Leadership Exam 1

• An accumulation of statutes and laws; Originated to protect the public from unsafe and unlicensed practice, by regulating nursing practice and nursing education.
• Each state & the District of Columbia has their own
• Nurses must know their state’s Nurse Practice Act

nursing as a profession, Sets standards, Guides practice - provides parameters within which we work

To provide confident, quality nursing care provided by qualified practitioners

• a board of nursing that has the authority to develop regulations and enforces them
• Must include a board of nursing, Education program standards, standards for scope of nursing practice, defines different types of licensing and requirements, and grounds for disciplinary actions for violations and potential remedies

• Oversees, empowers, and support all state boards of nursing
• involved in research, administers licensure test (NCLEX)
• not for profit organization

an administrative court that has the power to make decisions about nurses careers and disciplinary for violations to ensure laws are followed

A written plan of government - highest law in the land. Interpreted by the US supreme court. Gives authority to the other three sources of law

written laws enacted by legislatures at the state and federal level

• appointed agency that creates rules and regulations that governors professions, including board of nursing
• Writes rules and regulations and by conducting investigations and hearings to ensure the law’s enforcement. Administrative laws are valid only to the extent that they are within the scope of the authority granted to them by the legislative body.
• Does not create laws but instead enforces them as these agencies are executive and creating laws (in the context of a statute) would be unconstitutional.

• Tort laws
• Looks at previous court decisions that allow a reference for future court cases that are similar to know how to make a determination regarding future cases (precedent)

Locally, nurses can become politically active by assuming leadership positions in the healthcare system or contacting elected officials about legislation affecting the industry. Nurses can obtain formal training in politics, become involved in city councils and committees, or even run for local office

• Laws govern the conduct of individuals; The first priority of law is to protect the public.
• We have nursing laws because the risk of harm is inherent in nursing care because nursing requires specialized knowledge and skill, as well as autonomous decision making.

• Provides protection from conduct deemed injurious to the public welfare. Provides for punishment of those found to have engaged in such conduct. (Ex) stealing hospital supplies/drugs
• Crimes against individual or society
• Proof of the crime must be beyond a reasonable doubt
• Innocent until proven guilty
• Punishment: Incarceration or death
• Example: intentionally administering fatal doses of drugs to pt

protects the private and property rights of individuals and businesses. Based on preponderance of evidence; the judge has to believe that it’s more likely than not that the crime took place.

Typically monetary damages; most malpractice falls under civil cases. Private individuals or groups may bring legal action to court for breach of civil law. (Torts & Contracts)

one party asserts that the other party, in failing to fulfill an obligation, has breached the contract, and either compensation or performance of the obligation is sought as remedy.

• Individual sued by state or government agency
• Example – State Board of Nursing
• Punishment - being sued by the state board of nursing, actions against license (including suspension or revoking), drug testing
• Penalties - probation (can still practice but must meet certain requirements such as drug testing etc), suspension (lose license for a certain time frame), censure (placed on record that crime is committed and warning is placed) revocation (canceling license, losing it forever)

Originated to protect the public from unsafe and unlicensed practice, by regulating nursing practice and nursing education.

• Defines nursing
• Sets standards
• Guides practice scope
• Grounds for disciplinary action
• Types of licensure
• Each state & the District of Columbia has their own
• Nurses must know their state’s Nurse Practice Act

• Must include a board of nursing, an administrative court that has the power to make decisions about nurses careers and disciplinary for violations to ensure laws are followed
• Education program standards, standards in scope of nursing practice, defines different types of licensing and requirements and grounds for disciplinary actions for violations and remedies
• Each nurse practice act establishes a board of nursing that has the authority to develop laws and enforces act

• 9 members ensure that the laws are followed and they enforce them and create new policies
• made up of LPN, RN, lawyer, layperson, etc

violation of a civil law in which an individual has been wronged and seeks compensation.

malpractice (professional negligence) or negligence

Direct invasion of someone’s legal rights.

Threat or fear of harm, not necessarily touching

touching another person without that person’s consent

Restraints for no reason

Communicating to a third party false information.

Verbal defamation

Written or printed defamation (including social media)

Mix of unintentional and intentional. -a voluntary act that causes injury or distress without intent to injure or cause distress. -usually involve situations of communication that violate a person's reputation, personal privacy or civil rights.

• The tort of breach of confidence is, in United States law, a common law tort that protects private information that is conveyed in confidence. A breach is generally an impermissible use or disclosure that compromises the security and privacy of Private Health Information.
• Confidentiality can be breached legally only when one provider must share information about a patient so that another provider can assume care.

