Nursing Management

1. LEGAL ISSUES IN
NURSING
R.RUPPAMERCY
M.Sc Nursing II year
DR.MGR Educational & Research
Institute

2. CONTENTS
Introduction
History
Terminologies
Types of law
Purposes
Legal rights and responsibilities
Liability and its types
Legal issues in nursing
Medico legal issues
Journal reference
Legal safeguards in nursing practice

4. INTRODUCTION
The legal aspects of nursing have an impact on the manner
in which care is delivered to patients by nurses. Legal
concerns shape the environment in which nursing is
practiced and determine how documents are kept or shared.
Ultimately, nurses and the nursing care they provide are
judged based on a legal definition for the standard of care for
nurses. As a nurse, it has become an important necessity to
be aware of the legal aspects associated with caring and
helping people in the health industry today because nursing
covers a wide range of disciplines and health-care issues
that are always changing and at the forefront of what guides
this career path.

5. HISTORY
The American Civil War (1861–1865) had a profound effect on
the development of the nursing and medical professions and in
many ways laid the foundation for modern nursing.
In the beginning, nurse volunteers were inexperienced,
untrained, and disorganized in 1867.

6. In 1868, just three years after the end of the Civil War,
Samuel Gross, president of the American Medical
Association, strongly endorsed the formation of training
schools for nurses (Egenes, 2009).
in 1873, the first educational programs for nurses in the
United States were established in New York.
The period from 1863 to 1893 was distinctly a pioneering
period. The immediate problem was not to build a finished
educational structure, but to clear the ground, to provide
decent conditions for both patients and nurses, and to lay
the foundation for an adequate nursing service.

7. As the nineteenth century drew to a close, nurses
themselves, along with many women’s organizations and
their leaders, lobbied for nurse registration.
By 1900, between 400 and 800 nurse training schools
were operating in the US and both support for and
opposition to the regulation of nursing practice was strong.
Although a vocal proponent for improvements in education
and working conditions, an aging Florence Nightingale
famously opposed nurse registration.

8. Despite fierce opposition, In 1902 members of the newly
formed New York Nurses Association met at the Rochester
City Hospital to discuss the establishment of the nation’s first
nurse practice act.
In 1903, North Carolina passed the first “permissive”
registration law for nurses. Permissive licensure allowed
nurses who met certain standards (such as graduating from
a nursing school and passing a comprehensive exam) to
work as a nurse but did not allow the use of the title
“registered nurse.”
The First Registration and Practice
Acts:

9. NURSE PRACTICE ACT
Nurse Practice Act, signed into law by the governor on
March 2, 1903, read in part:
At meetings it shall be their duty to examine all applicants
for license as registered nurse, of good moral character, in
the elements of anatomy and physiology, in medical,
surgical, obstetrical and practical nursing, invalid cookery
and household hygiene, and if on such examination they be
found competent to grant each applicant a license
authorizing her or him to register, as hereinafter provided,
and to use the title “Registered Nurse” signified by the
letters R.N. The said Board of Examiners may in its
discretion, issue license without examination to such
applicants as shall furnish evidence of competency entirely
satisfactory to them. Each applicant before receiving
license, shall pay a fee of $5.00, which shall be used for

10. By, 1921, 48 states followed North Carolina’s pursuit the
practice of professional nursing licensure.
These laws all changed during the Great Depression
states started to become more lenient and lacked the
reinforcement of nurse licensure. Many uneducated
nurses were working with the sick just for pay. This
created a competition for positions within the work field
between the educated and the uneducated.
By the help of the ANA in 1940 it became a mandated law
that all nurses must be licensed to practice the nursing
profession.

11. TERMINOLOGIES
LAW
Rules of conduct, established and enforced by authority,
which prohibit extremes in behavior so that one can live
without fear for oneself or one’s property.
Sullivan and Decker,2001
Law is a system of rights and obligations which the state
enforces.
--Green
Nursing law:
A rule of conduct, executive orders, regulations and legal
precedents which protects the individuals and the community

12. Contd..
Legal:
Established by or founded upon law or official or accepted
rules
Legal system:
A legal system is a procedure or process for interpreting
and enforcing the law.
Legal issues:
Legal issues in nursing are those in which a person lead
to face legal problems in which nurse face problem when
not meeting proper patient care.

