Legal aspect in nursing

Introduction
Knowledge of legal aspect in nursing is absolutely essential for each nurse to safeguard self and
clients from legal complications. Consumers are becoming increasingly aware of their legal rights in
the health care. Therefore a nurse should know her legal rights and professional boundaries, and their
consequence of nonconformity. As a nurse it has become an important necessity to be aware of the
legal aspect associated with caring and helping people in the health industry today.
There are six kind of authorities which give guidance to legal responsibility for nursing practice.
These are:
1. The central government acts
2. The state government act
3. The international code for nurse subscribed to by the TNAI
4. Institutional rules and regulation
5. Standing orders
6. Precedent or an example of court decision has been made in a same case.
LAW
The word law is derived from the Anglo-Saxon language, meaning that which is fixed down.
Definition
Blacks law dictionary define, law as that which is laid down, or established, a body rules of action
or conduct prescribed by controlling authority and having binding legal force, and that which must
be obeyed and followed by citizen subject to sanctions or legal consequences.
Classification of law
Criminal law: defines offense that affects the public welfare and security and imposes penalty. It
deals with crime.
Civil law: includes the rules and regulation that specify the required course of action to be followed
by the individual in the business and social relationship with others. Civil law causes harm the
individual but no grave to society. It refers to the body of law that deals with the relationship
between individual and the governmental agencies.
Two types of civil laws that are most relevant to practice of nursing profession are:
1. Tort law
2. Contract law
Importance of law in nursing
It protects patients against deliberate and inadvertent injury by a nurse
It protects the nurse also against the suits if she render right care
Legal liability in nursing
Liability is anything that is hindrance, or put individual at a disadvantage. In a law a legal liability is
a situation in which a person is liable, and is therefore responsible to pay compensation for any
damage.
When nurse fails to meet the legal expectation of care, the client can initiate action if harm or injury
incurred by the client.
1. TORT
Tort law is civil wrong committed against a person or persons property. Tort law is based on fault
which is something that was done incorrectly or something that should have been done was not done.
 Types of Torts

TORTS

NON INTENTIONAL INTENTIONAL

Negligence Assault
Malpractice Battery
False imprisonment
Invasion of privacy
Conversion of property
False imprisonment
Defamation of character

NON INTENTIONAL TORT

Negligence: It is a general term that denotes conduct lacking in due care. It is a failure of individual
to provide care that is expected of an ordinary, reasonable person. Thus negligence equates with
carelessness, a deviation from the standard of care that a normal person would use in a practical set
of circumstances.
An example is fall by an elderly person who is being cared by a nurse. The reasonable person in the
place of nurse has a standard of care to prevent such fall.
Malpractice: this is professional negligence that is negligence that occurred while the person was
performing as a professional. This includes wrongful conduct, improper discharge of professional
duties, or failure to meet the standards of acceptable care which result in harm to other person.
Malpractice applies to physician, nurse and lawyers.
For a case of nursing malpractice, the following six elements are to be present:
Duty: the nurse must have had relationship with client that involves providing care and
following an accepted standard of care.
E.g., a nurse assigned to care of a patient in the home or hospital.
Breach of duty: There must be a standard of care that is expected in the specific situation, but
that the nurse did not observe. That is, something was done that should not have been done
or nothing was done when it should have been done. This is failure to act as a reasonable,
prudent nurse, under the circumstances.
E.g., an incorrect medication was administered to a patient or a scheduled medication was
omitted.
Foreseeability: The nurse should have known that failure to follow the standard of care could
result in such harm.
E.g., fall of patient without side rails.
Causation: A link must exist between the nurses act and the injury suffered. It must be
proved that the harm occurred as a direct result of the nurses failure to follow the standard
of care.
 E.g., medication is incorrectly administered in wrong dosage and patient is suffer because of
that.
Harm or Injury: The client must demonstrate some type of physical, financial harm or injury
resulted from the breach of duty owed the patient.
Damages: The nurse is held liable for damages that may be compensated financially.
E.g., using equipments incorrectly. Giving the patient incorrect information.

