Module3

• Nurse Practice Act


  Defines scope of practice, standards for education programs, licensure requirements, and grounds for disciplinary actions
• The North Carolina Nursing Practice Act regulates the practice of Nursing in North Carolina and guides the work of the Board
• Nursing Practice Acts


  • Series of laws that define the scope of practice of a licensed nurse
  • Similar state to state but may have some variation
  • Each NPA addresses the duties and responsibilities of nursing students
• Guidelines for Student Nurses provided by the National Student Association

  • Ensure patient safety
  • Know the facility's policies and procedures
  • Ensure knowledge about patient's condition, interventions, medications and treatments
  • Never perform care for which you are not prepared
  • Seek help before beginning procedure
  • Nursing students are held accountable to the same standards of care as licensed nurses
• Abilities of the LPN/LVN graduate according to the National Association of Practical Nursing Education (NAPNE)


  • Effectively communicate with clients, families, and other health care providers using interpersonal and therapeutic communication skills
  • Demonstrate competence in the collection of data from various sources, report the data to other health care providers, and evaluate the client's response
  • Use collected data to collaborate with the registered nurse to plan and revise client care based on nursing analysis, regulations, and collection and evaluation of information
  • Display a caring demeanor in the delivery of safe, individualized therapeutic care
  • Care for the client as directed by the health care provider (registered nurse, physician, or dentist) to perform interventions or delegate to assistive personnel
• Accountability


  Answerable for the outcomes of a task or assignment
• Standards of Care for Nurses

  • Professional conduct
  • Scope of practice; Nurse Practice Act
  • Job descriptions
  • Policies and procedures
  • American Nurses' Association (ANA) Standards of Practice
  • Specialty nursing organizations standards of practice
• Sources of Laws


  • Constitution
  • Legislation (Statutes)
  • Administrative Law
  • Common Law
• Types of Laws Affecting Nurses

  • Common Law
  • Criminal
  • Legislative (Statutes)
  • Nurse Practice Act
  • Good Samaritan Act
  • Child and Adult Abuse
  • Advance Directives
  • Sexual Harassment
  • Americans with Disabilities Act
  • Contract
• Types of Criminal Laws

  • Homicide
  • Falsifying records
  • Active euthanasia
  • Insurance fraud
  • Sexual assault
  • Theft
  • Illegal possession of controlled drugs
• Types of Civil Laws

  • Negligence
  • Abandonment
  • Malpractice
  • Contract violations
  • Invasion of privacy
  • False imprisonment
• Types of Tort Laws

  • Intentional
  • Unintentional
  • Negligence
  • Malpractice
  • Assault/Battery
  • Slander/Libel
  • False imprisonment
  • Invasion of
• Common Negligent Acts


  • Failure to follow standards of care
  • Failure to use equipment in a responsible manner
  • Failure to communicate
  • Failure to document
  • Failure to assess and monitor
  • Failure to act as a patient advocate
• Additional Common Negligent Acts

  • Failure to assess and/or monitor; identify nursing diagnosis
  • Failure to monitor in timely fashion
  • Failure to use proper equipment to monitor the patient
  • Failure to document the monitoring
  • Failure to notify the health care provider of problems
  • Failure to convey discharge instruction
  • Failure to follow orders
  • Failure to follow the six rights of medication administration
  • Failure to ensure patient safety
  • Failure to follow policies and procedures
  • Failure to properly delegate and supervise
• Prevention of Negligence


  Discuss with the person next to you some ways that you might be able to prevent negligence
• Health Insurance Portability and Accountability Act (HIPAA)

  • Provides privacy rights information to all patients
  • Protected health Information includes name, address, DOB, Social Security Number, and any information that can be used to identify an individual
  • Information should only be shared with those who are directly involved in the client's care
• Informed Consent


  • Patient's have a right to be informed of any healthcare procedure or treatment
  • Healthcare provider has duty to explain in understandable terms
  • Must include alternatives, risks, benefits, diagnosis that requires treatment, purpose, and what the patient can expect to experience/feel
  • Patients have the right to refuse
• Requirements for Informed Consent

  • Consent must be obtained voluntarily
  • Technical words should be avoided or explained thoroughly
  • Language barriers - offer and use interpretative services
  • If unable to read, consent must be read to the patient who must then verbalize understanding
  • Specific procedures is the responsibility of the person performing the procedure
  • Expressed or implied consent acceptable for most nursing tasks
• Informed Consent - Competency

  • Presumption of ability to make your own decisions at the legal age of adulthood (typically 18)
  • Unless declared incompetent through a court order due to debilitating brain injury, dementia, mental illness, stroke, or development delays
• Informed Consent - Emergencies


  • Imminent danger of loss of life or limb
  • Assumption is that the individual would reasonably consent if able to do so
• Informed Consent - Minors

