Legal issues in Nursing

1. Prepared by: GIANNE T. GREGORIO

2.  Introduction
 Types of Law
 Tort law
 Components of Malpractice
 Elements of Negligence
 Nurses’ responsibilities
 References

3.  The legal implications of nursing practice are
tied to licensure, state and federal laws,
scope of practice and a public expectation
that nurses practice at a high professional
standard. The nurse’s education, license and
nursing standard provide the framework by
which nurses are expected to practice. When
a nurse’s practice falls below acceptable
standards of care and competence, this
exposes the nurse to litigation.

4. o Address conduct harmful to another individual or
society.
o May be punishable by fines or imprisonment.
o Act prohibited by statute, common law principles.
o Deals with rights and duties of private person.

5. - civil wrong committed against a
person or person’s property
oMalpractice/Professional Negligence
oNegligence

6. - occurs when a nurse fails to
competently perform his or her medical
duties and that failure harms the patient.
– results from injury that is
unintentional due to failure to take the usual
precautions expected or the legal standards
of care.

7. n injury occurred
within the
readth of duty of the
nurse where
ause of injury in the
failure to perform the
uty
• Nurse has a duty.
• Nurse fails to follow
the set standards.
• Actual harm or injury
occurs.
• Failure to act
according to
standards caused
the injury.

8. – It is an obligation created either by law or
contract or by any voluntary action. It is the first element
that must be proven, as it arises from the nurse-client
relationship.
– It occurs when a HCP fails to act in
accordance with the standards of care; an act of
commission or omission of the care giver may constitute
a breach of the standards of care.
– Physical, financial or emotional harm must be
demonstrated by person making the claim to prove
negligence.
– It is the breach of duty which is proven to
have legally caused the injury

9.  A patient undergoing surgery is given an
anesthetic which, due to a previous
treatment, poses an increased risk of use. As
a result of using the anesthetic, the patient
suffers liver damage and dies.
In this case all three elements are present - injury, negligence and cause.
Had the patient not died and perhaps recovered quickly, there would be
no damages for which to sue, despite the fact that the doctor negligently
administered anesthesia.

10.  A patient suffering deep vein thrombosis (a
blood clot in the deep vein of the leg) goes to
see his doctor about some pain and swelling in
his leg.The doctor misdiagnoses the symptoms
as a simple leg cramp. One week later, the blood
clot is dislodged leading to a pulmonary
embolism and death of the patient.
Again, the doctor’s failure to diagnose the patient’s illness correctly
led to an otherwise avoidable death, for which the doctor can be held
accountable.

11.  A patient suffering abdominal pain is taken to
the emergency room.The doctor fails to
diagnose appendicitis and sends the patient
home. After several hours, the patient goes
into shock and dies.
The doctors failure to recognize the signs of appendicitis and act
appropriately was a direct cause of the patient’s death, and
could lead to a medical malpractice lawsuit.

12.  A nurse will be liable for malpractice if he or
she injures a patient with a piece of medical
equipment.This can happen in a variety of
ways, like knocking something heavy onto
the patient, burning the patient, or leaving a
sponge inside the patient after surgery.

13.  Administering medication according to the
doctor's orders is a common nursing task. If
the nurse fails to follow the orders, she or he
will be liable for malpractice if the patient is
injured.The nurse may also be liable for
negligently following otherwise proper
orders, like injecting a medication into muscle
instead of a vein or injecting the wrong
patient.

14. Doctrine of – “The thing speaks
for itself”
3 conditions required to establish a defendant’s
negligence without providing specific conduct:
 The injury was of such nature that it would
normally occur unless there was a negligent act
on the part of someone.
 The injury was caused by an agency within
control of defendant.
 The plaintiff (injured party) himself did not
engaged in any manner that would bring about
the injury.

15. Doctrine of – “Irresistible force”
one that is unforeseen or inevitable. No
person shall be held responsible for those
events that cannot be foreseen, or which
though foreseen, are inevitable, except in
cases expressly specified by law. Failure to
provide service during circumstances such as
flood, fire, earthquake is considered
negligence.

16. Doctrine of – “Let the
master answer” Captain of the ship approach,
shared responsibility of employee &
employer.
The liability is expanded to include the master
as well as the employee and not a shift of
liability from the subordinate to the master.

17. INFORMATION CONSENT
Presentation: Competence:
Disclosure to the person
must be in understandable
works and manner.
This is the ability of the
person to receive the
information, remember,
understand and assess it.
urrent Medical Status
and general course of
illness.
isks and benefits of
proposed treatment.
lternatives to
proposed treatment.
roposed treatment
rationale.
FREE
•FREE (Competent)
•INFORMED (Disclosure)
•Right to refuse
•Staff nurse as WITNESS
•Physician’s legal responsibility to secure informed
consent from the patient
•GUARDIANSHIP
•PSYCHIATRIC PATIENT

18. A process to provide adequate
information for the patient or disclose
in a reasonable patient’s legal
representative to make an informed
decision on the proposed treatment,
including medications, moderate to
deep sedation or procedure.

