Key Concepts, Chapter 7, Legal Dimensions of Nursing Practice

As the roles and duties of nurses expand, so does their legal accountability. Nurses who

wish to avoid legal conflicts need to develop trusting nursepatient relationships

(satisfied patients rarely sue), practice within the scope of their competence, and identify

potential liabilities in their practice and work to prevent them.

A law is a standard or rule of conduct established and enforced by the government that is

intended chiefly to protect the rights of the public. Law may be public, private, civil, or

criminal. Four sources of laws exist at both the federal and state level: constitutional law,

statutory law, administrative law, and common law.

A lawsuit is a legal action in a court. Litigation is the process of bringing and trying a

lawsuit. The person or government bringing suit against another is called the plaintiff.The

one being accused of a crime or tort (defined later) is called the defendant. The defendant

is presumed innocent until proved guilty of a crime or tort.

Each state has a Nurse Practice Act that protects the public by broadly defining the legal

scope of nursing practice. You should obtain a copy of this act from your state Board of

Nursing and study it carefully. Nurse Practice Acts list the violations that can result in

disciplinary actions against a nurse and also serve to exclude untrained or unlicensed

people from practicing nursing.

Three processes are used for credentialing in nursing. The first is accreditation, the

process by which an educational program is evaluated and recognized as having met

certain standards. The second is licensure, the process by which a state determines that a

candidate meets certain minimum requirements to practice in the profession and grants a

license to do so. The third is certification,the process by which a person who has met
 certain criteria established by a nongovernmental association is granted recognition in a

specified practice area.

A wrong committed against a person or that persons property may be categorized as a

crime or a tort. A crime is a violation punishable by the state; a tort is subject to action in

a civil court, with damages usually being settled with money.

Intentional torts include assault and battery, defamation, invasion of privacy, false

imprisonment, and fraud. The Health Insurance Portability and Accountability Act

(HIPAA) addresses privacy concerns. As a student in a health care setting, you should

discuss privacy guidelines with your instructor and nurse mentors.

Negligence and malpractice are unintentional torts. Liability involves four elements that

must be established to prove that malpractice or negligence has occurred: duty, breach of

duty, causation, and damages. The nurse may be involved in legal proceedings as a

defendant, a fact witness, or an expert witness.

A variety of safeguards are in place in the health care system, both to protect nurses from

exposure to legal risks while performing the duties of their role and to ensure that the

practice environment is geared toward enhancing patient and personal safety. These

safeguards include competent practice, informed consent or refusal, contracts, collective

bargaining, patient education, safe execution of physician orders, safe delegation, legally

prudent documentation, adequate staffing, whistle-blowing, professional liability

insurance, risk management programs, incident reports, sentinel events, never events, the

Patient Bill of Rights, and Good Samaritan Laws.

As a student nurse, you are responsible for your own acts of negligence if these result in

patient injury. Moreover, you are held to the same standard of care that would be used to
 evaluate the actions of a registered nurse. For no reason should you attempt a clinical

procedure if you are unsure of the correct steps involved.

Just as there are many safeguards in place to help protect nurses from the risk of legal

action, there are many laws in place that govern the practice of nursing to protect both

nurses and patients from harm. Such laws involve occupational safety and health,

reporting obligations, controlled substances, discrimination and sexual harassment,

patient privacy, use of restraints, nondiscrimination of people with disabilities, and other

issues.