Legal Considerations in Nursing

8/10/2019 Legal Considerations in Nursing

1/44

SEMINARON

VISIBILITY OF NURSES,

LEGAL CONSIDERATIONS,

ROLE OF REGULATORY BODIES


2/44

INDEXSl no Content Page

no

VISIBILITY OF NURSES

INTRODUCTION

Definition

Strategies to improve the visibility of nursing

1) Collective bargaining

2) Computer technology

3) Elimination of external sexism

4)

Development of internal media committee

5) External media committee

6) Education

7) Marketing

Nursing responsibilities for improving its own visibility

New forms of visibility of nursing

CONCLUSIONLEGAL CONSIDERATION

INTRODUCTION:

Concept of law

Meaning of law

Purpose of law

Terminologies

Types of law

Sources of law

Importance of law in nursing

Legal limits of nursing

Legal liability in nursing

Legal issues in nursing

Legal concepts and nursing practice:

Legal responsibilities of nurse


3/44

Legal issues in specialty practice areas

Maternal and infant nursing

Pediatric nursing

Medical surgical nursing

Psychiatric nursing

Medico legal aspects of death

CONCLUSION


INTRODUCTION

Definition of regulatory body

Role of regulatory bodiesTypes of regulatory bodies

International level

International Council For Nurses

American Nursing Council

Canadian Nurses Association

National League For NursingCentral level

Indian Nursing Council

Indian Nursing Council Act

Midwives And Auxiliary Nurses Midwives Association

Trained Nurses Association Of India

State level Health Visitors League

Karnataka Nursing Council

Rajiv Gandhi University of Health Sciences

Kerala Nursing Council

CONCLUSION

BIBLIOGRAPHY


4/44

VISIBILITY OF NURSES


5/44

INTRODUCTION

Although nurses comprise the majority of health care professionals, they are

largely invisible. Their competence, skill, knowledge are as a word image that suggest only a

reflection, not reality. (Sullivan E J 2004). The public of nursing and nurses are typically

based on personal experienced with the nurses which can lead to narrow view of nurses are

often based on brief personal experience. This experience may not provide an accurate

picture of all that nurses can do provide in the healthcare delivery system. The truth is that

most often the nurse is invisible. When in the hospital, the patients interact with many staff

and there is little to distinguish from one another, so the patient may refer to most staff as

nurse.

This does not mean that people does not value nurses, they do. However many people do notknow about the education required to become nurse or about the variety of educational entry

points into the nursing that lead to RN qualification. Nurses need to present themselves as

profession through all with whom they come in contact.

Visibility of nurses

Meaning

A quality or fact of, degree of being visible.

Degree of exposure to public notice

Capacity of providing a clear un obstructed view.

Strategies to improve the visibility of nursing

1) Collective bargaining

Collective bargaining is the process by which unions participate in administrative

division involving the terms of employment and the price of labor. Labor union tries to

expand and strengthen the position of the nurse as a large, potentially strong and powerful

group of professional people. Nurses must continue to foster a positive powerful image and

continue to organize.

2) Computer technology

The visibility of nurses can be influenced by the increase in computer technology.

The development and implementation of computer technology enhances the management and

delivery of healthcare, and will continue to do so in the future. Documentation, care


6/44

planning, laboratory values, quality management and administrative records can be

computerized. Nurses save time by assessing a computerized system.to acquire the necessary

skill; nurses must become educated and proficient in computer technology.

3) Elimination of external sexism

Sexism continues to harm and disrupt the professional visibility of nursing.

Nursing is not limited to one gender; nursing is genderless and its potential is equally as

limitless. It is suggested that increasing the number of male nurse will make the profession a

different one. The nursing profession and practice will also take on an improved public

visibility of nurses by having more balance between men and women.

4) Development of internal media committee

Internal media, in the form of catalogs, brochures, newsletters, annual reports,advertisements, films and educational materials are important to any health care institutions

relations but should be viewed as having equal importance to the image of nursing. It is

suggested that the health care facilities should have an internal media committee. Nurses

must become active in such committee and actively review all materials, paying special

attention to the effect these materials have on the visibility of nurse. Nurses must work with

the public relation committee to ensure that nursing is represented in a positive professional

manner to people.

5) External media committee

The mass media, print and broadcast are the most pervasive influences on public

attitudes and opinions in contemporary life. Numerous nurses and group of nurses suggest

that external nursing media committees be organization. These media watch groups must

take responsibility for monitoring the media for all references to nursing. The groups must

respond to the media for positive and negative referrals to nursing

6) Education

The visibility of nurses is changing due to the elevated efforts of our nursing

leader to attain the highest level of competency possible for our profession. The expectation

for nursing today call educated and motivated individual, so education strategies has become

one of the important strategies for improving visibility for nurses.

7)

Marketing


7/44


8/44


9/44

foundation for understanding what is expected by our society from professional nursing care

providers.

CONCEPT OF LAW

MEANING OF LAW

Law is a rule or a body of rules of conduct inherent in human nature and essential to

or binding upon human society and to guide human functions.

Law is the body of principles recognized and applied by the state and the

administration of justice.

PURPOSE OF LAW To define relationships among the members of a society and between individuals and

groups as they arise

To define which activities are permitted and which are not.

To allocate authority.

To dispose of troubled cases as they arise.

Functions of law in nursing

Terminologies related to law

Malpractice is defined as professional misconduct, unreasonable lack of skill or fidelity in

professional duties, evil practice, or illegal or immoral conduct.

Assault is any willful attempt or threat to harm another, coupled with the ability to actually

harm the other person.

Batteryis any intentional touching of another` s body or anything the person is touching or

holding without consent.