19. The nature of the patient’s
condition.
The proposed treatment, possible
treatment alternatives, including no
treatment.
The benefits of the proposed
procedure, as well as frequently
occurring & significant risks of the
proposed treatment & possible
problems related to recovery.
If applicable, the possible use in
education &/or research of blood or
tissue removed from the patient not
needed to further medical care.
The individuals will be providing
treatment and the role of everyone
providing the proposed treatment.
The patient or patient’s legal
representative should be given the
opportunity to ask questions &
receive additional information as
requested.
The patient should also be advised
that it is not possible to predict or
guarantee results.

20. MDEICAL
EMERGENCY
PATIENT’S
LACK OF
CAPACITY
MINOR
In an emergency situation
when patient is incapacitated,
consent should be signed by
two(2) Specialists.
In these cases, suitable alternative
procedures, including use of legal
guardian & surrogates where
appropriate , should be initiated if no
emergency exists.
Consent should be obtained from
father/mother/brother/sister/husband/
wife/legal guardian. Document proof
should be secured to prove relationship.

21. Who will take
the consent from
me? (Patient)
Me, your treating
physician/
anesthesiolgist. I will
also provide education
regarding risks, benefits
& alternatives of
anesthesia including post
op analgesia.
And as you Nurse, I
will sign as
WITNESS. 

22.  INFORMED CONSENT FOR SURGICAL
PROCEDURE
 INFORMED CONSENT FOR ANESTHESIA
 INFORMED CONSENT FOR BLOOD
TRANSFUSION
 INFORMED CONSENT FOR HEMODIALYSIS
 INFORMED CONSENT FOR PERITONEAL
HEMODIALYSIS
 HIGH RISK CONSENT

23. TYPE OF CONSENT AUTHORIZED TO SIGN DURATION OF
CONSENT
SURGICAL PROCEDURE Legal age is 18
the patient is competent
per procedure
ANESTHESIA CONSENT legal guardian and
surrogates
per surgery
BLOOD TRANSFUSION Below 18,
father, mother, brother,
sister, husband/wife or the
minor’s legal guardian
1 year for sicklier
1 month
HEMODIALYSIS 2 consultants or if not
available two specialist
initial only and its
continuing in the
course of treatment
PERITONEAL
HEMODIALYSIS
initial only and its
continuing in the
course of treatment
HIGH RISK CONSENT 2 consultants or if not available
two specialist
per surgery

24. is a statement
that describes a minimum, competent level
of clinical nursing practice care to be provided
to patient/families.
PURPOSE:
To provide nurses with nursing standards of
patient care

25. The department of Nursing Service shall
develop nursing policies and procedures
that will guide the nurses, assistant nurses
and midwives in providing nursing care to
patients according to MOH policies and
procedure in implementing rules and
regulations.

26.  Nursing care will be provided by nursing staff
that are competent to fulfill their assigned
responsibilities.
 Each patient will:
 Be assessed for physical, functional. Psychosocial,
nutritional, neglect risk, & discharge care needs.
 Be provided by nursing care based on the patient’s
needs and physician’s diagnosis.
 Have a plan of care that individualized interventions
and reflects recognized standards of care as well as
respect for patient’s rights.

27.  Each patient will have nursing care/interventions available to meet
his/her needs. Each patient will receive:
 Individualized care based on identified needs.
 Age appropriate Nursing Care/interventions.
 Education in respect to the patient’s health care needs/state.
 Nursing care/interventions designed to meet the patient’s/families
actual and potential post-discharge care needs.
 Nursing care/interventions designed to promote skin integrity.
 Nursing care/interventions in effective manner, give the current
state knowledge in order achieve the desired outcome for the
patient.
 Nursing care/interventions designed to promote Infection Control
to prevent Nosocomial Infection.

28.  Commitment to patient and family rights.
 The patient/family will be involve in his/her care
decision when appropriate.
 Protect the rights of the patient and their families in
the health care process.
 The patient/family’s personal privacy will be
maintained, as well as confidentiality of the medical
record.
 The patient’s as well the families’ psychosocial,
socioeconomic value or state related to health and
treatment are incorporated with the plan of care.

29.  Nurses, assistant nurses & midwives provide
consistent, individualized, quality nursing
care to patients regardless their differences
with the aid of the standards established in
the policy.
 Nursing Administration including Charge
Nurse and Supervisors, to safeguard patient
and family rights, being staff and patient
advocate.

30.  Falls
 Patient Identification
Apply 7 rights of medication administration:
 Right patient
 Right medication
 Right Dose/Rate
 RightTime
 Right Documentation
 Right response
Helps decrease
risk of bad
outcomes
Attentive
listening
Accurate
documentation and
reporting

31.  https://www.ncchc.org/cnp-ethical-legal
 https://www.slideshare.net/ParveenKumarCh
adha1/legal-issues-in-nursing-
practice?from_action=save
 Carl E. Balita Ultimate Learning Guide 2nd
Edition
 Informed Consent (PFR 003 -V02)
 NSPP NR 003