hi everyone it's Dr chair DMP um faculty here at Delgado charity School of Nursing uh this is adult Health nursing level one nursing 113 um I serve as faculty here again at charity I'm also an advance practice RN a family nurse practitioner in the community as well as a legal nurse consultant um this lecture is on the concepts of advocacy legal and ethical uh I know you guys uh have worked hard to get to where you are again congratulations on your acceptance into charity School of Nursing uh you guys have already sacrificed so much uh you've done so much to get here um just to get accepted into your seat here uh your prerequisites and everything and so we're going to talk about some of the legal aspects of nursing um protecting yourself in your nursing license protecting your patient and advocating for your patient um and just some of the ethical uh things uh ethical concepts of nursing uh concept and learning outcomes so this lecture is going to basically describe how values professional guidelines and moral principles play a role in nursing we're also going to discuss the role of the nurse as patient advocate in the delivery of ethical nursing care we're going to identify ways the American Hospital Association on the patient Bill of Rights we'll talk about uh the Ana code of ethics uh some guidelines for mandatory reporting we'll provide examples of unacceptable nursing decisions actions and behaviors uh some unprofessional conduct that would impact our nursing lure again you've worked hard uh to get here and so I want to uh talk to you guys about protecting yourselves and your license uh and unprofessional conduct we're also going to discuss ways uh that hippo regulations could be violated within Health Care settings and we're going to list some legal guidelines and purposes for written and electronic documentation so let's begin so the concept of Ethics basically nurses have ethical responsibility to be Patient Advocates based on what the patient wants that means that as a nurse we advocate for our patients based on their recommendations based on their Wars uh we to advocate for someone who expresses and defends another another person's cause basically to Advocate uh is basically to express or defend another person uh nurses advocate for patients on the basis of the patient value and not the nurses own ethical or moral Valu so what I feel and what I believe is null and void it's what my patient feels and what my patient believes and that is what I'm going to Advocate on nurses make sure that the patient is making an informed decision and how do we do that we give the nurses we give our patients all the advantages and all the disadvantages and we allow them to make an informed decision and then we advocate for them based on what their decision is are they going to ask us what we think they absolutely are but we do not offer our opinions we basically give them the advantages the disadvantages we allow them to get with their families and make an informed decision based on the advantages and disadvantages values are personal beliefs about truths and worth of behaviors thoughts and objects basically beliefs is an in interpretation or a conclusion that one accepts as true uh values reflect beliefs based on a pattern of mental views established by prior experiences and individuals may hold beliefs based on their own experiences that differ from the beliefs of a group uh every everybody has different personal values and basically our personal values are going to be developed through our observation and our experience uh it our personal values may strongly be influenced by our social traditions our culture our our ethnic background our religious Norms um and basically uh experience within our personal family or Associated group so everybody has different values what I think is important you may not think is important what I value you may not value uh what is of importance to me may not be of importance to someone else uh and so when we're advocating for our patient we're advocating for them based on what they value and based on what they think is important and again uh we all have different professional beliefs and different professional values and we'll continue to grow on those professional beliefs and professional values throughout our nursing career and basically we start developing that now as a nursing student and and then with our experience and our and and our continuing education we continue to grow on those values so professional values uh nurses acquire professional values through soci socialization uh into the nursing profession by faculty and others uh we also acquire our professional values through our clinical experiences through our life experiences and we basically follow and establish code of ethics values are classifications of process identifying and examining developing individual values uh nurses develop uh insight into their own values and how they influence nursing action and it helps the nurses to gain ability to choose actions on the basis of deliverable adopted values it helps nurses to learn to identify patient values and distinguish them from their own values so we have to as nurses when we're advocating for our patients uh take our values identify our values set them to the side uh so that we are advocating for our patients based on what their beliefs are and what their values are uh value uh clarification and exercise uh basically it comes from real life experiences and it continues to grow um what may be important to us today may not be important to us uh by level four or what may be important for us early on in our nursing career may not be important uh in our latter nursing career so we continue to grow on our values and it continues to expand B based on our clinical experiences and our experiences uh values the process for helping patients clarify values uh basically we list the Alternatives we examine the possible consequences of those choices you've heard me say that we give our Pat We allow our patients to make an informed decision we give them all the advantages and all the disadvantages and we allow them to choose freely we allow them to make a choice to feel good about their choice we affirm their choice and act upon their choice uh nurses should help the patient think each question through thoroughly but not impose our own values uh the nurse should rarely if ever offer an opinion even when the patient ask and are the patients going to ask us they absolutely are because they trust us because they know we've been doing this because we've taken care of them for days now and they feel like they've buil a rapport with us so they're going to ask us I've had patients ask me over and over and over Joy what do you think I should do and basically what I do is I give them the advantages of the procedure I give them the disadvantages of the procedure and I allow them along with their family family and loved ones to make an informed decision are we allowed to answer any questions that they have we absolutely are and if we don't know the answer to those questions then we find out what they are we give them all the information and we allow them to make an informed moral principles of professional nursing moral principles are statements about broad general or philosophical statements they basically