Contractis a written or oral agreement between two people in which goods or services are

exchanged.

Tort is a civil wrong for which remedy is common law action for liquidated damages and

which is not exclusively the breach of contract or breach of trust or other merely equitable

obligation.


10/44


11/44

II. Administrative law

Administrative law refers to the body of law which regulates bureaucratic managerial

procedures and defines the powers of administrative agencies.

III. Criminal law

Criminal law involves the state imposing sanctions for crimes committed by

individuals so that society can achieve justice and a peaceful social order.

IMPORTANCE OF LAW IN NURSING

It provides patients against deliberate and inadvertent injury by a nurse.

It protects the nurses against the suits if she renders right care.

It provides a framework for establishing which nursing actions in the care of clients

are legal.

It assists in maintaining a standard of nursing practice by making nurses accountable

under law.

It differentiates the nurses responsibilities from those of other health professional.

LEGAL LIMITS OF NURSING

Licensure:

All registered nurses and licensed practical nurses are licensed by the board of nursing

of the state or province in which they practice. The requirements for licensure vary, but

requirements for education are in most licensing acts, and the nurse must pass an

examination. Licensure permits persons to offer special skills and knowledge to the public,

LEGAL LIMITS

Standard of careLicensureDrug maintenance

Documentation

Correct identity Informed consent

Standing orders

Student nurses


12/44

but it also provides legal guidelines for protection of the public. All states use the National

Council Licensure Examinations (NCLEX) for registered and licensed practical nurse

examinations.

A nurse`s license can be suspended or revoked by the board of nursing if conduct

violates provisions of the licensing statue. For example, nurses who perform illegal acts such

as selling or taking controlled substances jeopardize their license status. Before licenses are

revoked, nurses must be notified of the charges and permitted to attend a hearing to present

evidence on their own behalf. These hearings are not court proceedings but are usually

conducted by the state or provincial board of nursing. Some states are provinces provide for

judicial review of such cases if the nurse has exhausted all other forms of appeal.

Standards of Care:One of the functions of law is to define the standards of care the nurse must provide.

All U.S. state legislatures and Canadian provincial parliaments have passed nursing practice

acts that define the scope of nursing practice.

Professional organizations are another source for defining the standards of care. The

American Nurses Association (ANA) and Canadian Nurses Association (CNA) have

developed standards for nursing practice, policy statements, and similar resolutions. These

standards are very general and include such recommendations as the obligation to provide

continuing education programs.

The written policies and procedures of the employing institution detail ways in which

the nurse is to perform duties. Such policies are usually quite specific and are set forth in

procedure manuals found in most nursing units. For example, a procedure and policy

outlining the steps that should be taken when changing a dressing or administering

medication gives specific information for nurses to perform these tasks. These policies

provide another definition of standards of care. Policies and procedures of institutions may

be more restrictive than nurse practice acts, but they can never request a nurse to act beyond

the standards of practice allowed by law.

Student Nurses:

If clients suffer harm as a direct result of nursing students` actions, the liability for the

incorrect action is generally shared by the student, instructor, and hospital or health care

facility. Student nurses should never be assigned to tasks for which they are unprepared and


13/44


14/44


15/44

Negligence is conduct that falls below the standard of care. It is established by law

for the protection of others against unreasonable risk of harm, and it is characterized chiefly

by inadvertence, thoughtlessness, or inattention (Black 1979).

If nurses give care that does not meet appropriate standards, they may be held liable

for negligence. Negligence may involve carelessness, such as failing to check a client` s arm

band and then administering the wrong drug. Another example of negligence may be

administering a medication even when it has been documented that the client has an allergy

to that medication. However, carelessness is not always the cause. If nurses attempt a

procedure for which they have not been trained and does it carefully but still harm the client,

a claim of negligence could be made.

Nurses have been involved in several common negligent acts including the following.

Intravenous therapy errors resulting in infiltrations or phlebitis.

Burns to clients

Falls resulting in injury to clients.

Failure to use aseptic technique where required.

Errors in sponge, instrument, or needle counts in surgical cases.

Failure to give a report, or to give an incomplete report, to an oncoming shift.

Nurses are responsible for performing all procedures correctly and for exercising

professional judgment as they carry out the orders of physicians and duties not ordered but

for which they have authority: And nurse who does not meet accepted standards of care

while discharging duties or who performs duties carelessly runs a risk of being found

negligent.

MalpracticeMalpractice is one type of negligence. It is defined as professional misconduct, unreasonable

lack of skill or fidelity in professional duties, evil practice, or illegal or immoral conduct

(Black 1979). In a malpractice lawsuit against a nurse, the following criteria must be

established.

The nurse (defendant) owned a duty to the client (plaintiff).

The nurse did not carry out that duty.

The client was injured

The client` s injury was a result ofthe nurse` sfailure to carry out his or her duty.


16/44

These are the criteria for every type of tort, not only malpractice (Prosser and Keeton,

1988).

The best way for nurses to avoid being named in law suits is to follow standards of

care, give competent health care, document assessments, interventions and evaluations fully,

and develop empathetic rapport with the client. Poor client relations are leading causes of

lawsuits. A client who believes that the nurse performed duties correctly and was concerned

with his or her welfare is unlikely to initiate a lawsuit. In addition, careful, complete, and

objective documentation are keys to avoiding malpractice.

Assault is any willful attempt or threat to harm another, coupled with the ability to

actually harm the other person. The victim believes harm will come as a result of the threat

(Black 1979). Assault may be subtle; for example, a nurse might attempt to coerce a clientinto taking a drug he or she does not wish to take. A more blatant example might involve a

nurse handing an uncooperative client in the emergency room. If the exasperated nurse yells.

