Fundamentals Final Exam
Chapter 23: Legal Implications in Nursing
SOURCES OF LAW
● Many types of law govern nursing practice, including constitutional law, statutory law,
common law, administrative law, and case law.
● Constitutional Law
○ Derived from federal and state constitutions
■ A constitutional right in the United States afforded to every citizen is the
right to refuse treatment
○ Constitutional laws are interpreted by each health care agency to ensure
adherence to the laws. Know your agency’s policies for such laws
● Statutory Law
○ Derived from statutes passed by the U.S. Congress and state legislatures. These
laws are either civil or criminal
■ Civil laws protect the rights of individuals and provide for fair and
equitable treatment when civil wrongs or violations occur
● Nurse practice acts are civil state laws that define nursing and the
standards nurses must meet within individual states
● Your state’s nurse practice act defines a nurse’s scope of practice,
the educational requirements you must have to be a nurse, and how
to obtain licensure as a nurse in your state
■ Criminal laws protect society and provide punishment for crimes, which
are defined by municipal, state, and federal legislation
● Typically, actions that violate criminal laws are defined as either
misdemeanors or felonies.
● Administrative law
○ Also regulatory law
○ More clearly defines expectations of civil and criminal laws
○ Regulations typically state that duty means you will observe, assess, diagnose,
plan, intervene, and evaluate patient care
○ Providing current, evidence-based care is essential to meeting nursing statutory
duty and regulations.
○ Regulatory law also describes the process to report incompetent or unethical
nursing conduct to a state board of nursing or the nursing commission. A nurse
who does not report unethical or incompetent conduct violates regulatory law.
Nurses can appeal violations to the state board of nursing or the nursing
commission.
● Common law
○ Originates from decisions that were made in the absence of law
● Case law
, ○ Describes decisions made in legal cases that were resolved in courts. After a case
is presented to a judge or jury, there is a report of the issue, facts, findings, and
subsequent decision that was made to resolve the issue
LEGAL LIMITS OF NURSING
● Scope and standards of nursing
○ The scope of nursing practice defines nursing and reflects the values of the
nursing profession.
○ Standards of nursing care reflect the knowledge and skill ordinarily possessed
and used by nurses to perform within the scope of practice
FEDERAL STATUTES AFFECTING NURSING PRACTICE
● Use your knowledge of federal statutes and regulations to help guide your clinical
judgement in nursing practice. Ultimately, statutes and regulations influence the context
of the health care settings in which you practice, affecting the decisions you make about
patient care
● Patient protection and affordable care act
○ The ACA is characterized by four themes embedded in nursing practice: (1)
consumer rights and protections, (2) affordable health care coverage, (3) increased
access to care, and (4) quality of care that meets the needs of patients.
● Emergency medical treatment and active labor act
○ Prohibits the transfer of patients from private to public hospitals without
appropriate screening and stabilization.
○ It is intended to prevent patient dumping
○ This act ensures that patients are medically screened when they come to the
emergency department or the hospital
● Health insurance portability and accountability act
○ Provides rights to patients and protects employees
○ Establishes patient rights regarding privacy of their health care information and
records
○ HIPAA established a patient’s right to consent to the use and disclosure of
protected health information, to inspect and copy one’s medical record, and to
amend mistaken or incomplete information
● Health information Technology act
● Americans with Disabilities Acts
● Mental health parity and addiction equity act
● Patient self-determination act
● Uniform Anatomical Gift Act
○ The UAGA provides the foundation for the national organ donation system.
Patient autonomy, individual autonomy, and public trust remain the ethical
principles on which organ donation occurs
● The Ombinus Budget Reconciliation Act
,STATE STATUTES AFFECTING NURSING PRACTICE
● Nurse practice acts
○ State laws intended to protect citizens, make nurses accountable, and ensure that
care is consistent with best practices within the scope and standards of nursing .
Creation of a state board of nursing, sometimes called a nursing commission, is
part of a state nurse practice act
○ The state board of nursing investigates, suspends, and/or revokes a license if a
nurse’s conduct violates the state’s nurse practice act
○ Although a license may be considered a privilege, it is also a means by which a
person is employed. When penalties are taken against a nurse’s license, statutes
regarding the right to employment may be triggered to protect the person’s ability
to work
○ Professional licensure defense is expensive when nurses do not have insurance
that covers the cost of keeping their licenses to practice nursing
● Health care acts and informed consent
○ Health care acts within each state describe and define the minimum standards of
care that will be provided within their geographical region. These acts and the
regulations associated with them are interrelated with other laws governing the
practice of nursing, such as expectations regarding informed consent
○ A patient’s signed consent form is necessary for admission to a health care
agency, performance of invasive procedures such as central line insertion, surgery,
some treatment programs such as chemotherapy, and participation in research
studies
○ Informed consent is a patient's agreement to have a medical procedure after
receiving full disclosure of risks, benefits, alternatives, and consequences of
refusal
○ Key elements of informed consent include the following:
■ The patient receives an explanation of the procedure or treatment.