provide the foundation for moral rules agreeing on principles of nursing basically as nurses as professional nurses uh Fidelity is important uh being faithful to our agreements and Promises uh our patients take our promises seriously and so should we so that means that if we tell a patient we're coming back in 10 minutes then we absolutely should come back in 10 minutes because they take our promises serious they take uh what we say serious and so so should we and so should you tell a patient you're coming back in 10 minutes absolutely never even if you are coming back in 10 minutes say I'll I'll be back within the next 30 minutes to an hour give yourself a window uh because there's so many different things happening we don't want to box ourselves in or I'll be back as soon as I can or have your call light or or different things like that um but just make sure that when we are giving our patients uh time frames and making promises to our patients remember that they take that serious that they're relying on us that they're depending on us to do what we said we're going to do so make sure that we take those uh those uh promises series accountability and responsibility accountability means being answerable to ourselves others for the outcomes of our task or assignments nurses are accountable for their own actions and behaviors and may be accountable for others what does that mean that as nurses we are accountable for other people's actions and behaviors that means that the nurse has is accountable and responsible for everything that goes on with our patient during the duration of our ship if we arrive on our ship and we have we are assigned to a patient have you ever had a family member in the hospital and the and people come to the hospital to see him they don't necessarily ask to see the secretary or ask to see can I see the physical therapist uh can I see the doctor can I see the case manager can I see the CNA can you call this person in when I get to the hospital to see my family member I want to see mom's nurse can I see mom's nurse because Mom's nurse is there more than anybody else and is spending more time with Mom and so mom's nurse is the one that's accountable and responsible for everything that happens with her and so if our patient is a high fall risk we're going to make sure that our patient's bed is in low position at all times and if x-ray goes in the room then we want to make sure that when x-ray comes out of the room that our bed that our patient's bed is still in a low position at all times because if our patient falls although we weren't the last person in the room we may be a accountable for actions of someone else so if it's our patient we're making sure that everything is done with our patient and so if somebody goes in my patients room I'm going in behind them or when they leave out I'm absolutely going in behind them to make sure that my patient is safe and their bed is in a low position and their call light is Within Reach and so that's what it means when we say nurses are accountable for our own actions and behaviors and we may be accountable for the actions of others our bment in our trainees responsibility specific accountability or liability associated with performance of duties of a role responsibility belongs to the person performing the duties e ethical nurse can explain rationale behind every action recognize standards to which nurses will be held as nurses we are are accountable and we are responsible morality of the nursing process we must provide high quality care to all patients regardless of the patients morality or immorality what does that mean that means that everybody gets the same care that everybody gets the same treatment doesn't matter who they are doesn't matter where they are uh some of us are going to be doing clinical rotation at different facilities that will house uh persons patients that are incarcerated I don't care what they did I don't care what's going on I care about providing high quality Care um nurses must have uh self-awareness of our own ethics uh through understanding of our requirements nurses must follow under the professional code of ethics we must understand uh reporting requirements in our state it is our responsibility to know what we have to report and what we don't uh we must understand uh the reporting procedures in our places of employment as students you report to your clinical instructor first uh we never it's never appropriate for nurses to allow our personal feelings about a patient to affect our the care that we provide again we provide high quality care to all of our patients uh no matter what their morality or immorality is illegal immoral unethical activities of professionals nurses have a legal responsibility to intervene on behalf of a patient if we have reason to believe that another professional is engaging in practice that is unethical unsafe substandard or unprofessional we have a legal responsibility nurses must follow established reporting procedures for our agency and facility the first step is always to notify our direct supervisor again in your clinical setting is going to be your clinical instructor uh and then that person can help assist you and facilitate the reporting procedure for the facility that you're in impairment of a coworker or a team member is one of the common situations uh that combine unethical unsafe unprofessional conduct and so it is Our obligation to report those situations uh in the event that we feel like we need to in the event that something has happened that we were're mandated to report a breach of privacy is also a growing concern and if you know that a patient's privacy has been breached then is your responsibility to report that information nursing code of ethics compliance compliance compliance the code of ethics for nursing is basically a general guide for the profession our code of ethics serves as a social contract with the public and us as the professional nurse basically our code of ethics serves as a contract and and we when we accepted our position into charity School of Nursing uh we've taken that oath uh to follow the nursing code of ethics uh the Nightingale pledge in 1893 was the first code of ethics for nurses in the United States uh today basically we follow the American Nurses Association or the Ana for code of ethics and we also have the Inn the international Council of nurses basically we use the code of ethics in everyday practice it requires that we know that we understand our patients needs and preferences uh and that we basically carry out our nursing code of ethics principles and practice of ethical decision making we have a right to self-determination inward autonomy the ability to make make choices outward autonomy choices not limited or imposed by others again our patients have the right to determine their own care uh nurses honor this principle by respecting the patient's decision even if they conflict with what we believe uh is in our patients best interest our person our patient still has the right uh to make their own choices um no one should be treated as impersonal source of knowledge and training uh beneficient means that uh it requires that one's action promote good it includes the principle of non-male feces nurses must Do no harm we must Safeguard our patients uh it can be