If you don` t take off those filthy clothes, I` m going to rip them off you! and moves

toward the client, a claim of assault could be made.

2. Intentional tort

These types of torts are deliberate actions in which the intent is to cause injury to a

person or property these are more likely to be assessed against nurses and some intentional

torts fall under the criminal law, if there is gross violation of the standards of care. The

following are some of the intentional torts.

Battery

Battery is any intentional touching of another` s body or anything the person is touching

or holding without consent. Injury is not a requirement (Black 1979). There have been

instances of battery of confined clients by personnel in mental institutions (J. Health and

Hospital Law, 1989). In a less drastic case, if a nurse attaches fetal electrodes during labor

without the consent of the mother, a claim of battery could be made. The important issue is

the client` s informed consent, which will be addressed later in the chapter.

In some situations consent is implied (Prosser and Keeton, 1988). For example, if a

nurse says, I have your injection, Mr. Jones, and the client holds out his arm, he is giving

implied consent to the injection.


17/44

Whether the procedure that constitutes battery helps the client is unimportant. In a

classic case from 1905,Mohr V Williams, the client gave written consent for surgery on his

right ear. After the client was anesthetized, the physician discovered that the left ear was

more seriously affected, and he operated on the left ear. The client sued because surgery was

performed on the wrong ear.

Invasion of Privacy

Clients have claims for invasion of privacy when their private affairs, with which the

public has no concern, have been publicized (Prosser and Keeton, 1988). A client is entitled

to confidential health care. All aspects of care should be free from unwanted publicity or

exposure to public scrutiny (Calloway, 1986). An example of invasion of privacy occurs

when clients are unnecessarily exposed in the room or in the corridors.Another form of invasion of privacy is the release of information to an unauthorized

person such as a member of the press or the client` s employer. Gossiping about a client` s

activities is another form of invasion of privacy and could lead to a charge of slander against

the nurse. Another example is a nurse s unwanted intrusion in private family matters. A

nurse has no right to intrude in matters not directly related to the client` s well-being. For

example, a nurse should respect a wish not to inform the client` s family of a terminal illness.

Defamation of Character

Defamation of character is the holding up of a person to ridicule, scorn, or contempt

within the community (Black 1979). There are two types of defamation: slander and libel

(Prosser and Keeton, 1988). For example, if a nurse tells a client that his physician is

incompetent; the nurse could be held liable for slander. If the nurse writes such a comment,

the charge would be libel. The important issues in a claim of defamation of character are

whether the information was shared with third persons (other than the client) and if harm has

been done to the reputation of the plaintiff (Prosser and Keeton, 1988).

LEGAL ISSUES IN NURSING

Legal issues in nursing practice reflect the changing trends in technology, medical

advancements and increased awareness among the patients.

Controlled substances

One of the legal issues that might arise for nurses involves the use of controlled

substances. The two acts that control the use of poison in medicine is: Misuse of drug act


18/44

1971 and Dangerous Drug Act 1965 and 1967. The misuse of drug act aims at checking the

unlawfully use of the drugs liable to produce dependence or cause harm if misused. A drug

affected by this act is referred to as controlled drugs. The common controlled drugs under the

dangerous drug act involves cocaine, heroin, methadone, morphine, opium, pethidine,

hallucinogens,etc.

Controlled substances should be kept securely locked, and only authorized personnel

should have access to them. Criminal penalties for misuse of controlled substances exist.

There have been cases in which physicians have illegally prescribed and dispensed controlled

substances, and if nurses employed by such physicians fail to report these activities, they

may be legally accountable for aiding and abetting the physicians.

Caring patient with AIDSThe care of AIDS and HIV+ patients has legal implications for nurses. Confidential

information must be protected of HIV + patients. An infected person cannot be discriminated

against based on contagiousness. The courts have upheld the employers right to fire a nurse

who referred to care for an AIDS patients.

Death and Dying

There are many issues regarding definition of death. The law identifies that death

occur when there is a greatly diminished brain function, despite function of other body organ.

Even though the client may be legally the brain death, the actual pronouncement of death is

usually the legal responsibility of the physician, nurses must be aware of legal definition of

death.

Autopsy and Organ donation

Legally competent persons are free to donate their bodies or organs for medical use.

Consent forms are available for the purpose. The nurse must be aware of the policies and

procedures of institutions and the laws in the state where they are asked to serve as a witness

for a person who wishes to give consent for a donation

Living Wills and Health care Surrogates

Living wills are documents instructing physician to hold or withdraw lifesustaining

procedures whose death is imminent. Each state providing for providing living will need two

witness, either of whom can be a relative or doctor are needed when the client sign the

documents, medical special directives also must be legally prepared with the appropriate


19/44

witness of the clients signature. Client executes these documents to appoint someone to

make health care decisions if and when they are no longer able to make decision on their own

behalf.

E.g. In terminally ill state and persistently vegetative state. Nurse should be aware of

institutional policies with the patients self-determination act.

Patients property

Many of the unconscious patients admitted in emergency their belonging should be

listed, checked by two nurses and put in safe keeping. While a patient is in hospital, the nurse

has no right to go through his locker or personal property without his consent unless it is

suspected that the patient intent to injure him or others and has the means to do so. When the

patient has died in hospital, his possessions must be recorded in the property book, butmoney and valuable should be listed and packed separately. Also write the color of

ornaments and also inform to administrative officers. Preoperatively and during delivery,

these things should be taken care of.

LEGAL CONCEPTS AND NURSING PRACTICE:

In addition to encountering legal problems in the care of clients, nurses may share

liability for errors made by physicians and other health care personnel or for inadequate care

provided by their employing institutions.

