Legal Responsibilities in Nursing
Legal issues in nursing are nearly always related to potential harm to the patient. The most egregious example of harm, active euthanasia, is illegal in every state – even Oregon’s euthanasia statute is under legal review – and a nurse who commits such acts can be charged with murder. But other seemingly minor problems may also have legal consequences. A medication error, failure to document, failure to report changes in the patient’s condition or acting outside of the scope of practice can land a nurse in court.
Standards of nursing care begin with the nursing code of ethics. This document, formulated by the American Nurses Association, discusses such as issues as putting the patient first, maintaining confidentiality, dealing with impaired nurses and other potential ethical issues. Many of the topics in the code of ethics carry over into nursing practice acts that provide specific direction about what constitutes legal practice. Although there are similarities in nursing practice acts, each state has its own act, and the nurse should be familiar with all aspects of the nursing practice act in her state.
Nurses are legally mandated reporters for child abuse and elder abuse in most states. They may also be mandated reporters for domestic violence. In California, domestic violence is considered a form of assault and the nurse is mandated to report under the same considerations that would apply if the patient had a gunshot or knife wound. Failure to report can lead to legal penalties such as fines or disciplinary actions against the nurse’s license.
Confidentiality is a very important issue in nursing. Breaking confidentiality is both an ethical and legal issue. Under the requirements of Health Insurance Portability and Accountability Act, or HIPAA, the nurse cannot share identifying information about a patient except to someone else who has a right to that information. A nurse who breaks confidentiality may face both legal and professional sanctions. Even an unintentional error can be devastating for the nurse concerned, as evidenced by the suicide of the British nurse who inadvertently connected radio talk show hosts to the Duchess of Cambridge during her admission for severe morning sickness.
Doing something outside of the nursing scope of practice is another serious legal issue. Nurses cannot practice medicine and a nurse who performs a procedure that only physicians are licensed to perform can be sued as well as lose her nursing license. There are gradations of scope within nursing as well. Both registered nurses and certified registered nurse anesthetists can inject a local anesthetic in most states, but only a CRNA can administer general anesthesia. An RN who gives a general anesthetic is acting illegally.
Most states require that nurses be competent. A nurse who performs a task for which she is not qualified can be sued, and nurses are expected to refuse an assignment for which they are not qualified. Unfortunately, the demands of patient care may put the nurse in a situation where she feels unqualified, such as floating to another unit. In that situation, the nurse should communicate with the nursing supervisor and comment her concerns, then provide only that care in which she is competent. To do otherwise puts the nurse at risk of legal liability and professional disciplinary action.
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