Understanding Nursing Legal Responsibilities and Ethical issues with examples and free PDF: NCLEX RN resource
Advance Directives:
Medical Power of Attorney (MPOA)
Purpose: Appoint a person (known as a healthcare proxy or agent) to make medical decisions on your behalf if you are incapacitated (unable to make medical decisions for oneself)
Scope of authority:
o The agent can make decisions about treatments, surgeries, medications, and other aspects of care not explicitly outlined in a living will.
o They are expected to follow your preferences and values or act in your best interest without guidance.
When it takes effect: A physician usually certifies that you cannot make decisions for yourself.
Without a Medical Power of Attorney (MPOA), if you cannot make medical decisions, the decision-making process typically follows state-specific laws regarding healthcare surrogacy or default decision-makers. Here’s what usually happens:
Hierarchy of Decision-Makers (Varies by State):
If no MPOA is designated, most states rely on a hierarchy of individuals who can act as healthcare decision-makers. The order may include:
Spouse or domestic partner
Adult children
Parents
Siblings
Other close relatives or next of kin
What Happens in the Absence of an Available Surrogate?
If no suitable family members or individuals can make decisions, healthcare providers may rely on hospital ethics committees or seek court intervention to appoint a legal guardian
Considerations When No MPOA Exists:
Living Will: If you have a living will, providers will follow your written directives regarding life-sustaining treatment and other care preferences.
Healthcare Surrogate Laws: State laws may automatically assign someone (such as a spouse or next of kin) the temporary authority to make decisions.
Court-Appointed Guardian: In some cases, the court may appoint a guardian to decide on your behalf, particularly in complex cases or disputes.
Living Will:
Purpose: Specify the types of medical treatments and life-sustaining measures you want or do not want if you cannot communicate your wishes due to serious illness or incapacitation.
Common directives include:
· Whether to use life support, such as intubation, mechanical ventilation or feeding tubes.
· Whether to pursue resuscitation (CPR), defibrillation (shock) or other life saving measures.
· Instructions on pain management and organ donation.
When it takes effect: When you cannot express your wishes, often due to terminal illness or a permanently unconscious state.
Do Not Resuscitate (DNR):
Purpose: A medical order indicating that healthcare providers should NOT perform CPR (cardiopulmonary resuscitation) or other life-saving measures if your breathing or heartbeat stops.
Scope: Typically includes no chest compressions, defibrillation, or intubation.
Where it applies: It can be used in hospitals, nursing homes, or even at home if specified through a portable DNR (sometimes called an out-of-hospital DNR).
Partial DNR:
Purpose: A more specific form of a DNR that limits certain interventions while allowing others.
Options within a partial DNR may include:
No CPR: It may allow certain life-saving measures like defibrillation or intubation
No intubation: But chest compressions and medications may be permitted
Comfort care only: Pain management and essential support are provided, but no resuscitative efforts are made.
Key Difference:
A DNR is an all-or-nothing directive to withhold resuscitation.
A Partial DNR allows patients or their healthcare proxies to customize the interventions they want or do not want based on their preferences and conditions.
Legal Considerations for Nurses: Overview
Nurses must adhere to various legal frameworks that protect patient safety, guide ethical behavior, and ensure accountability. These legal aspects include federal and state laws, torts, and civil and criminal laws.
1. Federal Laws:
These overarching laws apply nationwide, regardless of state. Nurses must comply with these regulations to maintain professional practice.
HIPAA (Health Insurance Portability and Accountability Act) Ensures patient confidentiality and protects health information
EMTALA (Emergency Medical Treatment and Active Labor Act) requires nurses and healthcare providers to deliver emergency care regardless of a patient’s ability to pay.
OSHA (Occupational Safety and Health Administration): Protects healthcare workers by establishing workplace safety standards.
The Americans with Disabilities Act (ADA) Prohibits discrimination against individuals with disabilities and ensures reasonable accommodations in healthcare settings.
2. State Laws:
State laws primarily regulate nursing practice, including each state’s Nurse Practice Act (NPA). The NPA defines the scope of practice, licensure requirements, and disciplinary actions for nurses.
Scope of Practice: Specifies what nurses can and cannot do based on their level of licensure
Mandatory Reporting: State laws often require nurses to report abuse, neglect, or communicable diseases.
Licensure Requirements: Nurses must comply with state-specific licensure renewal and continuing education mandates.
