Texas Patient Advocacy and Whistleblower Protections, (Reproduced with permission of Texas Nurses Association.). The Online Journal of Issues in Nursing, (12)3, Manuscript 2. doi: 10.3912/OJIN.Vol12No03Man02. Petitionelements of the claim: The plaintiff outlines what the defendant nurse did wrong and how, as a result of that alleged negligence, the plaintiff was injured. Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action. Even though the patient is legally brain dead, the patients organs are sometimes healthy for donation to other patients. In general, courts define nursing malpractice as the failure to use that degree of skill or learning ordinarily used under the same or similar circumstances by members of the nursing profession (Box 23-2) (Austin, 2006). NPAs frame nursing practice by defining a professional scope and educational requirements for practice. While many nurses recognized the reuse practice as inconsistent with safe infection control practices, complacency among coworkers and fear of retaliation inhibited reporting of concerns. Licensure eligibility criteria and the first licensure exam were developed in 1904. Litigation from improper restraint use is a common nursing legal issue (Evans and Cotter, 2008). (2013). In one case a television crew filmed a married couple who were participating in a hospital program. Find Your Nurse Practice Act | NCSBN Durable power of attorney for health care (DPAHC), p. 299. Ch 7: Legal Dimensions of Nursing Practice PrepU - Quizlet Almost every state uses this 1965 Illinois Supreme Court case as legal precedence. An existing policy of enhanced criminal penalties for assaults against first responders, such as peace officers, firefighters, and emergency medical service workers (which elevated the seriousness of the offense from a misdemeanor to a felony) inspired a similar approach to deter violence against nurses. Elected legislative bodies such as state legislatures and the U.S. Congress create statutory law. Work to understand the law as it applies to the client's clinical condition. Nurse staffing advocacy. While the Medicare Conditions of Participation (68 Federal Register 3435, 2003) have long required hospitals to have policies in place to ensure adequate nurse staffing, specific policy has lagged. Setting standards for nursing education was an important component of early nursing regulation (Russell, 2012). Initially, outcomes data related to nurse staffing was sparse. Written orders include a specific episode with start and end times. State legislature What are the requirements for medical licensure? Together the NPA and rules/regulations guide and govern nursing practice. PDF Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact Learn more about the. In Handbook of Texas Online. The jury uses the standards of care to determine whether the nurse acted appropriately. gists, and medical laboratory technologists. As gaps in protection are identified, nurses work to address them through policy change. List the elements needed to prove negligence. New Jersey, New York, and Virginia quickly followed suit. The legal guidelines that nurses follow come from statutory law, regulatory law, and common law. At the turn of the 20th century, states took an interest in establishing rules and regulations for nurses, up until then, almost anyone could simply say they were a nurse. If you leave the patient without properly transferring or handing him or her off to a capable person, you may be liable for patient abandonment and responsible for any injury suffered after you leave him or her (Dachs, 2008). Safe nursing practice requires understanding the legal framework of health care. HIPAA violations have civil and criminal sanctions. A patient must authorize the release of information and designate to whom the health care information may be released. Wrongful handling of a deceased persons remains causes emotional harm to the surviving family. This law allows up to $25,000 per occurrence to deter retaliatory behavior (Texas Senate Bill No. In the privacy section of the HIPAA, there are standards regarding accountability in the health care setting (Carter, 2010). NPAs frame nursing practice by defining a professional scope and educational requirements for practice. For the first time, patient outcomes could be specifically mapped to nursing care Nurse staffing is resource intensive and is the largest component of hospital operational budgets. The ADA protects the rights of individuals who are disabled in the workplace, in educational institutions, and throughout our society. Health insurance companies have followed suit with pay-for-performance and shared-savings programs (Wallace, Cropp, & Coles, 2016). The following states are currently participating. List the elements needed to prove negligence. This database became a powerhouse of information for researchers interested in studying relationships between nursing staff characteristics and patient outcomes (Dunton, 2007). 