Introduction

NCONN Core Competency Area 1:

Professional, Legal and Ethical
Nursing Practice
Mary Lou Woodford, RN, BSN, MBA, CCM
June 12-14, 2014
5th Annual NCONN Conference
Atlanta, Georgia
 Disclosure

Mary Lou Woodford, RN, BSN, MBA, CCM has no

significant financial relationships to disclose.
 Competency Area 1

“The Oncology Nurse Navigator will

integrate the philosophy of nursing care and
evidence-based practice into care of the
oncology patient.”

(NCONN, 2013)
 Objectives

1. Discuss professional, legal, and ethical

nursing practice as applied to
navigation.
2. State an understanding and the
significance of current clinical guidelines
in implementing treatment plans as set
forth in the NCCN guidelines.
 Agenda
Nursing Law and Practice Ethics and Nursing Practice

• The Legal Environment • Ethics

– Regulation in Nursing Practice – Ethical Decision Making
– Standards of Care
– Professional Boundaries and
– Professional Liability
Patient Relationships
– Moral Courage and Patient
• Liability and Patient Care
Advocacy
– Patient Bill of Rights
– Social Media and Online
– Confidential Communications
Professionalism
– Informed Consent
– Refused Treatment – Reporting Illegal, Unethical,
– Pain Control
or Unsafe Conduct
– Patient Teaching and Health – Advance Directives and End
Counseling of Life Decisions
– Medication Administration
 Regulation of Nursing Practice
• Licensure
– Enables nurse to work as an RN and use the title
– Mandatory
– Multi-State licensure
• Nurse Practice Acts
– Entry Requirements
– License Renewal
– Scope of Practice
• Credentialing
– Recognition of knowledge and skills exceeding basic practice
– Recognition by Specialty Organization
– Can use title with RN
 Standards of Care
The Oncology Nurse Navigator has the duty to practice nurse
navigation using the applicable standard of care.

The most commonly utilized standard of care for the Oncology Nurse
Navigator is the National Comprehensive Cancer Network Guidelines*

Other Sources of the Standard of Care

– Multiple sources including professional organizations, evidence
based guidelines, nursing literature, federal administration
codes, court decisions, expert testimony, PDR or medication
inserts, medical equipment vendor recommendations, etc.

*NCCN.ORG
 National Comprehensive Cancer
Network Clinical Practice Guidelines
in Oncology®
The National Comprehensive Cancer Network®
(NCCN®) is an alliance of 25 of the world’s leading
cancer centers working together to develop treatment
guidelines for most cancers, and dedicated to research
that improves the quality, effectiveness, and efficiency
of cancer care. NCCN® oncology guidelines are one of
the most respected practice standards in the industry.
 Professional Liability

• Malpractice
– Common areas of nursing malpractice
– Avoiding malpractice claims

• Liability Insurance
– Types of Policies
– Policy Provisions and Coverage
– Individual vs Employer coverage
 Liability and Patient Care
• Patient Bill of Rights
• Confidential
Communications
• Informed Consent
• Refused Treatment
• Pain Control
• Patient teaching and health
counseling
• Medication administration
 Ethical Decision Making
Moral Principles of Ethical Decision Making

• Autonomy
• Freedom
• Beneficence
• Do no harm
• Veracity
• Confidentiality/
privacy
• Fidelity
• Justice
 Professional Boundaries
Code of Ethics
• Professional Boundaries
• Boundary Crossings
• Boundary Violations
• Improper Sexual misconduct
Examples of Typical Boundary
Crossings
• Accepting gifts
• Socializing
• Keeping secrets
• Buying gifts
• Discussion of personal problems
• Visiting patient while off-duty
• Participating in business
relationship
• Sharing personal information
 Moral Courage and Patient Advocacy
Moral Responsibility

• Ethical Drift

• Moral Courage
 Social Media
Social Media Online Professionalism
• Benefits and Risks • Recognize potential
• Consequences of Misuse of boundary crossing
Social Media • Evaluate the situation and
options
• Act responsibly and use
professional conduct
 Reporting Illegal, Unethical,
or Unsafe Conduct
1. Legal and Ethical Framework
2. Consequences of Not Reporting

Ensure proper reporting ----- Risks of Reporting

 Advance Directives and
End of Life Decisions
• Durable Power of
Attorney for
Healthcare
• Living Will
• Advance Directives for
Healthcare
• Psychiatric Advance
Directives
• Do Not Resuscitate
(DNR) orders
 Resources
• Westrick, S (2014) Essentials of Nursing Law and Ethics, Jones & Bartlett Learning
• DeMartino, J Larsen, J Equity in Cancer Care Pathways, Protocols, and Guidelines. J Natl Compr Canc Netw 2012: 10:5-
9.
• American Cancer Society, April 14, 2009; Navigating difficult waters. The history of the patient
navigators.http://www.cancer.org/cancer/news/features/navigating-difficultwaters-the-history-of-the-patient-
navigators

• Brown, CG, Cantril, C, McMullen, L. Barkely, D, Dietx, M Murphy, CM Fabrey, L (2012) Oncology Nurse navigator role
definition study: an ONS report. Clinical Journal of Oncology Nursing 16, 581-585.

• Fillon, L Cook, S Veillette, A Aubin M deSerres, M Rainville, F etal (2012) Making the case for nurse navigators:
benefits, outcomes, and return on investment. Oncology Issues 26(5) 26-33

• Pedersen, A Hack, TF (2010) Pilots of oncology health care: a concept analysis of the patient navigator role. Oncology
Nursing Forum, 37, 55-60

• Murray, j (2010) Moral courage in healthcare: acting ethically even in the presence of risk. Online Journal of Issues in
Nursing, 15(3),1-14

• Lachman, V, Ethics, Law and Policy, Ethical Challenges in the Era of Health Care Reform, Medsurg nursing, july-august
2012; v.21.vol 4 http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethical-Challenges-in-
the-Era-of-Health-Care-Reform.pdf
• Lachman, V Ethics, Law and Policy, Applying the ethics of your nursing practice. Medsurg nursing, march-april 2012.
V21.no2

• National Council of State Boards of Nursing,(2011) White paper: A nurse’s guide to the use of social media.
https://www.ncsbn.org/social _media.pdf

• http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Applying-the-Ethics-of-Care-to-Your-
Nursing-Practice.pdf
 Questions??

Mary Lou Woodford, RN, BSN, MBA, CCM

Marylou.woodford@cancer1source.org
508-630-2442