The unauthorized release of (medical) information including photographs. Privacy refers to the freedom from intrusion into one's personal matters, and personal information.

the restraint of a person’s liberty of movement by another party who lacks the legal authority or justification to do so.

Injured party

the accused

failure to exercise the care toward others that a reasonable or prudent person would do in the circumstances, or taking action that a reasonable person would not. Is accidental, or “careless” (Ex) reckless driving

• specialized form of negligence applicable only to professionals (licenced), act or continuing conduct of a professional that does not meet the standard of professional competence and results in provable damages to his or her client or patient.
• omission to do something that a reasonable person would do or doing something that a reasonable person wouldn't do
• a failure of a person that has professional training to perform and fails to act in a reasonable a prudent manner

• The care that should be given under the circumstances (what the reasonably prudent nurse would have done) Ex: a nurse should give medications accurately, completely, and on time.
• The testimony of other nurses in the same specialty as the defendant may be used to prove

• failure to use the degree of care required under the circumstances
• not doing anything can lead to this as well Ex: a nurse fails to give medications accurately, completely, or on time.

• a nurse's obligation to have knowledge about the standard of care and understand that failure to meet the standard may result in harm or injury. Ex: The drug handbook specifies that the wrong dosage or route may cause injury.
• Ignorance of the law is not an excuse

Harm or damage. Ex: Convulsion or other serious complications occur.

a relationship between what was done incorrectly and the injury that the patient acquired. Ex: wrong dosage causes a patient to have a convulsion.

• Assess patient appropriately
• Report changes in patient status
• Document in a patient’s record
• Obtain informed consent
• Report a coworker’s negligence
• Provide adequate education

• is a landmark report issued in November 1999 by the U.S. Institute of Medicine that may have resulted in increased awareness of U.S. medical errors.
• asserts that the problem is not bad people in health care--it is that good people are working in bad systems that need to be made safer

• 1- prevent injury
• 2- improve communication
• 3- injury compensation that is patient centered and serves the common good (bean counters)

• 6 Medication rights + Pyxis
• Daily assessments(Every patient, every shift)

• (Including pt. Interaction, strong relationship)
• Communication - establishing a relationship with patients and families will decrease likelihood of being sued

• Practice within the scope of the Nurse Practice Act
• Observe agency Policies and procedures
• Model practice after evidence based standards
• Put the patient first
• Know the law
• Know your limitations and areas of competence
• Get educated and certified in your specialty

• Get legal representation
• Through your institution, personal attorney, liability insurance company
• Maintain file of all papers/correspondence
• Give all information to your attorney.

This is the formal process of exchanging information between the parties about the witnesses and evidence they’ll present at trial. Discovery enables the parties to know before the trial begins what evidence may be presented.

• Record of unusual or unexpected incidents that occur during a patient's treatment
• Important to remember!
• Incident reports are not part of the patient record
• They should never be placed in the patient record
• The existence of the report should not be mentioned to the patient or mentioned in the chart
• Document what occurred with the patient in the chart

• The nurse's role is to be the WITNESS of the signing of the consent.
• The patient must have had an explanation of the procedure from the provider of the procedure

• A competent adult
• Legal guardian or DPOA
• Mature minor
• An emancipated (minor declared as adult) or married minor
• Parent of a minor child
• Court order

chemical abuse, pregnancy, and STI

a pt isn't able to sign (ex. Unconscious trauma patient) but treatment is needed and a 2nd doctor validates treatment is needed

• is given when admitted to hospital through paperwork during admission i.e. consent for IV, catheters, etc
• This is the standardized consent via form signature.

a law that concerns treatment and end of life issues, durable power of attorney, and advance directives

legal document designed to indicate a person's wishes regarding care in case of a terminal illness or during the dying process. Includes codes status, directs care-

• a legal agreement that allows an agent or representative of the patient to act on behalf of the patient.
• Responsibilities can be divided between subjects such as health, estate/financial, ect with separate individuals being designated for each.

a statute that relieves medical professionals from liability for ordinary negligence when they stop and render aid to victims in emergency situations. Only works when the individual practices within the scope of their practice

• Health Insurance Portability and Accountability Act of 1996
• protects pts rights to confidentiality
• Pts must give permission for their records to be shared
• penalties for unauthorized release for pts personal information and photographs in medical records when done civil laws occur and are punishable by fines and imprisonment, or loss of license.

a systematic study of what a person's conduct and actions should be with regard to self, other human beings and the environment what guides a person's actions on what is right and what is wrong "doing the right things"

Applying the values and norms of a profession when making decisions regarding the everyday problems that occur. comes from the purpose of the profession (values and norms)

the rules people develop as a result of cultural values and norms that guide what you consider important and unimportant.