192, 2011). A brief history of Florence Nightingale and her real legacy, a revolution in public health. Patients in end-stage renal disease are eligible for Medicare coverage for a kidney transplant, but private insurance pays for other transplants. Online Journal of Issues in Nursing, 12(3). These internal standards of care are specific and need to be accessible on all nursing units. The hospital broke the law when it retaliated against the nurses for making an external report. Where creative models of care to reduce costs dominated dialogue around nurse staffing in the 1990s, attention was cued to staffing outcomes following the IOM report. 567.3. Standards reflect the knowledge and skill ordinarily possessed and used by nurses actively practicing in the profession (Guido, 2010) (see Chapter 1). The key component is the patients consent. This occurs when nurses restrain a patient in a confined area to keep the person from freedom. and more. for Nursing Education, Nurses Leading the Way to Better Support Family Caregivers. 394, 1999). Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact: Texas Occupations Code. Nurses are negligent for failure to initiate safety procedures when the patient condition necessitates it. The most recent iteration of the code (ANA, 2015) addresses the ethical imperative for engagement in policy. However, lawmakers in each state will include provisions that address specific issues in each state. Washington, DC: National Academy Press. Failure to assess and/or monitor, including making a nursing diagnosis, Failure to use proper equipment to monitor the patient, Failure to notify the health care provider of problems, Failure to follow the six rights of medication administration, Failure to convey discharge instructions, Failure to ensure patient safety, especially patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative, Failure to follow policies and procedures, Failure to properly delegate and supervise, Only gold members can continue reading. Although the courts will not force adults to undergo treatment refused for religious reasons, they will grant an order allowing hospitals and health care providers to treat children of Christian Scientists or Jehovahs Witnesses who have denied consent for treatment of their minor children. A form of medical practice management system whereby two or more parties practice together under a written agreement specifying the rights, obligations, and responsibilities of each partner. Rules and regulations must be consistent with the NPA and cannot go beyond it. Retrieved from https://statutes.capitol.texas.gov/Docs/HS/htm/HS.257.htm, Texas Department of State Health Services. A misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year. (2016). The visitor asks the nurse to provide a brief outline of the client's illness. The statute stated that a competent individual with a terminal disease could make an oral and written request for medication to end his or her life in a humane and dignified manner. There are two classifications of crimes. One example in Winkler County involved two nurses, Anne Mitchell and Vikki Galle, who were retaliated against for reporting unsafe medical practice. Describe the nurses role regarding a do not resuscitate (DNR) order. Seek out the nursing supervisor in conflicting situations B. The risks are not only damaging to the health of nurses and patients, but also are costly in terms workers compensation insurance and nurse turnover. Nurse staffing is resource intensive and is the largest component of hospital operational budgets. Twenty two nurses were investigated by the Nevada State Board of Nursing for alleged violations of the Nevada Nursing Practice Act, notably failure to safeguard patients (Black, 2011). Define legal aspects of nurse-patient, nursehealth care provider, nurse-nurse, and nurse-employer relationships. Decades of research have confirmed the relationship between nurse staffing and patient outcomes such as mortality (Aiken et al., 2012; Aiken, Clarke, Sloane, Lake, & Cheney, 2008), healthcare-associated infections (Cimiotti, Aiken, Sloane, & Wu, 2012), financial, and nurse outcomes (Unruh, 2008). Retrieved from https://capitol.texas.gov/tlodocs/86R/billtext/html/HB02410F.htm, Thomas, M. B., & Willman, J. D. (2012). Discuss the nurses role in witnessing the informed consent process. Registered nurses experience musculoskeletal injuries at a rate of 46.0 cases per 10,000 full-time workers, much higher than the rate for all occupations, 29.4 cases per 10,000 workers based on data from the U.S. Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses. States wanted to legitimize the profession in the eyes of the public, limit the number of people who hired out as nurses, raise the quality of professional nurses, and improve educational standards in schools of nursing, according to NCSBN. The medical assistant infoms her friend that the friend's teacher was in the doctor's office getting checked out for kindey stones. This article from the Journal of Nursing Regulation provides an overview of state nurse practice acts and how they provide the framework for safe, competent nursing practice. Treating physicians or health care providers depositions: Before subsequent treating, physicians or health care providers depositions are taken to establish issues such as those concerning preexisting conditions, causation, the nature and extent of injuries, and permanency. 