Physician Orders:

The physician is responsible for directing the medical treatment of a client. The nurse

is obligated to follow the physician` s order unless he or she believes the order is in error or

would be determined to clients. Therefore all orders must be assessed, and if one is

determined to be erroneous or harmful, further clarification from the physician is necessary

(Cushing, 1990; Cournoyer, 1989). If the physician confirms the order, but the nurse still

believes it is inappropriate, the supervising nurse is informed. A written memorandum to the

supervisor detailing the events in chronological order and the reasons for refusing to carry

out the order should protect the nurse from disciplinary action. The supervising nurse should

help resolve the questionable order. A nurse who carries out an inaccurate order may be

legally responsible for harm suffered by the client (Cushing, 1990).

The physician should write all orders, and the nurse should be sure they are transcribed

correctly. Verbal orders are not recommended because they leave possibilities for error. If a


20/44

verbal order is necessary as in an emergency, it should be written and signed by the physician

as soon as possible, usually within 24 hours (JCAHO, 1933).

A difficult area regarding physician orders involves an order of no code or do not

resuscitate (DNR) for a terminally ill client. In the past many physicians were reluctant to

write such an order because they feared legal repercussions for abandoning a client

(Younger, 1987). If a physician has documented in his progress notes that the client` s

condition is deteriorating and that the decision not to administer cardiopulmonary

resuscitation has been made, the physician us perfectly justified in writing a no code order.

Unless the physician decides that such a discussion would be detrimental to the client` s

condition, the order should be discussed with the client. In such cases, the physician should

also discuss the order with the family. A no code order should be written, not given verbally.Physicians should regularly review DNR orders in case the client` s condition warrants a

change. The nurse should be familiar with the institution` s policies and procedures

concerning DNR orders. Physicians can list all specifics of DNR orders. For example, a

physician may order vasopressors and fluid management to maintain a client` s blood

pressure. But also state DNR in the presence of cardiac standstill, lethal dysrhythmias, or

respiratory arrest.

Short Staffing

During nursing shortages, the issue of inadequate staffing may arise (Horsley, 1981).

The JCAHO has established guidelines for institutions to determine the level of staff needed.

These are referred to as staffing rations. Legal problems may arise if there are not enough

nurses to provide competent care (Rosen, 1990). If assigned to care of more clients than is

reasonable, nurses should attempt to reject assignments by informing the nursing supervisor

that they are inappropriate. If nurses are required to accept the assignments, they should

make written protests to nursing administrators. Although these protests would not relieve

nurses of responsibility if clients suffered because of inattention, it would show that the nurse

was attempting to act in good faith. Nurses should not walk out when staffing is inadequate

because a charge of abandonment could be made.

Nurses are sometimes required to float from the area in which they normally

practice to other nursing units. In one case, a nurse in obstetrics was assigned to an


21/44

emergency room. A client entered the emergency room and complained of chest pain. He

was given a markedly increased dosage of lidocaine by the obstetrical nurse and died after

suffering cardiac arrest and subsequent irreversible brain damage. The nurse lost the

malpractice lawsuit brought against her (Goff, 1989).

Nurses who float should inform the supervisor of any lack of experience in caring for

the types of clients on the new nursing unit. They should also request and be given

orientation to the unit. Nurses floated to a unit are held to the same standards of care as

nurses who regularly work in that area (Murphy, 1988).

Incident:

An incident reportis filed when something arises that could or did cause injury and

that was not consistent with good care. For example, if a nurse administers an incorrect doseof medication, a client falls out of bed, or an intravenous solution infiltrates the skin causing

sloughing and scar formation, the nurse should complete an incident report (Orlikoff and

Vanagunas, 1988). Most institutions provide specific forms for this purpose. The nurse

objectively records the details of the incident, and the physician examines the client and

reports any untoward effects caused by the error (Figure 6-2). Subjective assumptions

should not be included on the incident report nor should statements assigning blame be

included.

Reporting Obligations:

Nurses are required to make a report in such situations as child abuse, rape, gunshot

wounds, attempted suicide, or certain communicable diseases to the appropriate authorities

(Kreitzer, 1981). The nurse may also be required to report unsafe or impaired professionals.

Because information that must be reported varies among states and provinces, the nurse

should become familiar with the appropriate statutes.

Good Samaritan Laws:

Good Samaritan Laws have been enacted in almost every state and province to

encourage health care professionals to assist in emergency situations. These laws limit

liability and offer legal immunity for people who help in an emergency, providing they give

the best possible care under the conditions (Northrop, 1990). If a nurse stops at the scene of

an automobile accident and gives appropriate emergency care such as using caution when

moving the injured person in case of a spinal injury or applying pressure to stop hemorrhage,


22/44


23/44


24/44

Failure to diagnose a high risk pregnancy

Delay in performing a cesarean section

Improper vaginal delivery or failure to perform a cesarean section

Improper use of forceps

Incidence surrounding inducting labor and use of Oxytocin

Delay in arriving at the hospital

Nonattendance at the delivery

The common causes for lawsuits against nurses will include the following

Problems of medication

Failure inadequate client monitoring

Failure to adequately assess the client

Failure to report changes in the patient

Abortions

Nursing care of newborn

PEDIATRIC NURSING

As in all areas of nursing practice, negligence involving pediatric clients is possible. Pediatric

nurses are responsible for preventing children, and their care, from accidently harming

themselves.

MEDICAL SURGICAL NURSING

As in the case of pediatric clients, disoriented adults may require some form of restraints.

Some common acts of negligence in medical surgical nursing are as follows

Overlooked sponges, instruments needles: in the operation theater it is a responsibility

of the nurse to count the sponges, instruments, needles before the closure of theabdomen or any cavity.

