NURSING REGULATORY MECHANISMS AND CONSUMER ACT

INTRODUCTION The standard of nursing care delivery is set by certain regulations of nursing practice called nurse practice acts. Nurse practice acts are legally defined and describe regulations of nursing actions by an administrative board such as a state board of nurse examiners. These boards generally have the authority to regulate nursing practice and education within the states. OBJECTIVES General objectives At the end of the class the students will be able understand in detail regarding nursing regulatory mechanisms, patient rights and consumer protection act Specific objectives At the end of the class the students will be able to Discuss nursing regulatory bodies Describe the process of accreditation Explain the agencies of accreditation Discuss regarding licensure Discuss the licensure activities Explain the process of renewal Discuss the consumer protection act Describe the CPA forums Discuss the CPA councils

TERMINOLOGIES Appeal: (law) a legal proceeding in which the appellant resorts to a higher court for the purpose of obtaining a review of a lower court decision and a reversal of the lower court's judgment or the granting of a new trial Licensure: The act of giving a formal (usually written) authorization Accreditation: The act of granting credit or recognition (especially with respect to educational institution that maintains suitable standards) Jurisdiction: (law) the right and power to interpret and apply the law
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Adjournment: The act of postponing to another time or place NURSING REGULATORY MECHANISMS The main functions of these regulations include To protect patient or society To define the scope of nursing practice To identify the minimum level of nursing care that must be provided to clients The regulatory bodies that define the laws and regulations in nursing practice are the nursing councils at the international national and state levels. Such as International council of nurses Indian nursing council State nursing council ACCREDITATION The concept of accreditation of educational programs in nursing is very important. Accrediting is the process whereby an organization or agency recognizes a college or university or a program of study as having met certain predetermined qualifications and standard Accreditation refers to a voluntary review process of educational programs by a professional organization. The organization is called an accrediting agency is invited to compare the educational quality of the program with established standard and criteria. Accreditations has four major purposes which include the following Maintenance of adequate admission requirements Maintenance of minimum academic standards Stimulation of institutional self improvements, and Protection of institutions of higher education against educationally socially harmful pressures

Accreditation is vital to the welfare of institution of higher education. Accrediting organizations in higher education are generally classed into three types i. ii. iii. National accrediting agency National professional accrediting agency State accrediting bodies
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National agencies National accrediting agencies are concerned with appraising the total activities of the institutions of higher learning, and with safe guarding the quality of liberal education, the foundation of professional programs in colleges and universities. Each agency establishes criteria for the evaluation of institutions in its region it reviews those institutions periodically, and it publishes from time to time a list of those agencies which it has accredited. India has following all India Educational Councils: Central advisory board of education All India council for Elementary education All India council for secondary education University grants commission All India council for technical education National assessment and Accreditation council

National Professional Accrediting Agency These professional groups aim to foster research, to improve service to the public and the number of individuals admitted to the profession. Controlling admissions is vital to a professional group particularly in the early stages when the professional is struggling for status. In India, particularly in the field of health, national professional accrediting agencies have existed. Medical Council of India Indian Nursing Council Dental council of India Pharmacy council of India Central council of Indian system of Medicine

Indian nursing council, (INC) is the official accrediting agency for all programs of nursing, which include Diploma (GNM), Bsc Nursing (both basic and post basic), NM/Msc N /M.phil (Masters) and PhD (Doctoral programs in Nursing) NURSING LICENSURE

