In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of legal rights and responsibilities in order to:

  • Identify legal issues affecting the client (e.g., refusing treatment)
  • Identify and manage the client's valuables according to facility/agency policy
  • Recognize limitations of self/others and seek assistance
  • Review facility policy and state mandates prior to agreeing to serve as an interpreter for staff or primary health care provider
  • Educate client/staff on legal issues
  • Report client conditions as required by law (e.g., abuse/neglect, communicable disease, gunshot wound)
  • Report unsafe practice of health care personnel and intervene as appropriate (e.g. substance abuse, improper care, staffing practices)
  • Provide care within the legal scope of practice

Some of the legal terms that you must be familiar with include these:

  • Common Law: Common law is law that results from previous legal decisions. They are based on legal precedent. (Berman and Synder, 2012)
  • Statutory Law: Statutory law is law that is passed by a legislative body such as the state's legislature or the US Congress. (Berman and Synder, 2012)
  • Constitutional Law: Constitutional law is law that is included in the Constitution of the United States of America and its amendments. (Berman and Synder, 2012)
  • Administrative Law: Administrative law is rules and regulations that are legally enacted to support some statutory law. For example, nursing boards enact administrative rules and regulations relating to state enacted laws such as the state's nurse practice act and legislated continuing education requirements for the relicensure of nurses. (Berman and Synder, 2012)
  • Criminal Law: Criminal law, part of public law, covers acts that are illegal and against the law. Criminal law includes felony and misdemeanor infractions of the law. (Berman and Synder, 2012)
  • Civil Law: Civil law, also part of public law, covers torts and contract laws. (Berman and Synder, 2012)
  • Torts: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in the nurse patient relationship. Some torts specific to nursing and nursing practice include things like malpractice, negligence and violations relating to patient confidentiality. (Berman and Synder, 2012)
  • Unintentional Torts: Unintentional torts include things like malpractice and negligence.
  • Intentional Torts: Intentional torts include things like false imprisonment, assault, battery, breaches of privacy and patient confidentiality, slander and libel.
  • Liability: Liability is vulnerability and legal responsibility, simply stated. For example, nurses are liable when they fail to carry out doctor's orders. (Berman and Synder, 2012)
  • Respondeat Superior: Respondeat Superior is the legal doctrine or principle that states that employers are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not, however, relieve the nurse of legally responsibility and accountability for their actions. They remain liable. (Berman and Synder, 2012)
  • Negligence: Negligence is a nonintentional tort. Negligence occurs when the nurse fails to follow established policies, procedures and standards of care in the same manner that another "reasonable" nurse would do in the same situation. (Berman and Synder, 2012)
  • Malpractice: Malpractice, also a nonintentional tort, has six elements. The elements of malpractice include a duty, a breach of duty as a nurse, reasonable foreseeability that the nurse's act has a connection with the patient injury that occurred, the patient was harmed, the link that act directly led to the harm and the patient has the right to financial compensation or damages. (Berman and Synder, 2012)
  • Assault: Assault, an intentional tort, is threatening to touch a person without their consent. (Berman and Synder, 2012)
  • Battery: Battery, another intentional tort, is touching a person without their consent. (Berman and Synder, 2012)
  • False Imprisonment: False imprisonment is restraining, detaining and/or restricting a person's freedom of movement. Using a restraint without an order is considered false imprisonment. (Berman and Synder, 2012)
  • Defamation: Defamation is making false statements about a person in writing or orally that leads to the destruction of a person's reputation. (Berman and Synder, 2012)
  • Slander: Slander is oral defamation of character using false statements.
  • Libel: Libel is written defamation of character using false statements.

Identifying Legal Issues Affecting Staff and Clients

Some of the most commonly occurring legal issues that impact on nursing and nursing practice are those relating to informed consent and refusing treatment as previously detailed, licensure, the safeguarding of clients' personal possessions and valuables, malpractice, negligence, mandatory reporting relating to gunshot wounds, dog bites, abuse and unsafe practices, for example, informed consent, documentation, accepting an assignment, staff and client education relating to legal issues, and strict compliance with and adherence to all national, state, and local laws and regulations.

Licensure

All registered and licensed practical, or vocational, nurses must be currently licensed to practice nursing in their state of practice. Licensure protects the consuming public and insures that the nurse has completed a state approved nursing school, has successfully passed their licensure examination and has also continuously met the requirement(s) for relicensure each biennium without any suspensions or revocations of their license.

Practicing without a current and valid license is illegal and it amounts to practicing without a license.

The Safeguarding of Clients' Personal Possessions and Valuables

Nurses are responsible for the safeguarding and respecting the clients' personal possessions and valuables; they must also NOT, under any circumstances, borrow or steal their personal possessions and valuables.

Although policies and procedures relating to the safeguarding of clients' personal possessions and valuables may vary a little from one healthcare facility to another, these policies and procedures typically include discouraging clients to retain personal possessions and valuables while hospitalized, and then securing maintained and retained personal possessions and valuables in a locked and secure safe using an envelope that fully documents the client's name, room number and the contents of the envelope, including things like jewelry, cash and credit cards, that were collected from the client with their permission.

Items that are placed in this envelope are itemized and listed using a description such as a "ring with a purple stone", a "yellow metal bracelet" or a "white metal necklace" rather than an amethyst ring, 14 carat gold bracelet or a sterling silver necklace because the nurse cannot determine and confirm that indeed these items are anything more than inexpensive costume jewelry.