RI it can be a risk of harm and Performing interventions intended for good uh but patients decide after being informed of the potential benefits and the risk as well principles and practices of ethical decision making Justice Means treating all patients fairly in accordance with honor standards of law it arises when decisions about scarce resources must be made and nurses must weigh situations carefully to provide care justly we must always tell the truth it can be challenging when family members want information withheld from patients underlies the need to give our patients complete information before obtaining informed consent for procedures and it applies to the need for timely and accurate docum documentation of nursing interventions basically uh we have to tell the truth to our patients if our patients are capable if our patients are of mental capacity uh you're absolutely going to have a family that comes out and says that mom's mom's 80 and her test results came back and it and uh it may have been in a malignancy maybe mom's got cancer and so they may come to you and say we we know that Mom's got that it was malignant but we don't want to tell her uh can can you not tell her if Mom is of sound mind uh then we have a duty to our patient to tell them the truth so we're not allowed to withhold that app that uh information from our patients we and of course it can be challenging um but we are not allow to to withhold any information from our patients principles and practices of ethical decision making uh applying these principles basically uh we're applying the principles uh the goal of ethical reasoning uh process is basically to arrive at a decision that is in the patient's best interest and it preserves the Integrity of all the people involved uh nurses must weigh in the competing factors when making these ethical decisions uh and we're responsible uh ethical decision making is our rational system systematic it's based on ethical principles and codes of Ethics it's not based on our own emotions or our intuitions or our fixed policies of Precedence uh several individuals besides the nurse are usually involved it involves the patients the patient family other members of The healthc Care team uh some patients may want their spiritual advisors present uh and then there's collaboration and communication and a compromise is made um Stress Management uh is also important uh during this procedure principles and practices of ethical decision making basically again uh we apply all these principles we give our patients all of their information that they need and we allow them to make inform decisions uh choice is affected by personal feelings and particularly context of the situation there are moral principles or Frameworks that can be used to provide justification for one or more actions but we again uh these are are difficult choices we again allow these patients to make uh these decisions when conditions are not met the nurse should refer to Professional Standards of practice for guidance and determining appropriate uh choice of action the concept of legal issues legal issues include rights responsibilities scope of practice for nurses uh as defined by the state nurse Practice Act uh as legislated through criminal and civil laws all patients have a legal right to expect confident nursing services so our patients expect us to know what we're doing all patients have a legal right to expect competent nursing services do we all know everything no healthc care is ever evolving it continues to grow everybody's learning things change from day to day covid-19 is a national pandemic that started in 2020 that was four years ago and we have treated covid-19 in so many different ways and it keeps changing and next year we will we treat Co the same as we treat it this year absolutely not things keep changing charity School of Nursing uses one textbook this this semester but did we use the same textbook last semester we absolutely did not and did we use a different different textbook the semester before we absolutely did because Healthcare is ever evolving and things continue to grow and things continue to change it is okay to say I do not know the answer to that but let me find out it is okay to say that I don't have the answer to that question I'll be back I will let you know but our patients have a legal right to expect confident nursing care so they expect us to know what we're doing nursing students must be equipped to provide safe nursing care that is consistent with the legal requirements of a nurse male practice is any conduct that deviates from the standard of practice directed by a professional again malpractice is any conduct that deviates from the standard of practice dictated by a profession nursing malpractice cases are associated with liability risk of Nursing and it is increasingly uh increasingly wellin fored patients the nurse must know regulations of Health Care Providers we must know the regulations of our institutions of the payment system of federal and state laws that pertain to Health Care some strategies to prevent incidents of professional negligence continuing issues of medication errors is one of the biggest malpractice continuing issues of medication ER errors it must be clearly documented and discussed with the patient that means if you give the patient the wrong medicine you have to document it and you have to notify the patient you have to document what happened you have to document you notify the patient you have to document that you notify the provider and what the results were other problematic situations as communicating care concerns or some key information about the patient's con condition if you receive a verbal order always read that verbal order back uh so ensuring that ph's orders are clear uh if the physician tells you to administer venad dril 25 milligrams by mouth qhs as needed for itching you're going to say okay from what I understand you want me to administer vadil 25 mg PO qhs as needed for itching is that correct uh and so you're going to document that you receive the order and that you read the verbal order back it's also our responsibility as a nurse to understand how to use equipment that's why it's important when they have different ins services on your floor and different ins Services about uh new equipment that you attend those different ins Services because it's your responsibility to understand how to use the equipment again our patients expect that we provide Confident Care we must provide appropriate mentoring assessment care planning for our patients it's all expectations maintaining patient safety is a big one uh a lot of malpractice cases from maintaining patient safety patient safety is of utmost importance Failure to observe and take appropriate actions Falls the nurse is liable for malpractice if a patient is injured as a direct result of a nurse action or inaction leading to a fall what's an inaction leading to a fall you didn't put the bed back in a low position so the nurses are liable for malpractice if a patient is injured as a direct result of a nurse's action or inaction leading to a fall most hospitals and nursing homes have policies regarding the use of safety devices uh ignoring a patient's complaint is a type of malpractice it's Failure to observe and take appropriate