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Legal Issues for Nurses

Nurse Practice Act

Obtain a copy of the Nurse Practice Act from your State Board of Nursing. This is the standard that will be used if a malpractice suit is filed. Be familiar with the applicable acts and duties of the personnel in your area of practice, which will vary from state to state.

  • Can an LPN care for patient with a Swan-Ganz catheter?
  • Can an LPN hang a piggyback with 50 cc's of fluid in it or push IVmeds?
  • Can an RN remove chest tubes, manipulate Swan-Ganz, etc.?
  • What are the duties of a nurse's aid and/or tech and are the RN's liable?

The answers to these types of questions can be found in your Nurse Practice Act. If you don't have one, request one now and if you relocate, request a new one with your license.

Policy and Procedure Manuals

Review and always double check both the general nursing manual as well as any that pertain to your specific area of practice. If your hospital's policy differs fro the Nurse Practice Act, follow the guidelines in the Nurse Practice Act. i.e.: If your institution allows unlicensed personnel to insert foley catheters, but the policy found in the Nurse Practice Act requires that insertion by performed by licensed personnel only, the licensed nurse should insert the foley. Remember, if there is a negative outcome, the licensed nurse will be judged by the standards of the Nurse Practice Act.

Insurance

This is a must-have. Shop around for a policy that suits your needs. There are two types:

Occurrence Type:
means the company that covered you during the period of the occurrence will be responsible for damage and expenses.

Claims Type:
means the company will cover any claims made while the policy is in effect, no matter when the occurrence happened.

Questions to ask the company representative include:

"Can I select my own attorney to represent me?" "Does your company routinely settle claims or can I have my day in court?"

Education

Continuing education is a must. Not only does it keep you abreast of the most current changes and innovations in your specialty area, it is an area that attorneys will investigate if a claim is filed.

License and Certifications

These must remain current at all times. This is another area that attorneys will investigate if a claim is filed.

Terms To Know

Negligence: failure to act as a reasonably prudent person would act under the same circumstances --- failure to do something --- to do something carelessly or recklessly

Malpractice: negligence by a professional

Assault: a threat or attempt to inflict bodily harm combined with the ability to commit the act. i.e.: "if you move one more inch, I'll tie you to the bed."

Battery: intentional harmful or offensive contact that occurs without consent (use of restraints without an order or a written policy of protocol).

Libel: publication of defamatory statements (Nurses Notes will be scrutinized for libel.)

Slander: oral defamatory statements (can be words or gestures)

Statute of Limitations: there are periods defined by state statute during which you may file a claim or it is forever barred (the clock starts at the time of the occurrence or at the time the occurrence was discovered or should have been discovered, such as a lap sponge left in a patient's abdomen that was discovered several years post operatively).

Informed Consent: permission given for a proposed treatment or procedure following full disclosure of risks, benefits, and alternatives by the physician --- when you are asked to sign your name as a witness on the consent form. Remember you are witnessing the patient's signature only

Physician Orders

Telephone Orders: Repeat each order to verify what you heard is what was ordered.

Illegible Orders: Ask the physician for the interpretation. NEVER GUESS!

Inappropriate Orders: Inform the physician of the policy and standards. If the physician insists that the order be completed, contact the supervisor immediately.

Communication

Be honest. 

 

- Don't be afraid to apologize if an apology is needed.

- Be a good listener. Sometimes it isn't what they say, but how they say it.

- A little PR goes a long way.

- Schedule time each shift to speak with the patient and his family.

- The medical record is the ultimate communication tool.

Remember, most lawsuits are filed simply because the patient or the family isn't happy. Good communication skills can alleviate this.

Documentation

- Be accurate, objective, and complete.

- Beware - negative charting (check lists) may not hold up in court. It is beneficial to document in narrative form a complete assessment at least once during your shift as well as any event. Many courts still feel that if you didn't chart it, you didn't do it.

- Use only approved abbreviations (found in the Policy and Procedure Manual).

- If you make an error, draw a line through it and write "mistake in entry" followed by your initials. Do not write "error" as it has a negative connotation.

- Document calls to physicians noting the time the page was made or the call was placed, as well as the time the call was returned and the physician's response.

- Document all teaching. If family members are present, list their names in your note.

- Document the review of "discharge instructions" including the review of any medications prescribed and any handouts provided is of utmost importance.

- Document all patient comments regarding their condition, both the positive and negative ones.

- Record the effects of medications as well as the med, dose, time, route and reactions to treatments and your response.

- If something unusual occurs, record all pertinent information in your notes, them complete an incident report. Do not mention the incident report in your notes.

- If you perform a procedure on a patient assigned to another nurse, you must document your actions in the patient's chart.

- Not every treatment or procedure that you perform or assist with is going to have a positive outcome. If there is a negative outcome, document the details truthfully in your notes and if necessary, complete an incident report.

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