• to help individuals stay healthy and safe
• to do no harm
• promoting health
• put the patients needs and desires first
• advocate for patient
• truth telling
• always remaining professional
• taking ownership for mistakes
• practice within scope
• agent and advocate for pt, doctor, and facility (can cause conflict because the facility and pt's goals are not always the same)

specific ideas that people hold to be true. May not always have factual evidence.

focused on good vs bad - the rules people develop as a result of cultural values and norms (derived from our conscious) (The motive behind a person’s actions)

• self-determination; being independent and self-governing, personal liberty, freedom of choice; accepting responsibility for your choice; keep patients informed
• Ex obtaining informed consent, accepting the situation when pt refuses medications, maintaining confidentiality

• doing good; actions taking to promote good; what is best for the patient
• Ex planning performance appraisals, manager is likely to view them as a means of promoting them

duty to do no harm. If you can't do good then do not do harm. Accept the lesser harm to avoid the greater harm. Avoids negligence

Assuming the authority to make a decision for another - does limit the other persons freedom but can be justified (Don’t let a friends drink and drive, etc)

• is the doctrine that an action is right insofar as it promotes
• happiness, and that the greatest happiness of the greatest number should be the guiding principle of conduct.

practicing utilitarianism ethical thinking the good of many outweighs what is best for the individual

treating people fairly and equally. Equals should be treated equally and unequals should be treated according to their differences

Telling the truth; honesty

keeping promises and commitments made to others, usually through moral obligation.

Protecting a person’s privacy and information; respecting the rights of others.

Be the voice for representing the patient's best interests

• Inform pt (and family) of what their options are
• Mediate
• Question (advocate if applicable) when patient's wishes aren't followed

• self aware; not all leaders have a leadership role
• demonstrates risk taking in ethical decisions
• is a role model
• clear communication
• promote patient self determination and informed decision making
• accepts that negative outcomes occur; owns their mistakes

• Functions for the organization; is a title and job description.
• use a systematic approach
• identifies outcomes in ethical decision making
• uses established ethical framework
• knows the legalities
• constantly assesses levels of moral uncertainty, distress, and outrage
• recognizes and rewards ethical conducts

occurs when an individual questions why morality in practice is even necessary

an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is

• occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action
• Contributes to nursing turnover; feelings of isolation/frustration
• Prolonged exposure to moral distress elicits fight or flight stress symptoms

occurs when an individual witnesses the immoral act of another but feels powerless to stop it

a decision that involves a conflict of values; every potential course of action has some significant negative consequences. Choosing between two or more undesirable outcomes;

• 1. Identify the problem
• 2. Gather data to analyze the causes and consequences of the problem
• 3. Explore alternative solutions
• 4. Evaluate the alternatives
• 5. Select the appropriate solution
• 6. Implement the solution
• 7. Evaluate the results

ADPIE

• M—Massage the dilemma (collect data)
• O—Outline options (identify alternatives and analyze cause and consequences of each)
• R—Review criteria and resolve
• A—Affirm position and act
• L—Look back. Evaluate the decision making

groups of people responsible for reviewing proposed research to ensure that it meets the accepted standards of science and provides for the physical and emotional well-being of research participants

a set of principles that guide practice established by nursing profession

• not legally binding, but outlines and guides ethical decisions
• 9 statements in total
• First 3 - protection of pt rights and pt safety
• Second 3 - promoting a healthy work culture and self care
• Last 3 - relate to obligation as nurses to society and the profession

• Provides the greatest good for the greatest number of people “Utopia”
• ex : sending everyone to a small in town conference instead of sending two people to a national conference in vegas

• Right-based reasoning
• Duty-based reasoning
• Intuitionist

• based on the belief that individuals have basic inherent rights focuses on respect for human dignity
• judges rather the action is right or wrong regardless of the consequences
• Ex: each job applicant has the right to fair and impartial consideration of their application

• States that some decisions must be made because there is a duty to do something or to refrain from doing something.
• Ex :supervisor feels a duty to hire the most qualified person for the job, even if the personal cost is high, or working overtime even though you have previous plans

Each case weighed on a case-by-case basis to determine relative goals, duties, and rights (Looking a the whole picture and weighing all the options)