action if your patient says that they're in pain and you say oh I'm not going to do anything about that they're not in pain when I went in there she was sitting up laughing that's ignoring a patient's complaint it's a type of male practice uh Failure to observe and take appropriate action and so you will be you can be liable uh and two fale practice incorrect identification of a patient can lead to occurrences such as surgery on the wrong patient uh and it renders the no nurse liable for a male practice always use two patient identifiers it does not matter how many times you've seen that patient you're going to always always always use two patient identifiers and you're going to go back and identify your patient you're going to always ask them for their name and their date of birth uh if you don't do this uh it can lead to occurrences uh such as administering the medication to a wrong patient and so you have to make sure that you have the correct patient when you're doing these these are all all uh maintaining patient safeties and these are all very very important minimizing the risk of medication errors nurses need to strictly apply the seven rights of medication administration nurses need to strictly apply the seven rights of medication administration the right assessment the right drug the right dose the right patient the right route the right time and the right documentation new technology such as electronic health records must be evaluated for Effectiveness and reducing errors and so that's why some of the hospitals now mandate that you scan the patient's ID band and you scan the patient's medication this is all just a checklist to help minimize the risk of medication errors nothing can replace your nursing judgment in preventing a medication error uh when you're getting medication out of the pixes make sure that you are and that you have quiet and that you're focused on what you're doing uh if you think something is wrong again you have a nursing judgment and nothing replaces that use your own intuition and stop double check yourself it's going to save you a lot of time money it's going to actually save your career because it's going to prevent you from making a medication error always clarify any unclear orders if you have any questions always clarify any unclear orders get any questions that you have answered and know each medication before you administer them know why you're administering the medication what's going to happen when you administer it uh what class of medication it is some of the possible side effects as well as some of the adverse side effects of the medication uh if it's a new medication for the patient you want to also make sure that you're observing those different things these all help minimize the risk of medication error and very very important you've had an entire lecture on communication but again you see that using effective communication can save your lure can save you and prevent malpractice uh poor communication coupled with a negative outcome increases the chances of a malpractice claim that means clear communication of directions and explanations provision of effective patient education can help reduce or decrease the risk of bad outcomes attentive listening skills demonstrate caring accurate documentation and Reporting provide information to support or refute allegations of malpractice nursing documentation serves as a legal record of what occurred nurses should document defensively it must be inclusive and it must not rely on your own or your your patient's memory of details that means that if it's not documented it's not done the only thing that you have that is a legal record is your nursing documentation and again your documentation should be defensively it should be inclusive and it should not rely on your own or your patient's memory of details that means as soon as you can document document make sure that you document uh because you're doing so many things and taking care of so many patients you don't want to get sidetracked and so you need to document everything that you need to document on your patient again if it's not documented it's not done the only thing that serves as a legal record is your nursing documentation if you are called into court and a nurse there is and a a a patient uh is making an accus ation that they didn't receive a certain medication or that you didn't do a certain uh task that was ordered to be performed uh the only the only thing you have is your is the patient record that's the only thing that stands in court and so I mean I've seen nurses who have done who have who have been exceptional nurses who have provided exceptional care who have taken care of patients I mean and you can look at their documentation you can look at their track record you can look at everything throughout their nursing career and they get in court and the only thing that I have for them is the patient record the patients's medical record and so they read through the record and they're reading their own documentation and as they're reading the documentation they say okay some of this is coming back to me I think I remember when this happened and I know I remember taking out that catheter but if it's not documented and they cannot find it in that record then technically it's not done so make sure that you're documenting because if it's not documented it's not done and it's the only thing that stands in court is that patient chart so again nurses should document defensively it should be inclusive and should not rely on your own p on your own or your patient memory of details so by now I'm thinking oh my God all of this education and everything that I'm going through and everything that I'm learning and oh my God it can all be going down the drain at 1 second uh have one instance um but that's why it's important for us to always um maintain our professionalism and be professional uh that's why uh Nursing education is so strenuous uh that's why it's important that we document uh accurately and that we report um allegations and different things that need to be reported that's why it's important that we follow the moral principles of the nursing practice uh and that we're taking uh into consideration the concepts of ethics and everything that uh that we're being taught that's why it's important that we understand that nurses have accountability and responsibility and uh understand the morality of the nursing process and that we're in compliance and that we understand the principles and practical practices of ethical decision making um because all these different things are are very very important uh it's important that we understand the concept of legal issues because we have to protect ourselves we have to protect our time we have to protect everything that we've worked so very hard for uh we have to make sure that we're protecting our lure our goal as nurses is to provide safe high quality care to our patients and of course we want to do know no harm but just realistically the world we live in today uh malpractice claims have increased and the outcomes have become negative uh and they continue to increase so it's very very important that we uh protect ourselves and protect everything that we're working so hard for um and so then again uh there is another insurance right uh just