■ The patient receives the names and qualifications of people performing
and assisting in the procedure.
■ The patient receives a description of the serious harm, including death,
that may occur as a result of the procedure and anticipated pain and/or
discomfort.
■ The patient receives an explanation of alternative therapies to the proposed
procedure or treatment and the risks of doing nothing.
■ The patient knows of the right to refuse the procedure or treatment without
discontinuing other supportive care.
■ The patient knows of the right to refuse the procedure or treatment, even
after the procedure has begun.
● Good Samaritan Laws
, ○ Good Samaritan laws encourage health care professionals to assist in emergencies
○ These laws limit liability and offer legal immunity if a nurse helps at the scene of
an accident
● Public health laws
○ Affect individuals, populations, and communities
○ They may be either federal or state statutes that are intended to improve the health
of people
○ These laws include reporting suspected abuse and neglect of a child, older adult,
or victim of domestic violence; reporting communicable diseases; ensuring that
patients in the community have received recommended immunizations; and
reporting other health-related issues to protect public health
○ Neglect means a pattern of conduct by a person with a duty of care to provide
services that maintain the physical and/or mental health of a child or an adult
○ Nurses must place the health and safety of the patient above that of the caregiver
when making the decision to report
● Termination of pregnancy
○ Varies by state
● Physician-assisted suicide
○ Varies by state
○ Providing end-of-life care in today’s world is challenging for health care
professionals because people are living longer.
○ The statute stated that competent individuals with a terminal disease could make
an oral and written request for medication to end their life in a humane and
dignified manner
○ Nurse is not involved in this manner
○ The ANA believes that nurses’ participation in assisted suicide violates the code
of ethics for nurses
● The Uniform Determination of Death Act
○ Many legal issues surround the event of death, including a basic definition of the
actual point at which a person is legally dead
○ The definitions vary by state law
○ There are two standards for the determination of death. The cardiopulmonary
standard requires irreversible cessation of circulatory and respiratory functions.
The whole-brain standard requires irreversible cessation of all functions of the
entire brain, including the brainstem.
○ Health care providers and nurses who are trained, are able to call time of death.
As well as firefighters or trained first responders
NURSING WORKFORCE GUIDELINES
● Staffing and nurse-to-patient ratios
○ California has mandated ratios
Chapter 23: Legal Implications in Nursing
SOURCES OF LAW
● Many types of law govern nursing practice, including constitutional law, statutory law,
common law, administrative law, and case law.
● Constitutional Law
○ Derived from federal and state constitutions
■ A constitutional right in the United States afforded to every citizen is the
right to refuse treatment
○ Constitutional laws are interpreted by each health care agency to ensure
adherence to the laws. Know your agency’s policies for such laws
● Statutory Law
○ Derived from statutes passed by the U.S. Congress and state legislatures. These
laws are either civil or criminal
■ Civil laws protect the rights of individuals and provide for fair and
equitable treatment when civil wrongs or violations occur
● Nurse practice acts are civil state laws that define nursing and the
standards nurses must meet within individual states
● Your state’s nurse practice act defines a nurse’s scope of practice,
the educational requirements you must have to be a nurse, and how
to obtain licensure as a nurse in your state
■ Criminal laws protect society and provide punishment for crimes, which
are defined by municipal, state, and federal legislation
● Typically, actions that violate criminal laws are defined as either
misdemeanors or felonies.
● Administrative law
○ Also regulatory law
○ More clearly defines expectations of civil and criminal laws
○ Regulations typically state that duty means you will observe, assess, diagnose,
plan, intervene, and evaluate patient care
○ Providing current, evidence-based care is essential to meeting nursing statutory
duty and regulations.
○ Regulatory law also describes the process to report incompetent or unethical
nursing conduct to a state board of nursing or the nursing commission. A nurse
who does not report unethical or incompetent conduct violates regulatory law.
Nurses can appeal violations to the state board of nursing or the nursing
commission.
● Common law
○ Originates from decisions that were made in the absence of law
● Case law
, ○ Describes decisions made in legal cases that were resolved in courts. After a case
is presented to a judge or jury, there is a report of the issue, facts, findings, and
subsequent decision that was made to resolve the issue
LEGAL LIMITS OF NURSING
● Scope and standards of nursing
○ The scope of nursing practice defines nursing and reflects the values of the
nursing profession.
○ Standards of nursing care reflect the knowledge and skill ordinarily possessed
and used by nurses to perform within the scope of practice
FEDERAL STATUTES AFFECTING NURSING PRACTICE
● Use your knowledge of federal statutes and regulations to help guide your clinical
judgement in nursing practice. Ultimately, statutes and regulations influence the context
of the health care settings in which you practice, affecting the decisions you make about
patient care
● Patient protection and affordable care act
○ The ACA is characterized by four themes embedded in nursing practice: (1)
consumer rights and protections, (2) affordable health care coverage, (3) increased
access to care, and (4) quality of care that meets the needs of patients.