13. TYPES OF LAW
PUBLIC
LAWS
PRIVATE LAW
OR
CIVIL LAWS
- CONSTITUTIONAL LAW
- CRIMINAL LAW
- ADMINISTRATIVE LAW
- TORTS
- CONTRACT LAW

14. PUBLIC LAW
PUBLIC LAW:
It refers to the body of law that deals with the relationship
between individuals and the government and the government
agencies.
CONSTITUITIONAL LAW:
Fundamental law written or unwritten, that establishes the
character of government by defining the basic principle to which
a society must conform.
CRIMINAL LAW:
Prevent harm to society and provides punishment for crimes.
ADMINISTRATIVE LAW:
When a state legislature passes a statute, an administrative
agency is given authority to create rules & regulations to enforce
the statutory laws.

15. PRIVATE LAW OR CIVIL LAW
 The body of the law that deals with relationship among private
individuals.
 CONTRACT LAW:
 Legally binding exchange of promises or agreement between
parties that the law will enforced.
 TORT LAW:
 It defines and enforces duties and rights among private individuals
that are not based on the contractual agreement.
 Tort is a legal wrong committed against a person, his or her rights or
property, intentional, willfully committed without just cause.
 A tort can be:
 Denial of a person’s legal right
 Failure to comply with a public duty
 Failure to perform a private duty that’s results in harm to another.

16. PURPOSES
SAFEGUARDING THE PUBLIC
The public safety is guaranteed
The individual is secure to the event of sickness or disability
with no fear of anxiety of being cared for by a competent
person.
It protects the patients /clients against deliberate injury by a
nurse.
SAFEGUARDING THE NURSE
It protects the nurses also against the legal action if she
renders right care.
Good rapport

17. LEGAL RIGHTS AS A NURSE
 Nurses have the right to
practice in a manner that
fulfills their obligations to
society and to those who
receive nursing care.
 Nurses have the right to
practice in environments that
allow them to act in
accordance with professional
standards and legally
authorized scopes of practice.
 Nurses have the right to a
work in an environment that
supports and facilitates
ethical practice, in
 Nurses have the right to a
work environment that is
safe for themselves and for
their patients.
 Nurses have the right to
freely and openly advocate
for themselves and their
patients, without fear of
retribution.
 Nurses have the right to fair
compensation for their work,
consistent with their
knowledge, experience and
professional responsibilities.
 Nurses have the right to

18. LEGAL RESPONSIBILITIES OF A
NURSE
 Be responsible for his or her own acts.
 Protect the rights & safety of patients.
 Witness, but not obtain, informed consent for procedures.
 Document & communicate information regarding client care.
 Refuse to carry out orders that the nurse believes to be
harmful to the client.
 Perform acts allowed by the nurse’s state nurse practice act.
 Reveal client’s confidential information only to appropriate
persons
 Perform acts for which the nurse is qualified either by
education or experience.
 Witness a will.
 Restraint clients only in emergencies to prevent injury to self or
others

19. WHAT ARE THE LEGAL RIGHTS
OF A PATIENT?
 Right to considerate and
respectful care.
 Right to information on
diagnosis, treatment and
medicines.
 Right to obtain all the relevant
information about the
professionals involved in the
patient care.
 Right to expect that all the
communications and records
pertaining to his/her case be
treated as confidential
 Right to every consideration of
his/her privacy concerning
 Right to expect prompt
treatment in an emergency
 Right to refuse to participate in
human experimentation,
research, project affecting
his/her care or treatment.
 Right to get copies of medical
records
 Right to know what hospital
rules and regulations apply to
him/her as a patient and the
facilities obtainable to the
patient
 Right to get details of the bill.
 Right to seek second opinion

20. LIABILITY
Liability is anything that is hindrance, or puts individuals at a
disadvantage
In law, a legal liability is a situation in which a person is liable
and is therefore responsible to pay compensation for any
damage incurred.

21. TYPES OF LIABILITY IN
NURSING
PERSONAL LIABILITY:
Each professional is responsible for his or her own actions
SUPERVISOR LIABILITY:
Supervisors are responsible for the actions of those working
under their directions
EMPLOYER LIABILITY:
Employers can be held responsible for actions committed by
employers

22. LEGAL ISSUES IN NURSING
UNINTENTIONAL
TORT
INTENTIONAL
TORT
QUASI-
INTENTIONAL
TORT

23. INTENTIONAL TORT
Deliberate actions in which the intent is to cause injury to a
person or property.
BATTERY:
Purposely touching or applying force on other persons or things
related to the person without his consent with the intention to
harm the person is known as a battery. EG. Actually punching
the person is considered as a battery.
The battery is often considered as trespass to a person, so it is
divided into two types:
Criminal Battery -intention to kill a person.
Civil Battery- NO intention to kill a person.