  • Anyone under the age of 18
  • Parent or legal guardian must provide consent
  • Exceptions include emergencies, emancipated minors, court order for treatment, contraceptive services/STI treatment, pregnancy, mental health/substance abuse treatment
• A nurse is working at an urgent care clinic and a 15-year-old presents seeking a pregnancy test and STI treatment. Can the facility care for this patient?
• Controlled Substances Act


  • Drugs must be classified based on medical use, risk of abuse, and safety risks
  • Schedule I - V
  • Tracking systems
• Good Samaritan Laws


  • Cover healthcare providers that respond to an emergency
  • Protect from liability
  • Still must adhere to the standards of care
  • Must be care that is within the level of training and licensure
  • Must continue care until situation resolves or care is handed off to someone who can provide the appropriate care
• Emergency Medical Treatment and Labor Act (EMTALA)


  • ED cannot turn away clients for reasons such as being under- or uninsured, or their inability to pay for care
  • Must provide equal care regardless of their insurance or financial status
  • All clients must have a medical screening evaluation (MSE)
  • If hospital cannot provide level of care needed must stabilize prior to transfer
  • If cannot be stabilized, a physician or another qualified medical professional must verify and sign off transfer, clearly indicating that the benefits of transfer outweigh the risks of transferring an unstable client
• Advance Directives


  • Expresses wishes regarding medical treatment if/when a patient is no longer able to communicate their preferences
  • Can only be executed by competent individuals
  • Formal, written document
  • Includes Durable Power of Attorney and Living Will
• Advance Directive - Nurses' Role

  • Assess if patient has AD
  • Reassurance of ability to change their mind about decisions made in the AD
  • Understanding of life-sustaining measures
  • Involvement in assessment of capacity (but not the ultimate decision-maker)
• Without an Advance Directive

  • All reasonable life-sustaining measures are taken
  • Healthcare decisions go to a surrogate (next of kin) who is encouraged to make decision based on what they believe the patient would want or in the best interest of the patient
• Examples of Advance Directives

  • Organ donation
  • Mental health AD
  • Living Will
  • Healthcare POA
  • MOST form
  • DNR form
• Patient Self-Determination Act


  Requires healthcare institutions to provide patients a written summary of their rights regarding making healthcare decisions, facility policy regarding advance directives, ask about existing advance directives and document existence, educate staff and community on advance directives, and ensure patient that discrimination does not occur based on presence or lack of advance directives
• Mandatory Reporting Requirements


  • Births & deaths
  • Neonatal deaths
  • Communicable diseases like STIs, TB, E. coli infections
  • Unethical, illegal, or incompetent conduct toward patients or other nurses/healthcare professionals/family members
  • Abuse/suspected abuse
  • Neglect
  • Gunshot wounds, powder burns or other injuries suspected to have come from discharge of a firearm
  • Illness that appear to have been caused by poisoning
  • Knife or other sharp object injuries that are suspected to have resulted from criminal activity
• Good Faith Immunity


  Healthcare workers are protected from civil or criminal liabilities when they report suspected child abuse, even if the investigation does not make a determination of abuse
• Americans with Disabilities Act

  • Service Animals: Dogs trained to perform a task directly related to a disability
  • May be kept out of sterile environments but cannot be restricted from other areas of the hospital
  • Requires physical accessibility and effective communication
• Risk Management - Implementing Physician Orders

  • Responsible for clarifying ambiguous or seemingly erroneous orders
  • Any order the patient questions
  • Any order if the patient's condition changes
  • Question and recording of verbal orders and the circumstances that warranted a verbal order
  • Any order that is illegible, unclear, or incomplete
• Risk Management - Guidelines for Protection

  • Function within scope of practice
  • Follow policies and procedures
  • Maintain good rapport with patients
  • Checking identity of patients
  • Observe and monitor accurately
  • Communicate and record significant changes
  • Prompt and accurate documentation
  • Give each task your full attention
  • Perform procedures correctly
  • Proper medication administration
  • Proper delegation of tasks
  • Protect patients from injury
  • Report all incidents
  • Always check orders a patient questions
  • Ask for assistance and supervision when necessary
  • Maintain competence
• Risk Management - Incident Reports

  • Never document that you completed an incident report in the medical record
  • Never include language that infers or points to who was liable for the incident
  • Only facts without assumptions, conclusions or blame
• Osteoporosis


  A disorder that results in a loss of bone density and can interfere with the mechanical support function of the bone

  
• Osteoporosis


  • People between the ages of 55 and 65 years are identified as a high-risk group
  • Postmenopausal due to loss of estrogen
• Juvenile Osteoporosis


  Sudden onset of bone pain & fractures in children & young adults, often due to fracture of trauma
• Idiopathic Osteoporosis Type-1


  Postmenopausal: Decrease in Estrogen Levels during menopause