Items are listed on the envelope. What appears to be gold, sterling silver or a ruby may indeed be only an inexpensive gold, silver or ruby look alike and the nurse may have no idea whether it is real gold, silver or a ruby or not. For this reason these items are listed as "yellow metal", "silver metal" and a "red stone", respectively. In addition to jewelry, other valuable items that must be secured include cash, credit cards and legal documents.

When the client is discharged from the facility or they choose to have their personal possessions and valuables returned to them, the nurse and the client check and confirm that all of the items listed on the envelope are indeed still in this envelope. The client also signs a statement that documents that they have been given back their personal possessions and valuables.

Malpractice

Malpractice is an act of omission or commission that does not meet established standards of care and causes some injury. Nurses, therefore, must provide all aspects of nursing care according to established standards of care, in a safe and competent manner, and also done in a complete, appropriate and timely manner.

The six essential components of malpractice include causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and, lastly, this breach of duty led to direct and/or indirect harm to the client.

Actions of omission and commission that lead to client injury place the nurse in jeopardy for malpractice.

Negligence

Negligence is also an act of omission or commission that does not meet established standards of care. It differs from malpractice because it lacks one or more of the six elements of malpractice that are essential to be considered malpractice.
Actions of omission and commission that lead to client injury place the nurse in jeopardy for negligence.

Mandatory Reporting

Nurses are legally mandated to report abuse, neglect, gunshot wounds, dog bites, some communicable diseases and any unsafe and/or illegal practices done by another health care provider.

Informed Consent and Refusals of Treatment which was fully detailed previously.

Documentation

All documentation and all forms of documentation are considered legal documents. Some of the legal aspects of documentation, in addition to the legal mandates associated with confidentiality, include the strict legal prohibitions against altering a record, obliterating entries in the medical record, and falsifying documentation.

Other guidelines for documentation include the use of permanent ink, the use of only accepted terms and abbreviations, legible writing, accurate spelling, proper grammar, accurate dating and time of the entry, the signature and title of the person who documented the entry, and a professional tone. If an error in documentation occurs, a thin line that does NOT obliterate the entry is drawn through the erroneous entry, the notation "Error" is written above the entry and the nurse signs this notation with their name and title.

The Acceptance of an Assignment

Nurse are legally accountable to accept only those assignments that are appropriate in terms of their nurse practice act and their scope of practice, and only those that the nurse believes that they are competent to perform.

RELATED:

The Provision of Staff and Client Education Relating to Legal Issues

As with other educational needs, nurses assess client and staff member educational deficits and educational needs relating to the legal issues that impact on their care and the care that nurses provide, respectively. After this assessment, educational activities to meet identified educational needs are planned, implemented and evaluated in terms of their effectiveness in meeting the educational need that was identified.

Compliance With and Adherence to Other Laws

Nurses are also expected to comply and adhere to other national, state, and local laws and regulations. For example, the compliance with the Centers for Medicare and Medicaid Services must be adhered to, state laws relating to professional licensure and mandatory reporting must be complied with, and local laws relating to the disposal of biohazardous waste must also be followed without fail.

Recognizing the Limitations of Self/Others and Seeking Assistance When Needed

Nurse are legally accountable to accept only those assignments that are appropriate in terms of their nurse practice act and their scope of practice, and only those that the nurse believes that they are competent to perform.

Reviewing the Facility Policy, Federal Mandates and State Mandates Prior to Agreeing to Serve as an Interpreter for Staff or Primary Health Care Providers

In addition to following the policies and procedures of the particular employing healthcare organization, nurses must also follow and comply with any federal and state laws relating to interpreters and serving as an interpreter.

Some of these laws include:

  • The Civil Rights Act of l964 and Title VI of this law states that "No person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal assistance."
  • Title VI Prohibition Against Discrimination on the Basis of National Origin- Persons with Limited English Proficiency states that, "Because of these language barriers, LEP (limited English proficiency) persons are often excluded from programs or experience delays or denials of services from recipients of Federal assistance. Such exclusions, delays or denials may constitute discrimination on the basis of national origin, and in violation of Title VI".

Since the year 1999, all healthcare organizations and agencies that get federal funding must provide interpreter services to those that need it.

Educating Clients and Staff on Legal Issues

As with other educational needs, nurses provide educational activities to clients, significant others, and other staff members about legal issues that can impact on the care that they provide.

Reporting Client Conditions as Required by Law

Some of the conditions that nurses are mandated by law to report some communicable diseases, gunshot wounds, and child and/or elder abuse or neglect.

Reporting Any Unsafe Practice by Health Care Personnel and Intervene as Appropriate

As previously mentioned, nurses are legally mandated to report any and all unsafe and inappropriate practices of healthcare staff and personnel. Once identified, the nurse must attempt to cease the unsafe and/or inappropriate practices and immediately report it.

Some examples of these practices and behaviors include improper client care, narcotic diversion, unsafe staffing practices and substance abuse by a member of the healthcare team.

Providing Care That is Within the Legal Scope of Practice

Legally, nurses can only accept assignments and provide patient care that is appropriate in terms of their nurse practice act and their scope of practice, and only those that the nurse believes that they are competent to perform. These legal issues were extensively described and detailed previously.

RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:

SEE - Management of Care Practice Test Questions