like you have homeowners insurance and car insurance and health insurance it's going to be important for us to obtain professional liability insurance uh just to protect ourselves and to protect our assets and look we hopefully have to never ever use it hopefully we never have to use our professional liability insurance but I'd rather have it and not need it than to need it and not have it so it's going to be important that we obtain professional liability insurance nurses should carry professional liability insurance and there are different types there's the urren based coverage this coverage covers incidents that occurred uh while the policy was in effect regardless of when the claim was made there's claims made policies that provide coverage if the incident occurred and the claim made during the active policy period policies may be individual they may be group or they may be employer sponsored individual coverage provides the broadest coverage for policy holders uh employer sponsor coverage provides the narrowest coverage for individual nurses nurses should generally carry uh nurses are generally required to carry liability insurance for the duration of their education program uh and some programs ensure the students under the broad institutional policy uh like here at charity School of Nursing you're covered under Delgado charity School of nursing's broad institutional policy while you are a nursing student here um but uh professional liability insurance may run you $ 20 to $30 or so a month uh and and you look at it and you say it's just another insurance I have to carry now but again i' rather you know have it and not need it um but it does protect yourself it it protects your professional um it protects your uh assets uh and your your family uh and your personal uh aspects the standard of care it is based on the nurse Practice Act the nurse practice act governs us not your employer the nurse Practice Act they provide lure to us and they C they they govern us um based on our applicable administrative rules and job descriptions these are all things that we follow but we cannot do anything outside of the nurse Practice Act the nurse Practice Act says what we can and cannot do uh and so our job descriptions cannot make us function outside of our scope of practice the laws can change and as nurses we need to be aware of the changes and when the changes are made so it's our responsibility to maintain our to obtain our license and to Main maintain our license again it's our responsibility as a nurse to obtain our license and to maintain our license uh it basically um tells us what we can and cannot do and again these laws change uh and there are different laws for every state the Louisiana State Board of Nursing governs what the nurses can and cannot do in Louisiana if you're licensed in Mississippi then there's a different set of rules and a different board uh if you like if you're practicing in Atlanta if you're practicing in Texas New York uh everybody has a different standard of rules and it's up to you to know what you can and cannot do uh wherever you are uh because everything changes uh the State Board of Nursing gives us direction for all practice the hospitals can limit us but they can't make us practice outside of our scope uh again employeers can limit but not expand our scope of practice uh nurses are held to functioning within their scope of employment let me give you the perfect example that employers can limit us but not expand our scope of practice now will somebody ask you to do something outside of your scope absolutely it's up to you to know what your nurse Practice Act says you can and cannot do it's up to you to protect your license because if you do something outside of your scope of practice then you have just set yourself up for male practice and you're liable and you can be sued and you can lose your nursing license again employees can limit but they cannot expand your scope of practice here's an example the Louisiana State Board of Nursing says that as a nursing instructor I can take 10 students to clinical with me that means that the Louisiana State Board of Nursing says that there's a one teacher to 10 student ratio that I can take everybody got it my nurse Practice Act Louisiana says nursing instructor can take 10 students to clinical Ashner says you can only bring eight here can they do that they absolutely can they can limit what the nurse Practice Act says but they cannot expand what the nurse Practice Act says nowc says state board says you can bring 10 you can bring 10 here can they do that they absolutely can because it's not expanding our scope now if a clinical site says well we're short we need the extra hands and help a nursing instructor can bring 12 students here can they do that they they might try but legally they cannot and you cannot bring 12 students because the nurse Practice Act says you can only bring 10 so Louisiana state board licensed me and governs me and if they say I can bring 10 I'm only going with 10 or less so that is what I mean when I say employers can limit you but they cannot expand your scope of practice and every state has different scopes of practice every state has different requirements every state has different things that you can and cannot do uh Louisiana is very strict Mississippi is smaller and so they have a different scope of practice Texas is larger and so you may be able to do a little bit more in Texas but is up to you to know where you are and what you can and cannot do does everybody understand that agency policies and procedures Define the standards of care if there's a conflict between the current practice and policy nurses should resolve the conflict through quality improvement programs prevailing National nursing standards defined standards of care American Nurses Association standards of practice uh and Specialty practice standards here's an example standards of care if a patient is three days posttop after an abdominal surgery they develop a fever tenderness around their incision and purin drainage from the wound the patient status is unstable and the patient response to wound care interventions are not predictable and the and the RN may not Del delate wound care to the LPN why the Louisiana State Board of Nursing rule 3701 and 3703 says that hospitals cannot tell you as the nurse it is okay to delegate to an LPN in this situation the Louisiana State Board of Nursing rule 371 and 3702 says that hospitals can say that the RN cannot delegate surgical patients postsurgical patients so the state board says that patients coming out of surgery need to be taken care of by a registered nurse and they cannot delegate it to an LPN therefore the hospital that you're working cannot say it's okay for you to delegate to an LPN because the Louisiana State Board of Nursing says that you canot the hospitals can limit what you can do but they cannot expand your scope of practice the Louisiana State Board of Nursing and the Louisiana State Board of Nursing nurse Practice Act is who governs what you can and cannot do if you go to Louisiana State Board of Nursing rule 3701 it basically gives you the general resp General responsibilities of a registered nurse and managing and supervising nursing care and 3703 is basically the section of Louisiana State Board of