● Emergency medical treatment and active labor act
○ Prohibits the transfer of patients from private to public hospitals without
appropriate screening and stabilization.
○ It is intended to prevent patient dumping
○ This act ensures that patients are medically screened when they come to the
emergency department or the hospital
● Health insurance portability and accountability act
○ Provides rights to patients and protects employees
○ Establishes patient rights regarding privacy of their health care information and
records
○ HIPAA established a patient’s right to consent to the use and disclosure of
protected health information, to inspect and copy one’s medical record, and to
amend mistaken or incomplete information
● Health information Technology act
● Americans with Disabilities Acts
● Mental health parity and addiction equity act
● Patient self-determination act
● Uniform Anatomical Gift Act
○ The UAGA provides the foundation for the national organ donation system.
Patient autonomy, individual autonomy, and public trust remain the ethical
principles on which organ donation occurs
● The Ombinus Budget Reconciliation Act
,STATE STATUTES AFFECTING NURSING PRACTICE
● Nurse practice acts
○ State laws intended to protect citizens, make nurses accountable, and ensure that
care is consistent with best practices within the scope and standards of nursing .
Creation of a state board of nursing, sometimes called a nursing commission, is
part of a state nurse practice act
○ The state board of nursing investigates, suspends, and/or revokes a license if a
nurse’s conduct violates the state’s nurse practice act
○ Although a license may be considered a privilege, it is also a means by which a
person is employed. When penalties are taken against a nurse’s license, statutes
regarding the right to employment may be triggered to protect the person’s ability
to work
○ Professional licensure defense is expensive when nurses do not have insurance
that covers the cost of keeping their licenses to practice nursing
● Health care acts and informed consent
○ Health care acts within each state describe and define the minimum standards of
care that will be provided within their geographical region. These acts and the
regulations associated with them are interrelated with other laws governing the
practice of nursing, such as expectations regarding informed consent
○ A patient’s signed consent form is necessary for admission to a health care
agency, performance of invasive procedures such as central line insertion, surgery,
some treatment programs such as chemotherapy, and participation in research
studies
○ Informed consent is a patient's agreement to have a medical procedure after
receiving full disclosure of risks, benefits, alternatives, and consequences of
refusal
○ Key elements of informed consent include the following:
■ The patient receives an explanation of the procedure or treatment.
■ The patient receives the names and qualifications of people performing
and assisting in the procedure.
■ The patient receives a description of the serious harm, including death,
that may occur as a result of the procedure and anticipated pain and/or
discomfort.
■ The patient receives an explanation of alternative therapies to the proposed
procedure or treatment and the risks of doing nothing.
■ The patient knows of the right to refuse the procedure or treatment without
discontinuing other supportive care.
■ The patient knows of the right to refuse the procedure or treatment, even
after the procedure has begun.
● Good Samaritan Laws
, ○ Good Samaritan laws encourage health care professionals to assist in emergencies
○ These laws limit liability and offer legal immunity if a nurse helps at the scene of
an accident
● Public health laws
○ Affect individuals, populations, and communities
○ They may be either federal or state statutes that are intended to improve the health
of people
○ These laws include reporting suspected abuse and neglect of a child, older adult,
or victim of domestic violence; reporting communicable diseases; ensuring that
patients in the community have received recommended immunizations; and
reporting other health-related issues to protect public health
○ Neglect means a pattern of conduct by a person with a duty of care to provide
services that maintain the physical and/or mental health of a child or an adult
○ Nurses must place the health and safety of the patient above that of the caregiver
when making the decision to report
● Termination of pregnancy
○ Varies by state
● Physician-assisted suicide
○ Varies by state
○ Providing end-of-life care in today’s world is challenging for health care
professionals because people are living longer.
○ The statute stated that competent individuals with a terminal disease could make
an oral and written request for medication to end their life in a humane and
dignified manner
○ Nurse is not involved in this manner
○ The ANA believes that nurses’ participation in assisted suicide violates the code
of ethics for nurses
● The Uniform Determination of Death Act
○ Many legal issues surround the event of death, including a basic definition of the
actual point at which a person is legally dead
○ The definitions vary by state law
○ There are two standards for the determination of death. The cardiopulmonary
standard requires irreversible cessation of circulatory and respiratory functions.
The whole-brain standard requires irreversible cessation of all functions of the
entire brain, including the brainstem.
○ Health care providers and nurses who are trained, are able to call time of death.
As well as firefighters or trained first responders
NURSING WORKFORCE GUIDELINES
● Staffing and nurse-to-patient ratios
○ California has mandated ratios
