necessary to collect damages
• Existence of a duty
• Breach of a duty
• Causation
• Damages

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 Common Malpractice Claims
 Failure to assess, recognize and analyze cues,
and diagnose
 Failure to plan/prioritize hypotheses and
generate solutions
 Failure to implement a plan of care/take action
 Failure to evaluate

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 Safe, Effective Nursing Care
A 64-year-old 12-hour postoperative patient’s vital signs have
shown a downward trend from initial baseline, with blood
pressure decreased from 150/90 to 130/78 and pulse rate
increased from 70 to 98 over a 2-hour period. Additionally, the
patient is becoming more confused. The provider indicated that
the vital signs are within normal limits and can be attributed to
the anesthesia.
 What is your nursing diagnosis?
 What are next steps to ensure the patient received
legally safe care?
 Analyze your potential liability in this situation.

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 Minimizing Malpractice Risk
 Practice proper documentation.
 Observe standards of practice.
 Use nursing process; follow
professional standards.
 Avoid medication and treatment errors.
 Report and document accurately.
 Obtain informed consent.
 Attend to patient safety.

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 Minimizing Malpractice Risk (continued_1)
 Maintain patient confidentiality.
 Provide education and counseling.
 Delegate, assign, and supervise properly.
 Accept appropriate assignments.
 Participate in continuing education.
 Observe professional boundaries.
 Observe mandatory reporting regulations.
 Be aware of legal safeguards for nurses.

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 Socratic Reasoning
A 54-year-old uninsured and unemployed female arrives
at the emergency department (ED) of a small private
hospital complaining of chest pain and nausea. The triage
nurse calls the on-call physician, who instructs the nurse
to send the patient to the county hospital several blocks
away. The nurse assesses the patient and contacts the
nursing supervisor, who instructs the nurse to contact the
medical chief of staff to indicate that the patient is in
need of emergency treatment.
 Discuss whether the nurse’s action was appropriate
or inappropriate.

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