INTENTIONAL TORT

Assault: An assault is any action that places another person in apprehension of being touched in a
manner that is offensive, insulting or physical injuries without consent or authority. No actual
touching of the persons is required.
E.g., a nurse who threatens a client with an injection after the client refuses to take medication
orally.
Battery: It is the wilful touching of a person that may or may not cause harm. Informed consent is
necessary in such a cases.
E.g., without consent do the procedure however its benefits to patients.
False Imprisonment: It is an unjustifiable detention of a person without legal warrant to confine the
person. It is the intentionally restraining another person without any legal right to do so. It occurs
when client is not allowed to leave health care facility when there is no legal justification to detain
the client or when restraining device used without an appropriate clinical need.
E.g., restraining the patient without consent or unnecessary
Invasion of privacy: It is intentionally patient information given to another person without patient
consent. It injures the feeling of a person.
E.g., without patient consent, patient document and report given to their family or relatives or
published.
Conversation of property: When the health care practitioner interferes with the right to profession
of the patients property.
E.g., helped patient relative during treatment taken sign from the patient in their wills without
knowing the client.
Defamation of character: It is issuance of a false statement about another person, which causes
that person to suffer harm. This is communication that is false or made with careless disregard for
truth and results in injury to the reputation of another.
E.g., if a nurse tells a client that his doctor is incompetent for his treatment.

2. Contract law
It involves the enforcement of agreements among private individuals or the payment of compensation for
failure to fulfil the agreements.

Classification

A formal contract is one, which by some special law, is required to be in writing.