3. Torts:
A tort is a civil wrong that causes harm to another person and can result in legal liability.
Intentional Torts: Include actions done on purpose, such as:
o Assault: Threat of harm.
o Battery: Unconsented physical contact.
o False Imprisonment: Restraining a patient without justification.
o Defamation: Damaging a patient’s reputation through false statements.
Unintentional Torts typically involve negligence or malpractice, which occur when nurses fail to provide the standard of care and cause harm.
o Negligence: Failure to act as a reasonable nurse would.
o Malpractice: A type of negligence specific to professional duties, such as medication errors or failure to monitor patients.
4. Criminal Laws:
Criminal acts by nurses can result in fines, imprisonment, or license revocation. Criminal law distinguishes between felonies and misdemeanors:
· Felony: Serious offenses, such as intentional harm, falsifying medical records, or abusing a patient.
· Misdemeanor: Less severe crimes, like minor drug possession or violation of public health regulations.
Examples:
· Narcotic theft or misuse: Stealing medications from patients.
· Patient abuse or neglect: Acts resulting in intentional harm or gross neglect.
5. Civil Laws:
Civil law deals with disputes between individuals or entities and typically involves compensation rather than criminal punishment. Nurses may be involved in civil cases, mainly regarding malpractice claims.
· Malpractice suits: When a patient sues for harm caused by substandard care.
· Breach of confidentiality: Violating HIPAA by sharing sensitive information.
· Failure to obtain informed consent: Performing procedures without proper patient authorization.
Summary: Nurses must be aware of the legal responsibilities outlined by federal and state laws while understanding the implications of torts, criminal acts, and civil liabilities. Maintaining proper documentation, practicing within scope, and following ethical standards help nurses avoid legal issues and safeguard patient care.
HIPAA: Overview
The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, is a federal law designed to protect patients' health information and ensure privacy and security in healthcare settings. It establishes standards for using, disclosing, and safeguarding Protected Health Information (PHI).
Key Provisions of HIPAA:
1. Privacy Rule: This rule governs how PHI can be used or disclosed by healthcare providers, insurers, and business associates.
2. Security Rule: Establishes standards to protect electronic PHI (ePHI) through administrative, physical, and technical safeguards.
3. Breach Notification Rule: This rule requires covered entities to notify affected individuals and the Department of Health and Human Services (HHS) of data breaches.
Client Privacy:
· Goal: To ensure patient confidentiality and prevent unauthorized access to sensitive medical information.
· PHI (Protected Health Information): Includes information related to a patient's health, healthcare services, or payment for services that can identify the individual. Examples include:
o Medical history
o Lab results
o Social Security numbers
o Diagnoses, treatment plans, or billing information
· Maintaining Client Privacy:
o Use private spaces when discussing patient care.
o Only access PHI when necessary for job responsibilities (minimum necessary standard).
o Secure patient records physically and electronically.
Common PHI Pitfalls:
· Unintentional disclosures: Discuss patient information in public areas such as elevators or cafeterias.
· Improper disposal of records: Discarding documents with PHI without proper shredding.
· Inadequate access controls: Allowing unauthorized personnel to access electronic records or sharing passwords.
· Social media violations: Posting patient-related information online, even without names, which could potentially identify the individual.
HIPAA Violations:
· Definition: This occurs when PHI is disclosed or accessed without proper authorization, violating HIPAA’s privacy or security rules.
· Common examples:
o Accessing patient records without permission (snooping on a celebrity’s medical history).
o Sharing PHI with unauthorized individuals, even if unintentional (e.g., sending medical records to the wrong email).
o Failure to provide proper safeguards for ePHI (e.g., leaving computer screens with open records visible).
· Consequences of Violations:
o Civil penalties: Fines ranging from $100 to $50,000 per violation, depending on the severity and whether the violation was intentional or due to negligence.
o Criminal penalties: Violators may face fines and imprisonment for intentional or malicious breaches.
o Employer consequences: Termination, disciplinary action, and possible license revocation by the nursing regulatory board
Preventing HIPAA Violations:
· Ensure staff training on HIPAA compliance.
· Use encryption and secure login measures for electronic health records.
· Always verify recipient details before sharing PHI.
· Limit discussions of patient information to secure or private environments.
Understanding HIPAA is essential to maintaining patient trust, ensuring legal compliance, and preventing breaches that could result in severe penalties.