68 FR 3435 - Medicare and Medicaid programs; Hospital conditions of participation: Quality assessment and performance Improvement. The purposes of public health laws are protection of public health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for care provided. We discuss this in the context of practice in the state of Texas. Nursing Science Quarterly, 19(1), 61-64. doi: 10.1177/0894318405283556. However, if health insurance plans provide mental health benefits, the Mental Health Parity Act of 1996 forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits. Nurses act as Good Samaritans by providing emergency assistance at an accident scene (Good Samaritan Act, 1997). She has authored numerous publications focusing on nursing practice, advocacy, and care of persons with serious mental illness. Information regarding the following is included: This brochure offers nurses an explanation of what boards of nursing (BONs) do for the profession and those who work in it. Health insurance plans are free to eliminate coverage for certain specialties and impose limits on the amount of coverage that they will pay for certain illnesses. Community and public health nurses have the legal responsibility to enforce laws enacted to protect public health (see Chapter 3). Initially, outcomes data related to nurse staffing was sparse.Measurements of quality shifted away from an interest in structure and process, and instead targeted outcomes: patient, staff, and financial. Be familiar with the policies of your institution complying with the act. Although the HIPAA does not require such measures as soundproof rooms in hospitals, it does mean that nurses and all health care providers need to avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any manner. Taft, S. H., & Nanna, K. M. (2008) What are the sources of health policy that influence nursing practice? American Nurses Association. In the mid- to late-1990s, the American Nurses Association (ANA) led nursing efforts to identify measures that would link availability of nursing services to quality (ANA, 1997; Montalvo, 2007). As a result, 115 patients at two endoscopy clinics were infected with the hepatitis C virus. Table. Silver Springs, MD: American Nurses Association. American Journal of Nursing, 111(6), 26-35. doi: 10.1097/01.NAJ.0000398537.06542.c0, Brigham, C. J. Nurse staffing is resource intensive and is the largest component of hospital operational budgets.The complexity of nursing characteristics (e.g., skill mix); patient characteristics (e.g., acuity and case mix); and the interaction of these variables within the hospital environment make it extremely difficult to define a template as simple as a nurse-to-patient ratio to ensure appropriate staffing (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007; Unruh, 2008). The prosecutor must prove anything that the nurse does not admit. (2019). Battery also results if the health care provider performs a procedure that goes beyond the scope of the patients consent. An unconscious patient has not been falsely imprisoned (Guido, 2010). Learn about the law and regulations that guide and govern nursing practice, Locate your state nurse practice act and regulations, Access nurse practice act educational resources. online nurse practice acts course program. She is active in policy development, actively negotiating legislative approaches to address nursings agenda. American Journal of Nursing, 108(1), 62-72. doi: 10.1097/01.NAJ.0000305132.33841.92, U.S. Government Publishing Office. An autopsy or postmortem examination may be requested by the patient or patients family, as a part of an institutional policy; or it may be required by law. As used in the Oklahoma Nursing Practice Act: 1. She encouraged all nursing associations to make violence prevention a top-priority and urged hospital leaders to adopt zero-tolerance policies. It also can be amended during a special legislative session called by the governor, although this has never happened. TNA developed a strategy to obtain funding for a statewide study of health care organizations (including hospitals, free-standing emergency centers, long term care facilities and homecare agencies), to validate the extent of the problem and provide the foundation for future violence prevention initiatives. Safe patient handling and mobility. 16, New York companion bills A11484, A07836, S05116, and S08358. NURS 242 Exam 2 - Nurse Practice Acts, BON, Laws - Quizlet The provisions of the Oklahoma Nursing Practice Act shall be liberally construed to best carry out these requirements and purposes. Privacy is the right of patients to keep personal information from being disclosed. This database includes measures directly related to nursing care and patient outcomes (Montalvo, 2007) such as: nursing hours per patient days; hospital-acquired infections and pressure ulcers; and skill mix (percent of total nursing hours supplied by different types of direct care providers). The ADA prohibits discrimination and ensures for persons with disabilities equal opportunities in employment, state and local government services, public accommodations, commercial facilities, and transportation. Nurses have been advocating for change since the day Florence Nightingale penned an urgent missive to the Secretary of State for War on