Nursing on delegation of nursing interventions it basically identifies that postsurgical patients must be take must be taken care of by an RN and that they cannot delegate these things to an LPN it is up to you as the registered nurse to know what you can delegate and what you cannot delegate under your nursing licensure anything else puts you at risk of malpractice and uh professional liability case providing competent nursing care we must provide care that is within legal boundaries of the nursing practice within boundaries of agency's policy and procedures nurses must be familiar with their job description which may vary between different agencies as nurses we are responsible for ensuring that our education and our experiences are adequate for the responsibility specific to our job description if we feel that our knowledge is inadequate then we must let somebody know if we have a patient that we feel like we cannot take and take care of if we feel like we have a a patient that is too complex for us then we need to let our manager and our supervisor and know that hey uh I feel like uh this assignment is inappropriate for me uh and explain the the details but it's your responsibility to make sure that you uh have the education needed to take care of the patients that you are ass it's our responsibility to apply the nursing process and the essentials of the nursing process all assessments and Care must be documented accurately um nurses need to approach every patient with sincere concern nurses should acknowledge when they don't know the answer to Patient questions tell the patient that you'll find out and make sure that you follow through it is absolutely essential that you follow through legal requirements for mandatory reporting as a nursing student you are mandated to report certain things uh sometimes when people are talking and you're in different environments and different settings uh sometimes when people are saying different things I get up and I excuse myself uh if I know the conversation is not um even if I'm outside of the workplace uh because some things I'm man I'm mandated to report uh I've taken an oath and uh it's ethically I have a responsibility I have a duty as a nurse to report certain things and so you want to make sure that uh you don't leave yourself open to any uh male practice or anything that would jeopardize you or your nursing license always think about everything that you went through and all your education and all the sacrifices that you made to get to where you are uh and make sure that you are um re protecting yourself um so there some legal requirements for mandatory reporting and Most states nurses are required to report abuse or suspected abuse including elder abuse that means if I think that a patient is being abused that means that if I suspect that a patient is being abused then I am I have a mandatory obligation ethically I have to report it that I think that I suspect abuse I'm obligated to report that certain type of injuries a patient keeps coming through the emergency room and she's got dog bites and different injuries at different stages of healing then I'm I'm mandated to report that I've taken an oath it's my legal responsibility to report that and any crimes involving minors I'm mandated to report report that I have to report that nurses have legal obligations to report incompetent unethical illegal conduct any violence or abuse any neglect toward patients or other nurses uh any conduct by family members or other health care providers were mandated to report it each state nurse practice act includes requirements for reporting nurses who violate the Practice Act nurses reports required information through the chain of command if you see something when you're in the clinical setting your first person that you need to report to is your clinical instructor you are on you are in your clinical rotation and you are operating Under The Lure of your clinical instructor and that is the first person that you need to report anything to you may be required to report to both the institution and the State Board of Nursing and once you report the only obligation that you are held to is reporting the only thing that you have to do is report you are not required to conduct any investigation that's not your job you're just mandated to report uh the REM reporting nurse may be granted immunity from liability uh if there is something that's going on uh but you don't have to perform any investigation the only thing you have to do is report and then it's somebody else's job to carry through but as nurses we have legal requirements for mandatory reporting and that starts now uh even as nursing student informed consent so we've talked a little bit about making sure that our patients have all the information that they need to take care of themselves uh the advantages and disadvantages of of different procedures let's talk a little bit about informed consents uh these are going to be important uh this is important documentation that is going to be required uh when our patients are having different procedures and different treatments patients legal and ethical rights to be informed of to give or refuse permission for any health care procedure or treatment informed consents must be taken by a health care provider a medical doctor a nurse practitioner a certified registered nurse anesthesist a physician assistant a nurse Midwife all have the duty to disclosed the information about proposed treatments and terms patient care can understand the information must be available about Alternatives the risk the benefits of each treatment option the patient's right to refuse treatment guidelines for information to be provided to the patient the diagnoses are condition requiring the treatment purposes of the treatment what patient can expect to feel or experience the intended benefits of the treatment uh the possible risk or the ne negative outcomes of the treatment the advantages and disadvantages of possible alternatives to the treatment including no treatment at all again an informed consent must be uh disclosed by a doctor or a provider um and it must be disclosed to the patient and everything must be given all the information must be given the pros and the cons to give the informed consent voluntarily uh patients cannot be cered the patients understanding is essential uh technical words and language barriers can inhibit some patients understanding if the patient cannot read then the health care provider must read the consent to the patient the patient must then State understanding before signing the form if the patient and healthc care provider do not speak the same language then a medical interpreter must be present you are not allowed to use a family member or anyone else in the room you don't know what they're saying you don't know if they're giving the patient all of the correct information every clinical setting that you'll be in is going to have a medical interpretation line sometimes there are medical interpreters in the facility you call those interpreters and you let them interpret for you uh but you give the patient all of the information and make sure they have that information nurses should follow the employing agency specific protocol consents must be obtained for all procedures and treatments including