An informal contract is one which is concluded as a result of a written document or
correspondence where the law does not require the same to be in writing, or as the result of oral or
spoken discussion between two parties.
An express contract is one concluded as the result of all terms and conditions having been written
or spoken or a combination of them between the part
An implied contract is one concluded as a result of acts or conduct on the part of the parties to
which the law subscribe an objective intention on entering into the contract.
 Legal responsibilities of nurse
As a health care team member nurse should aware about patient safety and institution development
by using legal aspect.
o Responsibilities of nurse manager
a) Appointing and assigning the nurse: The nurse administrators are responsible for staffing
and supervising nursing units to ensure safe, effective patient care. Each nurse has legal
responsibility to make full disclosure of her background, knowledge and skills and can notify
the nurse manager when given an assignment for which she is not qualified.
b) Quality control: The nursing administrators and the authority of the agency at all the level
have a legal obligation to ensure nursing care quality. A nurse managers legal responsibility
for quality control of nursing services imposes a duty to observe report and correct the
incompetence of any patient care provider.
c) Material management: The nurse administrators are responsible for providing quality
material for the treatment of the patients and management of material according to need of
the requirements of the hospital.
d) Proper documentation system: The nurse administrators and the authority of the agency at
all level have a legal obligation to prepare institutional rules and policies format which
followed by each staff during work. Professional conduct can be stated by the institution
regarding the employment such as period of time needed when giving notification for
resignation.
e) Effective public relation: The nurse administrators are responsible for maintain effective
public relationship by maintaining feedback system and taking round in the ward. Each nurse
has legal responsibility to protect public from injury by maintaining biomedical waste
disposal in a proper manner to protect the public from harm due to infectious waste.
f) Staff management: The nurse administrator has responsibilities to distribute equal work and
maintain staff patient ratio to decrease work load of staff.
g) Disaster management: The nurse administrators are responsible for managing disaster
condition. She has to train the staff for that and prepare framework for providing care to
people in this situation by the staff of the institution.
o Responsibilities of nurse practitioner
a) Carrying out physician orders: Nurses have a legal duty to follow the physician order and
according to that provide the care and treatment to the patient.
b) Verbal orders: Nurses have legal duty to follow the verbal command in critical situation
without written consent of physician for saving the life of patient.
c) Death and dying: There are many issues surrounded the events of death. Nurses must be
aware of legal definition of death because they must document the entire event when patient
in a care.
d) Maintaining safe environment: Nurses have a legal duty to provide safe environment for
protect the patient from injury like by providing side rails. Nurses have legal duty to observe
the patient frequently for prevention of any injury.
e) Use of safe equipment: To protect the patient from injury, a nurse must ensure that all
patient care equipment are fully functional and defective equipment are promptly replace.
f) Maintenance of records and reports: Nurses have legal responsibility for accurately
recording and reporting patient conditions, treatments that include information submitted by
all members of the health care team.
g) Drug administration: nurses have legal responsibility to administer medication by using
rights of drug administration to avoid harm to patient.
 Legal safeguard in nursing practice
Licensure: All nurses, who are in practice, have to possess valid licensure issued by the
respective State Nursing Council or INC. the purpose of professional licensure is to secure
society the benefits which come from the service of a highly skilled group and on the other
hand, to protect society from those who are not highly skilled yet professional.
Good Samaritan law: The law exempted doctors and nurses from liability when they are
rendered first aid during emergency.
Good rapport: Developing good rapport with the client is very important to prevent
malpractice.
Standing order: Although a nurse may not legally diagnose illness or prescribed treatment,
she/he may after assessing the patient apply standing order treatment guidelines that may
have been established by the doctors as appropriate for certain problems and conditions.
Standard care: All professionals practicing in the medical field are held to certain standards
when administrating care.
Contract: A contract is written or oral agreement between two people in which the goods or
service are exchanged. Any operation or treatment of serious nature in which an aesthetic is
involved, requires the written consent of the patient.
Correct identity: The nurse or the midwife has the great responsibility to make sure that all
the babies born in the hospitals are correctly labelled at birth.
Counting of sponges, instruments and needles: It is the responsibility of the nurse to count
the number of sponges, instruments and needles during surgery in order to make sure that it
may not left in the patients abdomen during surgery.
Drug maintenance: It includes two law regarding storage of poisonous drugs and misuse of
drugs.
Self-discharge of the patients: When the patients want to discharge himself, than the nurse
of duty to dissuade him and inform medical officer concerned with the case.
Professional confidence: Guarding the confidence of the patient is an ethical duty of the
nurse and the medical professional and take care that never to discuss personal information
received by the nature of their position, except with senior member of the staff.
Documentation: The nursing record is a legal document and admissible in the court as
evidence.
Patients property: It is the department of health; social security requires hospital to inform
all patients under its care that the hospital cannot accept the responsibility for value or money
unless they have been handed over for safe keeping.
Reporting: Nurses have obligation to report certain communicable disease or criminal
activities such as abuse, gunshot wound, and suicide or rape case to appropriate authority.

Legal issues in special practice area

A. Maternal and infant Nursing: many legal issues are involved in case of mother and infant.
i. Problem of medication: Nurses are authorized to administer medication. So many
allegation against nurse with regard to medication are there like improper
identification, wrong medication dosage,
ii. Failure in adequate client monitoring: Nurse is required to monitor the client at
appropriate time intervals that depend upon the client condition. The delivering
mother must be adequately monitored to prevent any maternal complications during
prenatal period, check foetal condition during labour and continues observation of
mother and infant during first 24 hours after delivery.
 iii. Failure to adequately assess the client: Nurses in all specialities area must maintain
higher level of assessment skills. They are responsible for the minute by minute
evaluation of the client progress.
iv. Failure to report changes in the client: Whenever the nurses assessment indicates
that the client condition has changed, the nurse must notify the concerned physician.
v. Abortion: Nurses cannot be forced to participate in procedures they find morally
offensive. Nurses have a right to refuse to assist with abortion if is not performed with
MTP Act.
vi. Nursing care to the newborn: These are certain legal requirements in providing
nursing care of newborn, such as properly identifying the infant mother pair as soon
as possible with finger prints.
B. Paediatric Nursing: paediatric nurses are responsible for preventing children in their care,
from the accidental harming themselves. All poisonous substances and sharp object should be
kept out of reach of children. Children must be kept under constant supervision to minimize
the harm.
C. Medical Surgical Nursing: Acts of negligence in medical surgical nursing are as follows:
i. Overlooking sponges, instruments and needles: in the OT, it is the responsibility of
nurse to count the sponges, instruments and needles before the closure of abdomen or
any cavity.
ii. Burns: The professionals nurse is required to know the cause, effect of heat
application so as to avoid burns, e.g., sitz bath, heating packs. The nurse is responsible
if she neglects to take proper safety measures prior to the applications of such
measures.
iii. Falls: The nurse should be held liable if the patient falls from the bed due to improper
security of the patient on examination table or improper application of restrain.
iv. Injury: Due to the use of defective apparatus or supplies, e.g., defective bedpans
infect the patients or unsterilized gauge in surgical dressing.
v. Assault or battery: Failure to take informed consent of the patient prior to the
procedure, treatment, investigation or operation, the nurse is held liable.
vi. Failure to report accident: The nurse has moral and legal responsibilities to report to
the concerned authority for any accident, losses etc.
vii. Maintenance of records: The nurse has legal responsibility to keep the record of
patients safely and not to give other person without concern to patient and higher
authority.
D. Psychiatric Nursing: The practice of psychiatric nursing is influenced by law, in concern for
the right of the patient and the quality of care they are receiving. The admission and
discharge procedure of psychiatric patient is a legal procedure.