the need for trained nurses to care for the wounded soldiers in the Crimea. Certain criteria are necessary to establish nursing malpractice: (1) the nurse (defendant) owed a duty to the patient (plaintiff), (2) the nurse did not carry out that duty, (3) the patient was injured, and (4) the nurses failure to carry out the duty caused the injury. The nursing profession has a long history of nurses influencing decisionmakers to make positive change in health policy. Texas Nurses Association. Journal of Nursing Administration, 38(5): 223229. For example, dissatisfied with the staffing by patient acuity model legislated in the early 1990s, (Coffman, Seago, Spetz, 2002) members of the California Nurses Association successfully pressed 164 legislators to pass a prescriptive bill specifying the maximum number of patients to be assigned to a registered nurse in each patient care area (California Assembly Bill No. American Nurses Association. Often policy change involves an incremental approach that requires persistence. Since the beginning of the profession, through individual and collective efforts, nurses have changed practice through policy most policy work involves collaboration among nurses and other stakeholders. Gangrene developed, and the mans leg was amputated. Nurses, especially those employed in community health settings, need to understand public health laws. See Table for examples of these laws. After the newscast they received phone calls and embarrassing questions. Nonfeasance. (2007). The couple filed a lawsuit. Protocols in these instances list specific actions that health care providers will take when providing cardiopulmonary resuscitation (CPR). Ignorance of the law or of standards of care is not a defense against malpractice. Exceptions to the ability to access medical records apply to psychotherapy notes or when the health care provider has determined that access would result in harm to the patient or another party (Privacy Rights Clearinghouse, 2011). Recognizing this gap in protection, TNA worked with Representative Stephanie Klick, RN, one of two nurses in the Texas Legislature, to pass House Bill 2410 Oral Safe Harbor (Texas House Bill No. The Patient Self-Determination Act (PSDA) (1991) requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. Unfortunately, the significance of nurse advocacy in protecting patients from harm is perhaps best illustrated in an example in which advocacy failed and patients were harmed. It allows employees to change jobs without losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage (Carter, 2010). These acts, which are deemed the practice of medicine, are regulated through state, State courts in Pennsylvania and New York have ruled that clinical laboratory testing is not the practice of medicine and is not subject to regulation by state, The state legislatures in every state handed over total power to them with, In that latter capacity, boards take disciplinary actions against physicians licensed in their states who violate the state, In an effort to crack down locally, about a third of states have amended their, From that decade onward, the states have told citizens whom they could patronize for medical care, by way of the, From that decade onward, the states have told their citizens whom they could patronize for their medical care, by way of the, In conclusion, ANA strongly believes that it is inappropriate for organized medicine to advise legislators, policy makers and boards of medicine to regulate, either directly or indirectly, the scope of practice of licensed providers whose scope of practice is authorized in statues other than, This Article then concludes by stating that voluntary self-regulation around a code of conduct is the most viable alternative for homeopathy--and other unregulated CAM modalities--in the context of an exemption from the, It is not the purview of physician organizations to advise consumers, legislators, regulators, policy makers or payers regarding the scope of practice of licensed healthcare professionals whose practice is authorized in statutes other than, We, therefore, will object when proponents of limited government propose to do away with the FDA or, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, Laboratory-developed tests are not the practice of medicine, Survey of state medical and osteopathy board disciplinary web sites in 2006. Introduction Welcome to the practice of nursing in the State of Texas. (2011). For example, a policy/procedure outlining the steps to follow when changing a dressing or administering medication provides specific information about how nurses are to perform these tasks. Monthly Labor Review. For the first time, patient outcomes could be specifically mapped to nursing careBecause the NDNQI provided unit level data, it enabled comparisons across like units and like hospitals. Black noted that while nurses are accountable for protecting patients from harm, often few protections exist for nurses raising patient safety concerns: employment at-will doctrine places nurses who witness unsafe practices in a difficult catch-22: if they report unsafe practices, they risk losing their jobs; if they dont, they risk losing their licenses. (p. 28). The most recent