Burns: the professional nurse is requires knowing the cause and effect of any heat

application so as to avoid burns. The nurse could be held liable if she/he neglects to

take proper safety measure prior to application of such measures.

Falls: the nurse could be held liable if a patient falls from the bed due to improper

securing of patient on examination table or improper application of restraint or

provision of a proper bed for an unconscious patient or a child.


25/44

Injury due to the administration of wrong medicine, wrong dosage and wrong

concentration: administration of medicine without prescription by any concerned

authority, mixing up of poisonous and non-poisonous drug in cupboards, leading to

errors, and failing to identify right medication for right patient in right dosage, at right

time considered as negligent act can be liable to be used.

Loss or damage: the nurse is held liable if a patients property is lost when it has been

entrusted to her/ his care.

Assault and battery: failure to take the informed consent of the patient prior to any

procedure, treatment, investigation or operation the nurse is held liable.

Failure to report accidents: the nurse has a moral and legal responsibility to report to

the concerned authority any accidents, losses or unusual occurrences. Failure to do thisis an act of negligence.

Maintenance of records and reports: failure to maintain accurate record and reports or

removing a position of record may also make the nurse liable.

Nurses working in critical care units are also legally accountable for performing their duties.

Critical care nurses require additional training and ongoing intensive education to provide

them with information. The possible problem occurs in critical care nurses is associated with

the use of electronic monitoring device.

PSYCHIATRIC NURSING

The practice of psychiatric nursing is associated and influenced by the right of patients and

quality of care they are receiving.

In psychiatric setting the process of hospitalization can be traumatic or supportive for the

individual depending on the institution, attitude of the family and friends. At present three

types of admission are being used that is voluntary and involuntary

I nformal admission

This type of admission to the psychiatric hospital occurs in the same way as a person is

admitted to a general medical hospital without formal or written application

Voluntary admission

Under this procedure any citizen of lawful age any apply in writing admission to a public or

private psychiatric hospital. This is preferred type of admission because it is similar to that of

any medical hospitalization. When admitted as voluntary the patient remains all civil rights


26/44

I nvoluntary admission

Involuntary commitments are continuously recognized by the court on the basis of two

theories; first under its police power the state has the authority to protect the community from

the dangerous acts of the mentally ill. Most laws justify commitments of the mentally ill on

these grounds

1.

Dangerous to others

2.

Dangerous to self

3.Need for treatment

State laws on commitment vary, but they attempt to protect the individual who is not

mentally ill from being detained in the psychiatric hospital against his will, for political,

economic family or other non-medical reason. Action is begun with sworn petition by arelative, friend, public official, physician or any interested citizen stating the person is

mentally ill and as in need of treatment. Some states allow only specific individuals to file

such petition

The decision as to whether the patient requires hospitalization is then made. Precisely

who makes this decision determines the nature of the commitment.

Legal roles of nurses

Nurse as provider of services, if any malpractice claims are filed under the

law of negligent tort, and should prove the following

1, a legal duty of care existed.

2, the nurse performed the duty negligently.

3, damage was suffered by the plaintiff as a result.

4, the damage was substantial.

-provide standard nursing care.

-know the laws.

-keep record and reports.

-consult a lawyer if any question arises.

Nurse as an employee, accurate supervision and evaluation of her

responsibility.

Nurse as a citizen,


27/44

Community health nursing. It is the combination of nursing practice and

public health practice. two legal aspects apply to most practice situation,

such as;

1, professional negligence or malpractice.

2, scope of practice

=examining the usual and customary practice of profession.

=taking into account how legislation defines the practice of profession

in a jurisdiction.

Medico legal aspects of death

Be with the patient during death.

Reassure the patient relatives.Do not whisper in the patient and relatives presence.

Death declaration should be the responsibility of the doctor.

Proper recording of the death should be done in the hospital record.

Respect the body and conduct all the last offices of mummification of the body.

Body should be kept for observation for at least 3 hours to prevent misconception

in case of cadaver spasm.

Take signature of the party, before handing over the body in death register and case

paper.

In case of unknown patient; intimate nursing superintend and sent to mortuary with

proper labeling.

In the case of MLC intimate the police.

CONCLUSION

The nurse in the modern era has multifunction in their work setting. In spite of

having in the job description, these job activities are not explicitly defined. There is job

ambiguity , so in that situation they need to know about the law and legal issues that can have

positive impact on them in day to day functioning and on their clients who are the recipient

of their care nursing practice is governed by many legal concepts. It is important to know the

basics of legal concepts, because nurse is accountable for their professional judgments and

actions.


28/44


INTRODUCTION

Each state has regulatory bodies, which provide a vital role to ensure the public

right to quality health care service; and to support and assist professional members. All

nurses are required to be licensed to practice with their designated provincial nursing

regulatory body. Legal responsibility in nursing practice is becoming of greater importance

as each year passes. In order to provide safe and competent nursing care an understanding of

legal boundaries is very essential. It is important to know the law in one state and the

authorities enforcing these laws.

DEFINITION OF REGULATORY BODY

Regulatory body is an external organization that has been empowered by legislation

to supervise and control the educational process and outputs.


To ensure the publics right to quality health care service.

To support and assist professional members.

Establish and enforce standards of nursing practice.

To provide public authority, credibility, protection and support to nurses.

To maintain and update knowledge, skill and attitude of professionals.

To promote regulation of profession of nursing.

To develop code of ethics, professional conduct and job classification measures.

To define scope and standards of education, training and practice.