all nursing care uh expressed consent can be oral or written that means that everything we do to our patient we must have their consent they must say yes it's okay for you to put my catheter in they must say yes it's okay for you to start my IV they must say yes it's okay for you to take out my IV expressed consent can be oral or written but consent must be given implied consent is a nonverbal expression of consent indicated by the patient's actions so who can give consent who's old enough who says who can give consent right so let's talk about competency for consent adults assumed to be confident if they're 18 or older can give their own consents if they're not declared Legally Legally incompetent they can give their own consents if they're 18 or over if they've not rendered temporarily incompetent they can give their own consents as long as they're 18 or over adults declared legally incomp competent are provided a legal guardian who gives consent for them a person may be rendered temporarily incompetent by medication or serious fall a person may be rendered temporarily incompetent by medication or serious Falls that means that if you've just administered medication to a person that makes them drowsy or makes them sleepy or incoherent then they could be temporarily incompetent by medication uh if they fell and had a hidden injury then they can be temporarily incompetent and somebody's going to have to be designated to consent for them uh they may become Inc confident gradually through dementia if a provider determines that a patient is not confident for purposes of informed consent emergency Doctrine May apply someone else may need to make Health Care decisions on the patient's behalf courts presume continuing confidency unless Health Care Facilities can show that patient cannot understand consequences of his or her action so if somebody comes in through the emergency room they're unconscious and nobody else is with them and there's not a family or somebody else around to make consent then emergency Doctrine May apply and the health care provider can consent for the patient here are some informed consent exceptions miners so we said that persons 18 or older can consent for themselves no problem 18 or older can consent for themselves however if they're a minor a parent or Guardian most of the time can give consent the same is true if an adult person has mental capacity of a child if someone has been appointed Guardian some states all miners consent for blood donation substance abuse treatment mental health treatment and reproductive concerns in Louisiana if you are a minor and you are pregnant you give consent for yourself in Louisiana if you are a minor and you need blood you give consent for yourself in Louisiana if you are a minor and you need substance abuse treatment you can consent for yourself in l Louisiana if you are a minor and need mental health treatment you can absolutely consent for yourself miners who are married miners who are pregnant military or emancipated may give consent for their s so in Louisiana you must be 18 to consent unless you need blood unless you're getting treatment for substance abuse unless you're getting mental health treatment or reproductive treatment if you're married you're not considered a a minor if you're pregnant if you're in a military you're allowed to consent for yourself now this is where the school Nur anybody want to be a school nurse this is where there's always a big issue or concern that if somebody comes to the school nurse clinic and they're a minor then they consent for themselves uh so if they are having any reproductive concerns or anything like that then you're allowed to consent for their themselves that means that you you don't you you can't disclose their personal information to anyone um because they're seeking reproductive uh treatment or mental health treatment or substance abuse or blood donation treatment and so they're allowed to consent for themselves and so um that's a lot of the issue that they have with minors uh consenting for themselves in the school systems uh in those clinics in the school system of course their parents find out once they get the insurance bill because they don't have their own insurance um but minors are allowed to content for the themselves under those certain circumstances if you're are unconscious or injured in any way that would not allow for consent the closest adult relative may give consent life-threatening emergencies uh the law generally agrees that consent is in applied to provide necessary care for the emerging conditions mental illness uh judge has deemed you incompetent then you refer to the state statute uh for specific rights uh but someone is usually court appointed uh to perform consents for you at that point so the Good Samaritan law so we are we're all uh nurses uh we've all signed up for for the nursing profession and so we all have a certain level of compassion uh and we all have a desire uh to be Good Samaritans uh we have a natural instinct to help uh but we just talked about uh laws and we just talked about legal aspects and ramifications of Nursing and we just talked about protecting ourselves uh and so here's the good Samaritan law basically uh the Good Samaritan law protects us uh as nurses and health care providers uh when we are acting outside of our employment agencies and when we're acting outside of uh different places that we work uh the Good Samaritan law encourages us to help but we don't necessarily have to in the event that we do the Good Samaritan law is in place however there are certain aspects and certain guidelines uh that we must uh follow in order to be covered by the Good Samaritan law again the Good Samaritan law encourages healthc care providers to help victims in case of an emergency uh it's designed to protect health care workers from potential liability when volunteering skills outside of the employment contract uh to be protected by law the nurse must adhere to standards of nursing care and provide only care that is consistent with the nurse's level of training and lure and then having decided to render emergency care then the nurse must follow through providing the necessary care uh safely placing the victim in the care of someone who can provide care that is appropriate that means that the Good Samaritan law is in place it encourages us to help however once we help once we decide to help we can only do what is in our scope of practice so we cannot perform outside of our scope of practice once we decide to help also once we decide to help we must help until someone else comes to take over so if we are in an emergency situation somewhere and we start helping uh we have to help until EMS arrives and takes over so we can't start CPR and then stop because we're tired once we say we're helping we're helping and we're covered under the Good Samaritan law all right let's talk about Advanced directives just a little bit Advanced directives basically um is in place uh just in case you need somebody to make decisions for you or you want your final wishes and writing basically uh we must recognize advian directives uh we ask patients if they have Advan directives uh in Louisiana there's a general La post that if you turn it in uh it's anywhere you go or any Hospital you end up in they can