The registry of nurses initiated by Nightingale provided institutions and clients with the means to ascertain the skills and knowledge of graduates. However, this was not enough. As nursing programs proliferated, variations developed among the programs. Educational programs were structured to meet the needs of the host hospital. Another method was needed to distinguish those trained in providing nursing care. This method led to nurses developing criteria for licensure. The primary purpose of licensure was, and still is, the protection of the public. Current licensure activities Efforts to provide common definitions of nursing practice, standards of education, and testing for entry into practice across state boundaries have been successful, although nurses are still required to apply for licensure in each state in which they practice. With the mobility of nurses, the movement toward telecommunications, and care of clients across wide distances, state boards of nursing recognized the need to provide practicing nurses with more than procedures of endorsement of their initial license. This need has led to further changes in nursing licensure. In 1997, the Delegate Assembly of the National council of state Boards of Nursing moved to a new level of nursing regulation. The assembly approved a resolution endorsing a mutual recognition model of nursing regulation. Through this model individual state boards will develop an interstate compact allowing nurses licensed in one state to practice in all other states and territories. Nurses will be responsible for following the laws and regulations of those states, although they will not be required to apply for individual state licensure. COMPONENTS OF NURSING PRACTICE ACTS All nursing practice acts include two essential components. First each includes statements that refer to protecting the health and safety of the public. The second is protection of the title of RN. This protection is ensured by describing those individuals covered by the regulations and those excluded from the act. The legal title, registered nurse, is reserved for those meeting the requirements to practice nursing in the state. A section of each nursing practice act describes the requirements for licensure. An initial requirement is graduation from high school and an accredited nursing program. ENTRY INTO PRACTICE Each nursing practice act includes the requirements and procedures necessary for initial entry into nursing practice. There are several steps necessary in obtaining a license to practice nursing. Candidates for licensure must submit evidence of graduation as defined