TYPES OF REGULATORY BODIES

International level

International Council for Nurses

American Nurses Association

Canadian Nurses Association

National League for Nursing

Central level


29/44


30/44


31/44

ICNs role in regulation

1)

Convening regular international meetings of National Nurses Association leaders,

government Chief Nurses, and national nursing regulatory authorities to address key

issues in regulation.

2) Monitoring and analysing nursing regulation and regulatory forces and trends

worldwide.

3) Providing regular opportunities for interaction among individuals, groups and

organisations who have an interest in or are responsible for regulating nursing. (e.g.

conferences, network and web based activities)

4) Providing national nurses associations and others with the tools(e.g. information,

guidelines, international standards, competencies and frameworks) to enable them to

remain up-to-date on regulatory matters

5)

Providing nursing and other key stakeholders with advice and consultation to

undertake reforms and to respond to changes having an impact on professional

regulation.

6) Liaising with international institutions addressing issues of regulation.

7) Influencing/negotiating regulatory reform in the best interest of the public and the

profession.

8) Establishing accreditation, certification and endorsement services in selected areas.

9) Collaborating with other groups and interested parties on regulatory activities and

issues of common interest.

10) Setting directions for the on-going development of nursing regulation

worldwide.

11) Promoting data collection in order to provide an evidence base for regulatory

policies and practices.

AMERICAN NURSES ASSOCIATION

The ANA is the professional organization for registered nurses in the United States to

advance and protect the profession of nursing the purpose of ANA are;

To work for the improvement of health standards and the availability of health care

services for all people.

To foster high standards of nursing and to stimulate and promote the professional

development of nurses and advances their economic and general welfare.

Aims

Provide certification for individual registered nurse

Supplies data for research analysis.

Provide public policy analysis and political education and maintains government

relations and political action activities.

Implements an economic and general welfare program.


32/44

Publishes a variety of publications including the American Nurses

Holds conferences and a biennial convention.

They are responsible for creating code of ethics for nurses.

ANA standards of clinical nursing practice

AssessmentOutcome identification

Planning

Implementation

Evaluation

ANA standards of professional performance

Quality of care

Performance appraisal

Education

Collegiality

Ethics

Collaboration

Research

Resources

Purposes

To work for the improvement of health standards

To foster high standards for nursing

To stimulate and promote the professional development of nurses.

Functions

Standards of nursing practice

Education and nursing practice

Code of ethics

Credentialing

Legislation Health policy

Evaluation

Research economic and general welfare

Professional leadership

Professional development of nurses

Affirmative action

Collective bargaining

Communicating with the members

Consumer advocacy

Representation of the profession


33/44

CANADIAN NURSES ASSOCIATION

It is the national nursing association of Canada. The Canadian Nurses Association has

developed national standards and a code of ethics and it offers support to all professional

associations. Though this foundation research grants, fellowships and scholarships and

offered to Canadian Nurses.The nursing profession in Canada is regulated in the public interest meaning that a

person is not allowed to work in a nursing job or even use the little nurse unless he/she is

registered with a provincial regulatory authority.

Goals

CNA advances the discipline of nursing in the interest of the public.

CNA advocates public policy that incorporates the principles of primary health care

CNA advances the regulation of Registered Nurses in the interest of the public.

CNA works in collaboration with nurses, other health-care providers to achieve andsustain quality practice.

CNA advances international health policy and development in Canada and abroad to

support global health and equity.

CNAs Mission

CNA is the national professional voice of Registered Nurses, supporting them in their

practice and advocating for healthy public policy.

CNAs Vision

Registered nurses: leaders and partners working to advance health for all.

Roles

Concerned with quality and quantity of nurses available

Standards of preparation and performance of professional nurse.

Social and economic welfare of nurse

Advancement of knowledge, techniques of competence

Functions

Regulating nursing education standards for nursing programs.

Setting criteria for admission to the professional

Setting standards for practice

Acting on complaints from the public

Disciplining members who fail to meet the necessary standards of life practice.

Providing support for nursing practice to registered members.

NATIONAL LEAGUE FOR NURSING

The mission of the national league for nursing is to advance the promotion of healthand the provision of quality health care within a changing health care environment by


34/44

promoting and monitoring effective nursing education and practice through collaborative

efforts of nursing leaders, representatives of relevant agencies, and the general public.

Functions

Strengthen nursings role in the promotion of quality health care that is both accessible

and affordable.

Promote quality in nursing practice.

Assure quality in nursing education.

Enhance the consumer involvement in attaining the goals of the organization.

Develop creative and collaborative approaches to the resolution of health care

problems.

Restructure the organization to provide flexibility for fixture growth and development.

Ensure the financial solvency of the organization.

The NLN is recognized in the United States as the national accrediting body for allbasic nursing education, programs, as well as for masters degree nursing programs.

Provide peers-review accreditation programs for home health agencies and community

nursing service.

Provide consultation services, continuing education, programs, analysis of statistical

data related to nursing education and a variety of information package to affect recruitment

image and legislative affairs.

INDIAN NURSING COUNCIL

The Indian Nursing Council is an autonomous body under the Government of India,

Ministry of Health and Family Welfare. Indian Nursing Council Act, 1947 enacted by, giving

statutory powers to maintain uniform standards and regulation of nursing education all

over the Country.

Purpose:

Providing uniform standards in Nursing education and reciprocity in NursingRegistration throughout the country.

To prescribe and specify minimum requirement for qualifying for a particular course

in nursing.

Advisory role in the state nursing council.

To collaborate with state nursing councils, schools and colleges of nursing and

examination board.

Responsibilities

1. Prescribes curricula for nursing education in all the states.

2. Refuses or Recognises Programmes of Nursing Education according to standards required.


35/44

3. Support high standards in Nursing.

4. Providing registration for foreign nurses.

5. Maintenance of the Indian Nurses Register. This register contains the names of all nurses,

midwives, auxiliary nurse midwives who are enrolled on all state registers.

