COMLEX Chapter 23 Legal Implications in Nursing Practice

Statutory law (Nurse Practice Act) -Criminal law (felonies or misdemeanors) -Civil law Statutory laws include the Nurse Practice Act found in all states. The Nurse Practice Act describes and defines the legal boundaries of nursing practice in each state. The Nurse Practice Act of each state defines the scope of nursing practice and expanded nursing roles, sets education requirements for nurses, and distinguishes between nursing and medical practice. Criminal laws are meant to prevent harm to society and to provide punishment for crimes. These are categorized as felonies or misdemeanors. A felony is a serious offense that results in significant harm to another person or society in general. Felony crimes carry penalties of monetary restitution, imprisonment for greater than 1 year, or death. Examples of Nurse Practice Act violations that may carry criminal penalties include misuse of a controlled substance or practicing without a license. A misdemeanor is a crime that, although injurious, does not inflict serious harm. For example, parking in a no-parking zone is a misdemeanor violation of traffic laws. A misdemeanor usually has a penalty of a monetary fine, forfeiture, or brief imprisonment. Civil laws protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur. The consequences of civil law violations are damages in the form of fines or specific performance of good works such as public service. Nursing negligence or malpractice is an example of a civil law violation. Regulatory law (administrative law) also known as administrative law, defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing. 00:02 01:01 Common law (judicial decisions) results from judicial decisions concerning individual cases. Most of these revolve around negligence and malpractice. Standards of care -Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care Best known comes from the American Nurses Association (ANA) Set by state and federal laws that govern where nurses work Joint Commission requires policies and procedures (P&Ps). Patient Protection and Affordable Care Act (PPACA) -Consumer rights and protections -Affordable health care coverage -Increased access to care -Stronger Medicare to improve care for those most vulnerable in our society Americans with Disabilities Act (ADA) Protects rights of people with physical or mental disabilities As defined by the statute and the U.S. Supreme Court, a disability is a mental or physical condition that substantially limits a major life activity, including seeing, hearing, speaking, walking, breathing, performing manual tasks, learning, caring for oneself, and/or working. The ADA protects health care workers in the workplace with disabilities such as human immunodeficiency virus (HIV) infection. Likewise, health care workers cannot discriminate against HIV-positive patients. Emergency Medical Treatment and Active Labor Act When a patient presents to an emergency department, they must be treated provides that if an emergency condition exists, staff must evaluate the patient and may not discharge or transfer him or her until the patient's condition stabilizes. Mental Health Parity Act as Enacted Under PPACA Strengthens mental health services requires parity (the state or condition of being equal) in provision of 10 specific services, including mental health, behavioral health, and substance use services. -Insurers may not discriminate or deny coverage to patients with mental illness because of preexisting conditions. -Patients may remain on their parent's health insurance until they are 26 years old. -Currently, admission of a patient to a mental health unit can occur involuntarily or on a voluntary basis. -If the patient's history and medical records indicate suicidal tendencies, the patient must be kept under supervision. The Patient Self-Determination Act (PSDA) enacted in 1991 requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. Living wills represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. Health care proxies or durable power of attorney for health care is a legal document that designates a person or people of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf. This agent makes health care treatment decisions on the basis of the patient's wishes. In addition to federal statutes, the ethical doctrine of autonomy ensures the patient the right to refuse medical treatment. In addition to patient refusals of treatment, the nurse frequently encounters a "do not resuscitate" (DNR) or "no code" DNR order. Documentation that the health care provider has consulted with the patient and/or family is required before attaching a DNR order to the patient's medical record. Cardiopulmonary resuscitation (CPR) is an emergency treatment provided without patient consent. Health care providers perform CPR on an appropriate patient unless there is a DNR order in the patient's chart.