Chapter 5

Legal and Ethical Issues

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives

Examine nurse practice acts and legal principles important in leadership and management. Analyze issues of malpractice and strategies to prevent malpractice. Analyze ethical principles. Value the need for orientation, education, and evaluation.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Nurse Practice Act

Licensed practical/vocational nurses Registered nurses Advanced practice nurses

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Negligence and Malpractice

Elements of malpractice Duty owed the patient Breach of duty of care Foreseeability Causation Injury Damages

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Liability

Personal Vicarious Corporate

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Causes of Malpractice for Nurse Managers

Assignment, delegation, supervision Duty to orient, educate, and evaluate Failure to warn Staff issues

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Assignment
The transfer of both accountability and responsibility from one person to another.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Delegation
Involves two or more people; includes transfer of authority to perform some task; includes retention of accountability.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Supervision
The active process of directing, guiding, and influencing the outcome of an individuals performance of an activity; directing, guiding, and influencing of various personnel who directly provide nursing care to patients.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Doctrine of Respondeat Superior

This includes knew or should have known as the legal standard in assigning and delegating.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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Orient, Educate, Evaluate

Be aware of others knowledge, skills, and competencies. Know if others are maintaining their performance levels. Know the standards to which we are held accountable. Know what the practice act requires in terms of accountability for others.

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Orient, Educate, Evaluate (contd)

Questions to ask yourself:

Is this staff person new? Has he or she completed orientation to the organization? To the unit? To the shift? Has this person participated in orientations to new equipment and procedures? Has this person been adequately supervised? Do I concur with the evaluation about performance?

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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Failure to Warn

Colleague accountability Nurse manager accountability

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Staffing Issues

Three key issues

Staffing levels Floating staff Use of temporary staff

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Staffing Levels

Staffing levels are mandated! Almost consistently, the wording is that adequate staffing levels must be maintained. What is adequate? What is the right mix of licensure levels? Is education important?

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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Being Proactive About Staffing Levels

Document concerns (anyone). Authorize overtime (manager/supervisor). Reassign personnel (supervisor). Restrict admissions (varies across organizations). Alert hospital administrators (nursing chain of command).

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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Floating Staff

Floating refers to moving a person temporarily from an overstaffed unit to one that is understaffed. Consider the following:

Staff expertise Patient care delivery systems Patient care requirements

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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Temporary or Agency Staff

Apparent agency concept Know:

The workers skills The workers competencies The workers knowledge

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Protective and Reporting Laws

Informed consent Privacy Confidentiality

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Employment Laws

Equal employment Age discrimination Americans with disabilities Affirmative action Equal pay Occupational safety and health Family and medical leave Employment at will and wrongful discharge National labor relations
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Ethical Principles

Beneficence Nonmaleficence Veracity Justice Paternalism Fidelity Respect for others

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Ethical Considerations

Code of ethics Ethical decision-making framework Moral distress Ethics committees Blending ethical and legal issues Future ethical concerns for nurses

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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