Aims and Objectives of Indian Nursing Council:

Nursing.

training of various Nursing

programmes.

Bachelors Degree / P.G. Diploma / Diploma /Certificate Courses in the field of Nursing.

reciprocal basis.

rsonnel.

of Nurses and the Nursing profession. This includes the issue of discipline, the promotion of

health and health care, proposing and commenting on planned legislation, as well as

proactively advising, alerting and offering comment to the Govt. on matters affecting

the Nursing profession. Indian Nursing Council prime responsibility is to set the norms and

standards for education, training, research and practice with in the ambit of the relevant

legislative framework. In this regard, the following issues are considered critical.

-going review of curriculum in response to national priorities.

-going review of the education system with a focus on community based education

Integrated education with a focus on problem - based learning to promote critical thinking.

-going review of the performance of work of nursing professionals with in the ambit

of the service delivery principles.

INDIAN NURSING COUNCIL ACT


36/44


37/44

Functions:

1)

It registers Nurse / Midwives

2) It serves as legal protections to the nurse

3)

It protect the public from incompetent nursing practice or poor nursing care

4)

It accredits and inspects schools of nursing and college of nursing

5) It prescribes the rules of conduct, table disciplinary action

6)

It takes united efforts to elevate the standards of nursing

7) It works for the welfare of the members

Unethical practices commonly prohibited by state

The dishonest use of certificate

Procuring registration by false means

Falsification of the register

Representation of registration by an unrecognized person

Representation of a registrant as a medical practitioner

Many states prohibit an unregistered person from holding a nursing position in an

institution wholly or partially supported by government funds. Some states prohibit

practice of any unregistered nurse.

A fine is the usual penalty imposed for disobeying the laws stated above

although imprisonment is also possible. In actual practice, the state Council often

delegates responsibility for the supervision of nurses to local authorities such as the

District Civil Surgeon or a board appointed for this purpose.

The Trained Nurses Association of Indiabases its standards for conduct of

professional nurses upon the International Code for Nurses.

TRAINED NURSES ASSOCIATION OF INDIA

TNAI means Trained Nurses Association of India, is a national professional

association of nurses. The level of organization moves to the district, state and national

levels. Members of TNAI are usually most active on the level of the local unit.

Activities and conference however are planned regularly by the state branches and

provide opportunities for valuable professional participation and development of the

individual member.

Objectives


38/44

Upholding the dignity and honour of the nursing profession.

Promoting a sense of espirit de corps among all nurses.

Enabling members to take counsel together on matters relating to the profession

Aims

The aims of TNAI are as follows:-

Upgrading development and standardization of nursing education

Improvement of living and working conditions for nurses in India

Registration for qualified nurses and reciprocity of registration within different states

in India.

Activities

Setting up of basic nursing curricula.

Development of higher education courses

Formation of nursing institutions

Help eliminate discrimination against male nurses

Monthly publication The Nursing Journal of India

Publication of nursing year book

Benefits

Gives the nurse a feeling of belonging and security

Information of the current events

Provides opportunities to publish articles

Railway concessions

Functions:

Up grading development and standardization of nursing education

Improvement of living and working condition for nurses in India

Registration for qualified nurses

It has promoted the development of courses in higher education for nurses

It gives scholarships for nurses who wish to go on for advanced study


39/44

Helped to organize the state nurse and midwives Registration Council

Helps to develop leadership ability

Helps to share and solve professional problems

Helped to remove discrimination against male nurses

Helped to improve economic conditions for nurses

The official organ of TNAI is the Nursing journal of India which is published monthly

Trained nurses association of I ndia

President: Sr. (Prof.) Gilbert

1st Vice President: Dr. (Mrs.) Bimla Kapoor

2nd Vice President: Mrs. Gracy Mathai

3rd Vice President: Dr. (Mrs.) S. Sasankan,.

Hony. Treasurer: Miss Surekha Sama.

Secretary-General: Mrs. Sheila Seda.

Deputy Secretary-General: Mrs. Nanthini Subbiah,

Assistant Secretary-General: Mrs. Sujatha Atri

HEALTH VISITORS LEAGUE

Health visitors league is an associate organization of TNAI

Objectives

To Uphold In Every Way the dignity and honour of health visitors

To promote espirit de corps among all health visitors

To enable members to take counsel together on matters affecting profession

To raise the standard of education and practice of health visitor.

STUDENT NURSES ASSOCIATION

The SNA was founded in 1929 with 1 unit in Madras. Its an organization of students

in the field of nursing in the country. Among its purposes is the improvement of nursing

education to improve health care, aid in the development of the nursing student, andencourage optimal achievement in the professional role of the nurse. It publishes a


40/44

journal,Imprint,five times a year, participates in legislative activities at all levels, and gives

scholarships, awards, and career workshops.

Objectives

To help students to uphold the dignity and ideals of the profession for which they are

qualifying

To promote a cooperative spirit among students

To furnish nurses in training with advices in their courses of study leading up to

professional qualification.

Activities

SNA exhibition

Fund raising

Special prizes

Annual meets for the students

KARNATAKA NURSING COUNCIL

The Karnataka State Nursing Councilwas constituted in the year 1971 under the

authority of Karnataka Nurses, Midwives & Health Visitors Act of 1961.