24. ASSAULT:
The assault is generally an attempt to harm someone else
which also includes threats against other people. So, assault
is a planned attempt to violently harm another person.
EG. Trying to punch a person is an assault
FALSE IMPRISONMENT:
It is intentionally restraining another person without any legal
right to do so.

25. QUASI - INTENTIONAL
A wrongful act based on speech committed by a person or
entity against another person or entity that causes economic
harm or damage to reputation
DEFAMATION:
Defamation is the issuance of a false statement about
another person’s reputation which causes that person to
suffer harm.
SLANDER
LIBEL

26. Fraud:
 Fraud is a crime or offence of deliberately deceiving
another in order to damage another – to obtain property or
services.
EG. Trying to obtain a higher position by giving incorrect
information to the prospective employer.

27. INVASION OF PRIVACY:
Invasion of privacy is the unjustifiable intrusion into the
personal life of another without consent.
The four most common types of invasion of privacy torts
are as follows:
Appropriation of Name or Likeness
Intrusion Upon Seclusion
False Light
Public Disclosure of Private Facts

28. UNINTENTIONAL TORT
A wrong occurring to another person leading to injury even
though it was not intended.
Negligence and malpractice are examples of unintentional
torts.
NEGLIGENCE:
Negligence is an individual to do something that a reasonable
prudent person would do or the commission of the act in
particular circumstances in standard of care to which a nurse
is legally bound, would not do under similar circumstances.

29.  Karimnagar: In yet another incident of apathy, an old age man
suffering from coronavirus died after falling down from the hospital's
bed. The man was admitted to district headquarters hospital in
Telangana's Karimnagar.
 The aged man was surviving on the oxygen cylinder and had a
breathing issue. When nobody attended him after he fell down from
bed, his breathing worsened. As a result of which the oxygen supply
stopped and the man died.
 Other patients who witnessed the man's condition raised an alarm
among hospital workers, but nobody came forward for help.

30. COMMON NEGLIGENCE
Failure to use aseptic technique where required.
Leaving a foreign object in a patient’s body during surgery
Failing to protect an infirm patient from failing, falls resulting
injuries to patients.
Administering wrong medicine to a patient.
Administering a care in such a manner that a patient suffers
injury, eg. Improper handling of hot water bag, burns to
clients.

31. MALPRACTICE
Malpractice occurs when an improper, injurious or faulty
treatment of a client that results in illness or injury.
Eg. Failure to perform proper assessment
Failure to take appropriate precautions
Failing to report another’s mistake
Failure to follow a physician’s orders
Delaying patient care
Incorrectly performing a procedure, or trying to perform a
procedure without training
Documentation error
Failure to get informed patient consent.

32. 6 ELEMENTS TO PROVE
MALPRACTICE
 1. DUTY: The nurse must have a relationship with the client that
involves providing care and following an acceptable standard.
 2. Breach of duty: standard of care that is expected in the specific
situation but that the nurse did not observe.
 3. foreseeability: a link must exist between the nurse’s act and the
injury occurred.
 4. causation: it must be proven that harm occurred as a direct
result of nurse’s failure to follow the standard of care.
 5. Harm or injury: The client must demonstrate some type of harm
or injury( physical, financial or emotional)
 6. Damages: if malpractice caused the injury, the nurse is held
liable for damages that may be compensated.

33. JOURNAL ARTICLE
TITLE: Malpractice an Updated Concept Analysis and Nursing
Implication in Developing Countries
AUTHOR: Eyad Abu Al-Haijaa RN,MSN,CPHQ,CHRM1 ,
Omar Ayaad RN,PHD(c)2 , Muna Al-Refaay RN,BSN 3 ,Tareq
Al-Refaay
NAME OF THE JOURNAL: IOSR Journal of Nursing and
Health Science
Volume 7, Issue 1
(Jan.- Feb .2018)
PP 81-85