by each state. Frequently a transcript of course work, a diploma or letter from the dean of the program attesting to the graduation of the applicant is necessary. A temporary permit may be available for nurses moving from one state to another. The process of obtaining a license in another state is to apply for licensure by endorsement. Nurses licensed in one jurisdiction apply for licensure in a second jurisdiction by submitting a letter to the second state board of nursing. Typically evidence for the new license is similar to that for initial licensure. In addition, proof of the nurses current license to practice will be required. RENEWAL OF LICENSURE In addition to outlining requirements for initial licensure, each nursing practice act includes information on renewal of licensure requirements. These regulations define the period; a license is valid and any additional requirements for renewal of licensure. All nurses are expected to remain competent to practice through various means of continuing education. CONSUMER PROTECTION ACT Till recently, all cases of disputes regarding negligence on the part of doctors or hospitals were raised in a court of law. It was filed either under the law of torts to claim damages or under the relevant sections (304A, 336,337 and 338) of the IPC, to get the negligent punished. However, after the introduction of the consumer protection act, a drastic change has taken place and litigants are preferring claims through the district, state or National forums. The two main reasons for this are that hardly any costs are involved in this procedure, and the case is decided in a short span of 3 to 4 months. Consumer protection laws are designed to ensure fair competition and the free flow of truthful information in the marketplace. The laws are designed to prevent businesses that engage in fraud or specified unfair practices from gaining an advantage over competitors and may provide additional protection for the weak and those unable to take care of themselves. Consumer Protection laws are a form of government regulation which aim to protect the interests of consumers. For example, a government may require businesses to disclose detailed information about productsparticularly in areas where safety or public health is an issue, such as food. Consumer protection is linked to the idea of "consumer rights" (that consumers have various rights as consumers), and to the formation of consumer organizations which help consumers make better choices in the marketplace. The Consumer Protection Act of India is also quite specific about what a complaint is, under the laws definitions. First and foremost, the complaint must be made in writing
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and should concern an unfair action by a business or individual acting in a commercial setting. Defects in goods or unsatisfactory service can be the subject of written complaints, as can excessively high charges for goods or services. Consumers are not charged a fee for filing such complaints. Decisions may involve complete removal of any defect in a product and replacement of the product. Refunds are specifically provided for in the law. A PRIMER ON CONSUMER PROTECTION ACT Consumer protection act (CPA in short) was enacted by Parliament in December 1986 and came into force on 1 September 1987. The aim of act is to provide a simple, speedy and inexpensive redressal for consumer grievances relating to defective goods, deficient services and unfair trade practices. The consumer protection Act defines the obligation of traders and manufacturers as well as of service providers, and if the consumer feels that the goods provided or the services given are not to his satisfaction, are defective, and below the standards prescribed normally, he is entitled for what he has paid. Under the CPA, courts have been established at District levels, as the District Consumer Redressal Forum, at the state level as the state Consumer Redressal Commission and at the National level as the National Consumer Redressal Commission. These have three members including the chairman who usually is a sitting judge or retired judge of District Court or State High Court or of Supreme Court of India, respectively, and other two members one of whom has to be a woman The District Forum can award compensation up to rupees five lakhs, while the state commission can award compensation up to rupees twenty lakhs. The National Commission usually deals with appeals made against the judgments of the state commissions, and can award any amount of compensation Though the medical profession was initially exempted from the Consumer Protection Act. As stated above, but on 13-11-1995, the Supreme Court of India in its judgment in civil appeal no 688 of 1993, in case of IMA vs VP Shanta and others held that medical practitioner can be sued under Consumer Protection Act 1986, for any negligence. The court held that any services rendered by Doctors, hospitals are covered in the service as defined under section 2 (1)(0) of the CPA 1986. CONSUMER PROTECTION COUNCILS They are at two levels namely Central and State protection councils
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Central consumer protection council The objectives of this council shall be to promote and protect the rights of consumer such as, The right to be protected against the marketing of goods and services which are hazardous to life and property The right to be informed about the quality, quantity, potency , purity, standard and price of goods and services, as the case may be so as to protect the consumer against unfair trade practices The right to be assured , wherever possible, access to variety of goods and services at competitive prices The right to be heard and to be assured that the consumers interest will receive due consideration at appropriate forums The right to seek redressal against unfair trade practices State consumer protection councils The state council shall consists of following members The minister incharge of consumer affairs in the state Government, who shall be its Chairman and Such number of other official or non official members representing such interest as may be prescribed by state Government The State Council shall meet as and when necessary, but not less than two meetings shall be held every year The objective of every state council shall be to promote and protect within the state , the rights of consumer DEFINITIONS CONSUMER Consumer means any person who hires any services for a consideration, and includes any beneficiary of such services other than the person who hires the services, when such services are availed of with the approval of the first mentioned person The status of a patient is that of a consumer, because the patient pays for the services or has the liability to which may be by full down payment, in installments or under any deferred payment system. If a person has received free services without paying for the
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same, he cannot be called a consumer. This is why government hospitals providing services without any charges are outside the preview of the act A person who avails himself of the facility of a government hospital is not a consumer because the facility offered in government hospitals is not service hired for a consideration. For deficiency of service in government hospitals, the aggrieved person will have to file a claim in civil court. If the conduct of the hospital doctor amounts to criminal negligence, the patient can cause to prosecute the doctor in criminal court. COMPLAINT It means any allegation in writing made by a complainant that The goods bought by him or agreed to be bought by him suffer from one or more defects An unfair trade practice or restrictive practice has been adopted by any trade DEFECT Means any fault , imperfection or short comings in the quality, potency, purity or standard which is required to be maintained by or under any contract or as is claimed by the trader in any manner whatsoever in relation to goods. DEFECIENCY Deficiency is any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance in pursuance of a contract or otherwise in relation to the service SERVICE Service means service of any description but excludes free service and personal service. Treatment in a hospital (excluding government hospitals) on payment amounts to hiring of service for a consideration. Therefore, a complaint would lie if there is deficiency in service rendered by a member of the medical profession TIME LIMITATION A claim for compensation under CPA must be filed at a Forum within three years of the subject matter of the complaint (e.g.; death) having arisen If an amendment to the act, presently under consideration of the government is passed, this period is likely to be raised to one year
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At the district forum, a case has to be heard within three months of being filed PATIENTS BILL OF RIGHTS The health care rights of patients have been the subject of much public debate and legislative action in the latter half of the 20th century. The fundamental right to quality medical care and compensation for medical malpractice, the right to informed consent, and the right to health care privacy, are all protected under United States congressional law. While these and other laws ensure many rights for medical patients, the changing nature of medical knowledge and care also ensures the continued need to regulate the relationships among patients, care-givers, and care-giving institutions. But quite apart from any legal issues, the recognition that patients have rights can transform the doctorpatient relationship from an authoritative and paternalistic one into a true partnership, with the result that the quality of medical care is enhanced. The government is concerned about the deteriorating services in medical care both in private nursing homes and public hospitals. Consumer organizations are also pressing for a charter of right of consumers of medical services. The legislative controls of nursing practice primarily protect the rights of the patients. Until the 1960s patients had few rights; in fact, patients often were denied basic human rights during a time when they were vulnerable. In 1973, however, the American Hospital association published its first patient bill of rights. The patient has the right to considerate and respectful care The patient has the right to and is encouraged to obtain from physicians and their direct care givers relevant, current, and understandable information concerning diagnosis, treatment and prognosis The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and notify patients of any policy that might affect patient choice within the institution The patient has the right to have an advance directive (such as living will, health care proxy or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy

 The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patients privacy The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records The patients has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives such a transfer The patient has the right to ask and to be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patients treatment and care The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or human experimentation is entitled to the most effective care that the hospital can otherwise provide The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other care givers of available and realistic patient care options when hospital care is no longer appropriate The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances and conflicts, such as ethics committees, patient representatives, or other mechanisms available
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in the institution. The patient has the right to be informed of the hospitals charges for services and available payment methods. A bill of rights that has become law or state regulation has the most legal authority because it provides the patient with legal recourse. Today, patients are more assertive and involved in their health care. They have more information to review when looking at treatment options and are demanding to be participants in decision making about their health care. The patients right to information and participation in medical care decisions has led to conflicts in the areas of informed consent and access to medical records. Although the manager has a responsibility to see that all patient rights are met in the unit, the areas that are particularly sensitive involve the right to privacy and personal liberty, both guaranteed by the constitution. Patient Responsibilities In order to receive optimal care, patient and his family are responsible for:

Providing accurate information about present illness and past medical history and wishes for your medical care. Seeking clarification when necessary to fully understand health problems and the proposed plan of care. Following through on agreed plan of care. Considering and respecting the rights of others. Being courteous. Providing accurate information for insurance claims and working with the Health System to make payment arrangements when necessary so that others can benefit from the services provided here. Following visitation policies of University Hospital.

CONCLUSION In the rapidly changing atmosphere of health care, many factors have affected how health care is practiced. The rights of the patient have also been affected. Patient rights have recently become the center of national attention in the practice of medicine. The push for legislation of a patients' bill of rights is to provide laws that would prevent health maintenance organizations (HMOs) and other managed health plans from refusing to pay for appropriate care. "Consumer protection law" or "consumer law" is considered an area of law that regulates private law relationships between individual consumers and the businesses that sell those
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goods and services. Consumer protection covers a wide range of topics, including but not necessarily limited to product liability, privacy rights, unfair business practices, fraud, misrepresentation, and other consumer/business interactions JOURNAL ABSTRACT The Patients' Bill of Rights and Responsibilities has three goals: to strengthen consumer confidence that the health care system is fair and responsive to consumer needs; to reaffirm the importance of a strong relationship between patients and their health care providers; and to reaffirm the critical role consumers play in safeguarding their own health. The Commission articulated seven sets of rights and one set of responsibilities: The Right to Information. Patients have the right to receive accurate, easily understood information to assist them in making informed decisions about their health plans, facilities and professionals. The Right to Choose. Patients have the right to a choice of health care providers that is sufficient to assure access to appropriate high-quality health care including giving women access to qualified specialists such as obstetrician-gynecologists and giving patients with serious medical conditions and chronic illnesses access to specialists. Access to Emergency Services. Patients have the right to access emergency health services when and where the need arises. Health plans should provide payment when a patient presents himself/herself to any emergency department with acute symptoms of sufficient severity "including severe pain" that a "prudent layperson" could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. Being a Full Partner in Health Care Decisions. Patients have the right to fully participate in all decisions related to their health care. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Additionally, provider contracts should not contain any so-called "gag clauses" that restrict health professionals' ability to discuss and advise patients on medically necessary treatment options. Care Without Discrimination. Patients have the right to considerate, respectful care from all members of the health care industry at all times and under all circumstances. Patients must not be discriminated against in the marketing or enrollment or in the provision of health care services, consistent with the benefits covered in their policy and/or as required
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by law, based on race, ethnicity, national origin, religion, sex, age, current or anticipated mental or physical disability, sexual orientation, genetic information, or source of payment. The Right to Privacy. Patients have the right to communicate with health care providers in confidence and to have the confidentiality of their individually-identifiable health care information protected. Patients also have the right to review and copy their own medical records and request amendments to their records. The Right to Speedy Complaint Resolution. Patients have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. Taking on New Responsibilities. In a health care system that affords patients rights and protections, patients must also take greater responsibility for maintaining good health. BIBLIOGRAPHY 1. AG Chandorkar, Hospital administration and planning. Paras publishing: 2nd edition: New Delhi; 2009. 2. Barbara cherry, Susan R. Jacob. Contemporary nursing issues, trends &management: Mosby publishers; Philadelphia; 1999. 3. BT Basavanthappa, Nursing Administration. 2nd edition, Jaypee Publishers ; NewDelhi;2009

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