The First council was nominated by Government with different members representing

various constituencies under section 3 of the Act, all together consisting of 22 members. The

Council is an Autonomous Statutory Registration body for qualified Nurses, Midwives,

ANMs and Health Visitors. Its function include besides others:-

1. Regulation of training programme of the diploma, Graduate and Post Graduate Courses.

2. Supervision of the practice of the profession by its Member.

3. Granting recognition to the training institutions and periodical Inspection there on, as theCouncil is governing authority of physical and clinical facilities in almost all the nursing

courses conducted in the institution.

4. Proscribing syllabus and curriculum for various nursing courses and conducting qualifying

examination there for.

5. Registration and granting certificate to qualified persons to practice their profession and to

watch and take action against practice of profession by quacks and check mal-practice as

well and to take action.

The Council is as per the Act headed by President and Vice-President of the Council

and both are duly elected by the members of the council under section 5 of the Act.


41/44

The Council meets under the Chairmanship of and takes decision on the matters covered by

its statutory functions as enumerated above. The expenditure of the Council will be met with

the fees charged for Registration and Renewal.

Karnataka nursing council

President - Dr. A. R. Aruna

Vice presidentDr. Smt G. Kasthuri

Registrar -Sri. H.L. Ramamurthy

Nurse registrar-Sri B.N. Muninarayanappa

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

Rajiv Gandhi University of Health Sciences, centered inBangalore,India, is a

unitary university set up in 1996 by the government ofKarnataka,India,for the regulation

and promotion ofhigher education inhealth sciences throughout the state of Karnataka. The

establishment of the university was directed by the Rajiv Gandhi University of Health

Sciences Act of 1994.

About 276 colleges throughout the state, affiliated with different universities, that

conducted courses onMedicine,Dentistry,Physiotherapy,Pharmacy andNursing were

placed under the Rajiv Gandhi University in order to establish uniform standards in

academics and administration. The institution is named after former Prime Minister ofIndiaRajiv Gandhi.Originally it was centered inMysore,but in 1998 the Karnataka State

Legislature directed that it be moved to Bangalore.

Functions

To verify the eligibility requirements of the students before each examination.

To arrange to conduct examination and issue Degree and post graduate Certificates to

successful Candidates.

To maintain and enhance the educational standards of college of Nursing by arranging

continuing education programs / workshops / exhibitions.

To prepare the Calendar of Events at the beginning of each academic year.

To decide the disciplinary action against students / concerned staff in case of

Malpractice in Examinations.

To nominate members for the panel of examiners forBSC AND MSC Nursingexaminations.

To appoint the examiners before annual and supplementary examination.
http://en.wikipedia.org/wiki/Bangalorehttp://en.wikipedia.org/wiki/Karnatakahttp://en.wikipedia.org/wiki/Indiahttp://en.wikipedia.org/wiki/Higher_educationhttp://en.wikipedia.org/wiki/Health_scienceshttp://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Dentistryhttp://en.wikipedia.org/wiki/Physiotherapyhttp://en.wikipedia.org/wiki/Pharmacyhttp://en.wikipedia.org/wiki/Nursinghttp://en.wikipedia.org/wiki/Rajiv_Gandhihttp://en.wikipedia.org/wiki/Mysorehttp://en.wikipedia.org/wiki/Mysorehttp://en.wikipedia.org/wiki/Rajiv_Gandhihttp://en.wikipedia.org/wiki/Nursinghttp://en.wikipedia.org/wiki/Pharmacyhttp://en.wikipedia.org/wiki/Physiotherapyhttp://en.wikipedia.org/wiki/Dentistryhttp://en.wikipedia.org/wiki/Medicinehttp://en.wikipedia.org/wiki/Health_scienceshttp://en.wikipedia.org/wiki/Higher_educationhttp://en.wikipedia.org/wiki/Indiahttp://en.wikipedia.org/wiki/Karnatakahttp://en.wikipedia.org/wiki/Bangalore


42/44

To appoint an auditor to audit the board accounts. To Co-ordinate and bring a uniform

standard of Nursing Education in Karnataka, in accordance with the requirements of

the Indian Nursing Council and Karnataka Nursing Council.

Governing bodies

Chancellor: H.E.Sri Hans Raj Bhardwaj

Pro-Chancellor: Sri. S.A. Ramadas

Vice-Chancellor: Dr.S.Ramananda Shetty

Registrar: Dr.D.Prem Kumar

KERALA NURSING COUNCIL

The Kerala Nursing Council And Midwives Council was established in 1953 under

the provisions of nurses and midwives act and works as an autonomous body under the

government of Kerala, Department of Health and Family Welfare. It is a regulatory body for

nurses and education in nursing in Kerala and it is monitored by Indian Nursing Council.

Function

To establish and maintain a uniform standard of nursing education for Nurses,

Auxiliary Nurses Midwives and Health Visitors by doing periodic inspection of the

institution.

To give registration to Nurses and Midwives who had undergone their training from

recognized institutions

To conduct undergraduate courses and to issue diploma and registration certificate

To conduct examinations for GNM, ANM, Post Basic Diploma Courses and Health

Supervision courses.

Power to withdrawn the recognition of qualification in case the institution fails to

maintain its standards

Organization

Registrar

Deputy registrar

Office staff

Committees
http://rajbhavan.kar.nic.in/governors/index.htmhttp://rajbhavan.kar.nic.in/governors/index.htmhttp://www.rguhs.ac.in/resumes/vcbiodata.dochttp://www.rguhs.ac.in/resumes/vcbiodata.dochttp://www.rguhs.ac.in/resumes/vcbiodata.dochttp://www.rguhs.ac.in/resumes/vcbiodata.dochttp://rajbhavan.kar.nic.in/governors/index.htmhttp://rajbhavan.kar.nic.in/governors/index.htm


43/44


44/44

Legal Considerations in Nursing

Documents

Transcript of Legal Considerations in Nursing