pull up your final wishes and look at everything um we provide educational materials advising patients of their rights to declare their personal wishes there are two types of advanced directives there's a living will which gives Specific Instructions about medical treatment and then there's a health care uh proxy or a durable power of attorney which uh appoint someone to take care of us or to make decisions for us in the event that we can't make those decisions for ourselves and then uh these must be notorized or witness statements appointing someone else uh basically to manage our health care Hippa our health insurance portability and accountability act uh more and more nurses are being sued for Hippa violations uh Hippa is a Privacy Rule it protects uh information that identifies individuals uh uh it also gives access to medical records it requires notice of privacy practices and opportunity confidential communication it limits the use of medical information Beyond sharing among Health Care Providers directly involved in patients care it prohibits the use of personal information for marketing uh if patients feel that a healthcare plan or provider has violated their patients rights then they may file a formal complaint to to the violating entity or office for civil rights or Department of Health and Hospital Services nurses must maintain understanding of current law to protect patients privacy and avoid legal repercussions one thing that Hippa does is give the patients or we all when we think Hippa we think of privacy and protection but it also gives patients access to their medical records it allows the patients um to see their medical records and so at any time a patient can see what it is that you document or or anything like that because Hippa gives them access uh to those different uh Records privacy versus confidentiality privacy is the right of individuals to keep their personal information from being disclosed uh the individual basically decides when where and with whom you share their information and that's privacy confidentiality is the assurance that patients has that private information will not be disclosed without the patient's consent uh it applies to both natur nature of the information obtained from the patient and how information is treated once it's disclosed uh disclosure uh patients protected health information can be disclosed under certain conditions without the patient's expressed uh permission so basically uh you don't need the patient's information if you're disclosing the information to the patient of course if you're disclosing the information to a provider that is treating the patient then you absolutely don't need the patient uh permission to do that uh when providing information to individuals involved in the payment process or other health care operations then you don't need the patient's information uh the patient's permission uh when required by law or court you don't need the patient information if you've been mandated by the court to report uh when necessary to protect Public Health you don't need the patient uh permission and when abuse or neglect is suspected you also don't need the patient's information information disclosed should be limited to minimum necessary for the situation that means you are asked the question and you answer it and that's it um basically you limit the information only to the information that is necessary when you're disclosing this patients information in these instances uh informal patient permission may be enough for providing information to family friends and others identified by patient um uh P families will catch you outside of the room in the hallway and ask you information about the patient you are not allowed to disclose that information unless you have permission from the patient uh incidental disclosures may occur but Safeguard should be in place to minimize uh one thing I want you to remember when you're going out into the clinical setting is that just because someone is in the room with the patient does not mean the patient wants them to know their private health information uh always give permission to speak to the patient and disclose the patient's information in front of who's ever in the room even if you're asked what medication is that she's taken you have to ask your patient if your patient's competent you ask your patient is is it okay to discuss your medicine with this person uh make sure you get that information also a lot of our facilities are now doing bedside report which means that you're in the room and you're giving report to the oncoming or ongoing nurse uh and so patients uh families are sometimes in the room please please please make sure before you start talking to patients private information that you get permission from the patient to discuss their information in front of whoever it is in the room if the patient is not okay with that you ask that family member or that guest to step outside of the room for just a second uh so that you can do your bedside report um but disclosure is very important make sure that you're protecting yourself uh in that aspect nursing students are held to the same responsibility as a nurse nursing students uh address duties and responsibilities uh the state looks at a nursing student just like they look at a nurse um nursing students can be sued uh just as a nurse uh npas address duties and responsibilities of nursing students in their state it includes language allowing nursing students to practice without license while engaged in clinical practicum of approved Nursing education programs under the supervision of a qualified faculty guidelines for clinical performance is to provide safe patient care to understand the program and Facilities policies procedures before undertaking any clinical assignment to demonstrate knowledge about the patient condition interventions medications and treatments and to perform care only to the highest level of their nursing knowledge if you are unprepared for a clinical uh assignment then it is your responsibility to inform your clinical instructor uh to seek help before beginning any procedures if you're unsure again nursing students are accountable for the same standards of care as a licensed nurse uh our patients again expect that they are provided competent nursing and what does it mean to be confident confidency is an expected level of performance that results from an integration of knowledge skills ability and judgment the knowledge encompasses the scope of practice standards of practice standards of professional performance content from science and Humanities practice experience and personal capabilities the skills include psychomotor communication interpersonal and diagnostic skills ability is the capacity to act effectively and requires listening Integrity self- knowledge of strengths and weaknesses positive self-regard emotional intelligence and openness to feedback judgment includes critical thinking problem solving ethical reason reasoning and decision making thank you so much for your time uh there is a discussion board if you have any questions uh you are allowed to go to the discussion board I'll see your questions there and I'll answer appropriately uh if you need to contact me my email address is J chair at dcc.edu that's j c h a i r at d cc.edu thank you