example is a nurse who contacted the TNA practice hotline because she was retaliated against for speaking up for patient safety. Licensure permits people to offer special skills to the public, and it also provides legal guidelines for protection of the public. Legally competent adult patients consent to a DNR order verbally or in writing after receiving the appropriate information by the health care provider. The Board of Registered Nursing (BRN) is a state governmental agency established by law to protect the public by regulating the practice of registered nurses. Texas Nursing, 93(3), 8-9. https://doi.org/10.3912/OJIN.Vol25No01Man02. Policies that protect nurses who advocate for patients are a vital element of safe healthcare delivery. - It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. Minimum nurse-to-patient ratios in acute care hospitals in California. Nurse Practice Acts define the scope of nursing practice, distinguishing between nursing and medical practice and establishing education and licensure requirements for nurses. Criminal Law. Florence Nightingale and healthcare reform. American Journal of Nursing, 110(3), 11. doi: 10.1097/01.NAJ.0000368933.60442.41, Texas Board of Nursing. New Jersey, New York, and Virginia quickly followed suit. Study with Quizlet plus behalten flashcards containing terms like Thing is the purpose about the medical practice act?, Who establishes medical practice acts?, Whatever are who requirements for medical licensure? reflects decisions made by administrative bodies such as State Boards of Nursing when they pass rules and regulations. The nurse did not carry out the duty or breached it (failure to use the degree of skill and learning ordinarily used under the same or similar circumstances by members of his or her profession). In the fall of 2007, the Centers for Medicare and Medicaid Services (CMS) announced that it would no longer reimburse hospitals for nursing-related, preventable complications occurring during a patient hospital stay (The George Washington University, 2007). includes a threat or attempt to injure; unlawful touching of another person without consent. This example represents a missed opportunity for nurses to change practice through policy. Likewise, it is an assault for a patient to threaten a nurse (Guido, 2010). Americans with Disabilities Act (ADA) (1990), National Council of State Boards of Nursing [NCSBN], 2005, The Americans with Disabilities Act (ADA) (1990), The Patient Self-Determination Act (PSDA) (1991), Health Insurance Portability and Accountability Act of 1996, Centers for Medicare and Medicaid Services (2007), Uniform Determination of Death Act (1980), Failure to assess and/or monitor, including making a nursing diagnosis, Failure to use proper equipment to monitor the patient, Failure to notify the health care provider of problems, Failure to follow the six rights of medication administration, Failure to ensure patient safety, especially patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative, Failure to follow policies and procedures, Failure to properly delegate and supervise. Because a license is a property right, the State Board has to follow due process before revoking or suspending a license. Drugs just a click away: online pharmacies can make dangerous drugs easy to get, but also can promote better health care. North Carolina enacted the first nurse registration law in 1903. Medical Assistant practice test questions Flashcards | Quizlet Retrieved from https://www.nursingald.com/uploads/publication/pdf/231/TX7_11.pdf. Such details within the Nurse Practice Act provide guidance for nurses and other healthcare professionals in Texas. In all cases, states have acts that provide for safe, competent nursing practice within their borders. Washington, DC: American Nurses Publishing. a. Deposition b. Evidence-based practices for safe patient handling and movement. (2019). Describe the nursing implications associated with legal issues that occur in nursing practice. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Orthopedic Nursing, 25(6), 366-379. Involuntary detention occurs when an individual files with the court within 96 hours of the patients initial detention. Documentation of precautions against suicide is essential. To this end, the Texas Nurses Foundation has a dissertation grant program to support research on the impact of nursing policies in Texas. Further protections (Texas Occupations Code, 2019) include refusal to engage in reportable conduct; reporting staffing concerns in hospitals; nurses who refuse to engage in conduct reportable to the board of nursing; and nurse reporting of concerns within a facility about patient exposure to substantial risk of harm or failure to conform to minimum professional, regulatory, or accreditation standards. https://doi.org/10.21916/mlr.2018.27, Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. Criminal laws protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation (Garner, 2006). We offer exemplars that illustrate policies that regulate the environment of practice, such as nurse staffing, musculoskeletal injury prevention, and failure to advocate, and discuss needed protections, including whistleblower protections in our state.