34. ABSTRACT
Malpractice crisis is one of the emerging challenges of the current
healthcare system. Therefore, nurses are required to understand what
malpractice is and develop or adopt effective strategies to prevent its
occurrences. This paper aimed to update the baseline knowledge of
the concept of malpractice using Walker and Avant (2011) eight steps
concept analysis method and to guide nurses' practice in developing
countries with regards to safe nursing practice. It was found that the
concept of malpractice is related to professions and professionals,
characterized by unintentional misconduct and resulting in injury and
harm. The most common factors leading to nursing malpractice were
improper communication, documentation, patient assessment, use of
equipment, and deviation from standards of nursing practice, as well
as lack of patient advocacy role. Nursing administrators play an
important role in preventing the incidences of malpractice by
forecasting proper plan of actions to prevent the occurrences of

35. EIGHT STEPS CONCEPT
ANALYSIS METHOD

36. RESULT
The concept of this analysis was malpractice. The concept
was chosen because of its related importance to patient
safety, nursing profession, nurses and health care
organization. Malpractice may lead to catastrophic end to the
patients, nurses, health care organizations and the
healthcare system.

37.  TITLE: Legal Awareness and Responsibilities of Nursing Staff in
Administration of Patient Care in A Trust Hospital
 AUTHOR: Hemanth kumar,2012
 METHOD: An open ended questionnaire was prepared to assess
the level of legal awareness among the nursing staff. The GNM
and ANM nursing staff deployed at the nursing home and general
wards only were randomly screened and specialty nurses were
exempted.
 Results: The knowledge on various legal provisions, as was
applicable to nursing, across all categories of nurses which were
under review, was found to be poor. The nursing staff had poor
knowledge on patients’ rights and also on their legal obligations
towards patients. The GNM nurses fared better than ANM nurses.
However, 46.67 % of nurses were found to be aware about cases
of omission or commission.
 Conclusion: This study substantiated the fact that nurses had poor
knowledge on the law that governed their profession and that in
days to come, it would become increasingly difficult for them to

38. FIVE LEGAL ISSUES IN
NURSING:
DOCUMEN
T
REPORT
IT OR
TORT IT
YOU ARE
DOSING
WHAT?
RIGHTS TO
PRIVACY
SIGNATUR
ES ARE
GOLDEN

39. MEDICO LEGAL CASES
Medico legal situation is defined as where there is an
allegation or suspicion of causes attributing to body
injury or danger to life.
It needs immediate attention to avoid the loss of
important and vital sign that are helpful in confirming
the underlying cause.
Medico — Legal case (M.L.C.)
A medico legal case is a patient who is admitted to the
hospital with some unnatural pathology and has to be
taken care of in concurrence with the police and/or
court

40. TYPES
Types of clients which are categorized as MLC in a hospital
are.
Road traffic accidents.
Injuries inflicted during brawls/fights, shooting, bomb blasts
etc.
Suicide.
Burns.
Poisoning.
Rape victim.
Assault.

41. NURSES ROLE IN A MEDICO-
LEGAL CASE
• Obtain complete history from
patient or significant others
• Inform the police officer/constable
on duty in the hospital and the
CMO.
• When it is made a MLC, then
record it on the patient's case
sheet with red ink at right hand top
corner.
• Do not give any statement about
patient's condition to police,
magistrate or media. Only a doctor
has to give information.
• When a patient has to be
discharged, inform the CMO only.
After clearance from them, he/she
can be discharged.
• Document the care given to
patients timely, accurately and
duly sign the nurse’s notes.
• Records and all the documents
pertaining to patient should be
handled with care, during the stay
in the hospital. They must be kept
safely and should be handed over
to the authorized person as
designated by the hospital
authority.
• Incase death of a MLC; the body
is not to be handed over to the
relatives. It needs to be accurately
labeled and sent to the mortuary.
CMO and/ or police officer should
be informed simultaneously.
• Appropriately authority must be
informed.

42. LEGAL SAFEGUARDS IN
NURSING PRACTICE
Licensure
Good Samaritan law
Good rapport
Correct identity
Standards of care
Standing orders
Consent for operation & other procedures
Counting sponge, instrument and needle
Documentation
Patient’s property
reporting

43. QUESTIONS…??
?????

44. TAKE A QUIZ…
1. Which was the first law passed in nursing?
The First Registration and Practice Acts
1. What are the purposes of law in nursing?
Safeguarding the public and safeguarding the nurse
1. What are the types of liability?
Personal, supervisor and employer
1. What does this picture mean?

45. THANK YOU……