Legal issues in nursing practice area

Legal issues in nursing practice reflect the changing trends in technology, medical advancement and
increase awareness among the patients. The following are example of recent development in law:
Controlled substances
Caring patients with Acquired immune deficiency syndrome
Deaths and dying
Autopsy and organ donation
Patients property
Living wills and health care surrogates: Living wills are documents instructing
physician to hold or withdraw life sustaining procedure whose death is imminent.
 Roles and function of nurse in legal issues
Provides standards of care to the patients.
Update knowledge and skill in the field of practice and seeks professional certification to
increase expertise in a specific field
Protects the rights and safety of the patients
Maintain good interpersonal relationship with the patient
Taken consent before the procedure
Follow institutional polices and procedure for administering care and reporting incident
Do proper documentation, record and report
Follow safety standards
Maintain proper communication with other health care team member
Treat all the clients and families with kindness and respect
Follow the rights of drug administration before medication and any procedure
Take appropriate action to meet the clients nursing needs.
Refuse to carry out the orders that the nurse know harmful to the patients.
Practices nursing within the scope of the state nursing practice act
Provides educational and training opportunities for the staff on legal issues affecting nursing
practice.
Increase staff awareness of intentional torts and assist them in developing strategies to reduce
the liability in these areas.

Summary
Today we learnt about law, its definition, types, importance of law in nursing, legal liability in nursing, types
of torts, legal issues in speciality, legal safe guard for nurse, legal responsibility of nurse and role and
function of nurse in legal issues.

Conclusion
Legal aspect is very essential to know during work as a staff. Nurses should aware about the legal issues and
use the legal liabilities to reduce to arise of issues in working. She should use standard care and upgrade her
knowledge related to new trends and technology.
Bibliography
1. Basavanthappa BT, NURSING ADMINISTRATION;3rd edition,2014,jaypee publication,
new delhi;India;p.p no.27-29
2. Brar kaur navdeep, TEXTBOOK OF ADVANCE NURSING PRACTICE1st edition,2015,
jaypee publication,new delhi;India;p.p no.16-20
3. Basheer Shabir, A CONCISE TEXT BOOK OF ADVANCED NURSING PRACTICE 1st
Edition,2013,emmess publication,Banglore,India,p.p no. 17-20
4. Jacob Annamma,CLINICAL NURSING PROCEDURES:THE ART OF NURSING
PRACTICE"3rd edition,jaypee publication,new delhi;India;p.p no.656-663
5. Vati Jogindra, PRINCIPLES AND PRACTICE OF NURSING MANAGEMENT AND
ADMINISTRATION FOR B.SC AND M.SC NURSING1st edition,2013,jaypee
Publication, new delhi;India;p.p no.63-81.