did not alert Charlotte to changes in the patient’s status (or out of normal signs and symptoms for postoperative course). Thus, every right of delegation was violated.
INTERNAL POLICIES AND STANDARDS
For a nurse to be practicing within their scope of practice, they must be practicing within the ANA code of ethics, ANA scope and standards of nursing practice, the respective state nursing practice act, and the healthcare organization’s policies and procedures. Thus, the RN is accountable to a number of scopes of practice. Discussion: Shannon needs to review a number of documents to understand what her scope of practice is. First, she should look at her state’s scope of practice for RNs, including what is on the state’s BON website. This will provide her with the foundation of what she is allowed to do within the state she is practicing in. The ANA scope and practice standards also need to be reviewed. Shannon should also look at the website for the Oncology Nurses Association to see if there is specialty scope of practice information, she should familiarize herself with. Finally, Shannon needs to review the policies and procedures of both the hospital and unit where she is working. Duty Duty refers to a legal duty to the patient - an obligation recognized and enforceable by law. Legal duty to a patient exists as soon as the nurse–patient relationship is established, showing that the patient relies on the nurse for the delivery of safe and competent care. The basis for the element of duty is the professional standards of care that the nurse is responsible for adhering to. As previously noted, the NPA governs nursing practice. Thus, duty to the patient requires that the nurse adhere to the NPA, ANA standards of care and code of ethics, specialty nursing organization standards, and organizational policies and standards (Wacker Guido, 2020). Breach of duty Breach of duty is defined as a violation of nursing standards of care. The plaintiff’s attorney will provide evidence to support the claim that a breach of duty occurred. Such evidence can be obtained from written documentation on the plaintiff’s medical record, diagnostic test results, photos, and testimony from witnesses, including hospital personnel, other nurses, experts in the field, and the plaintiff’s family members. Breach of duty may also be claimed if a nurse abandons a patient after assuming a duty to them (Wacker Guido, 2020). Some states actually define what abandonment is and is not, so nurses should be familiar with any state regulations. Abandonment A specific type of breach of duty is Abandonment. For example, New York law prohibits nurses from committing what is commonly referred to as “abandonment” or “patient abandonment”. Abandonment typically occurs when: ● A nurse who has accepted a patient care assignment and is responsible for patient care abandons or neglects a patient needing immediate professional care without making reasonable arrangements for the continuation of such care. ● A nurse abandons nursing employment without providing reasonable notice and under circumstances that seriously impair the delivery of professional care to patients. The New York State Education Department (NYSED) evaluates each complaint of patient abandonment individually, taking into consideration the unique circumstances of each situation. Key considerations for determining whether or not a nurse has “abandoned” a patient include:
Each healthcare institution sets the policies and procedures for that particular institution. These polices cannot expand standards of practice as stated in the state’s nurse practice act. However, an institution can set narrower limits on practice of the RN. These polices usually include education, experience, and other directives that explain the scope of practice for the RN (Wacko Guido, 2020). Case study #3 Shannon is a newly licensed registered nurse. During orientation to her new role as an RN on an oncology unit, Shannon is told that she must become familiar with (and stay familiar with) the scope and standards of nursing practice of the state in which she practices. Shannon has studied, in general terms, scope and standards of nursing practice during her years in a BSN program. However, as she is now a licensed professional, Shannon wants to understand, in more depth, the scope of practice that defines nursing actions. Questions: 1. Where should Shannon look for her scope of practice? 2. What other information should Shannon review to be within her scope of practice? Ethics and law overlap to a certain extent. Codes of ethics generally describe a vision that exceeds what is expected under prevailing laws. The law says what must be done. Ethical codes provide a picture of what ought to be done. Therefore, ethical conduct means that, at the very least, a nurse or other healthcare professional performs duties legally and acts with integrity and fidelity according to the profession’s principles of ethical behavior (Wacko Guido, 2020). Nurses should be familiar with legal terms that are the basis for safe practice. Below is a list of terms nurses should be familiar with and examples of nursing practice where the term would be applied. Advocacy The nurse speaks on behalf of the patient for the patient’s right(s) to receive appropriate care, and intervenes on behalf of the patient in situations where there are changes in health status that may or may not affect care (Wacker Guido, 2020). Assault Assault is action that placed another person in a position of being touched in a manner that is considered offensive, insulting, or physically injurious without consent (Wacker Guido, 2020). An example of this would be threatening a patient with an injection if the patient does not do something. Battery Battery is harmful or unwarranted contact with someone (Wacker Guido, 2020). An example of this would be holding a patient down forcibly to insert an intravenous catheter when a patient has refused the procedure. Causation An injury must have occurred that was directly due to the action(s) of the nurse. This can be cause-in-fact or proximate cause (Wacker Guido, 2020). An example of cause-in-fact would be administering an incorrect medication resulting in an adverse effect. An example of a proximate cause would be a patient falling out of bed after being given a narcotic and the bedrails were not in correct position. While cause-in-fact is a direct link, proximate causation has foreseeability connected to the concept (Wacker Guido, 2020).
LEGAL IMPLICATIONS OF NURSING PRACTICE
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