Nur4327 Del 5 Material
Sources of Law
The legislative branch develops what is known as statutory law, or laws
that are codified and impact all citizens of the state. Examples include
Medicare at the federal level and Medicaid at both the state and federal
level. The executive branch enforces the laws and establishes the
authority of agencies or departments. The agencies develop the rules
and regulations and provide for specific police power to allow the
agencies to enforce the regulations, which is referred to as
Administrative Law. The judicial system interprets the statutory law. The
state’s courts make decisions regarding cases including those brought by
individuals in civil courts as well as those provided by the state against
individuals, corporations, and other entities.
Types of Law
One way to classify law is whether it is criminal law or civil law. Criminal
law is concerned with violations against a society based on criminal
statutes or code. Penalties can be monetary, imprisonment, and death.
Misdemeanors are usually lesser crimes where punishment is a fine or
less than one year in prison.
An example would be the possession of drugs, which could be classified
as a misdemeanor or a felony. Felonies are more serious crimes
punishable by higher fines, more extended imprisonment, and even
death, depending on the state. In many states, a felony is a cause for
revoking the license to practice. A nurse may be prosecuted criminally for
practicing without a license, falsifying information in obtaining his license,
failing to provide life support to a terminally ill patient who does not have
a Do-Not-Resuscitate, or patient abuse.
Civil law involves laws related to negligence, malpractice, labor, and
privacy issues. Negligence and malpractice include allegations that the
healthcare provider failed to provide care that met the standard of care
and harm resulted to the patient. Failure to follow regulations related to
privacy issues are often prosecuted as civil cases, although HIPPA
violations are also covered under federal criminal law. Most civil cases
involve a monetary award.
Most states have Good Samaritan Laws that protect those who provide
healthier for an emergency or disaster without reimbursement. Good
Samaritan Laws would also include someone who stops to assist in an
A tort is harm against a person where an individual brings a legal action
against another person. A tort can involve simple negligence or be an
intentional tort such as assault, battery, false imprisonment, intentional
infliction of emotional distress, and trespass. One of the critical factors is
the intent to cause harm. To be successful in pursuing a lawsuit for
international tort, the plaintiff must prove that the defendant had the
requisite intent, that injury resulted from the defendant’s action, and that
no defense was present.
Quasi-international torts are much like intentional torts but involve
speech, including defamation of character, invasion of privacy, or breach
of confidentiality. Violation of privacy can be purposeful or merely due to
a nurse not being sufficiently aware. Breach of confidentiality has
become more of an issue with the use of phones and social media. Be
mindful of your organization’s social media policy and the details of
All nurses should understand how the law defines the acts. Not only
violating these principles but witnessing others must be reported
immediately to the chain of command to limit your liability and that of
your institution. Understand that the Chief Nursing Officer is obligated to
report these acts to the state Board of Nursing that has a responsibility
for licensure and oversight of registered nurses.
Nursing Practice and Licensure
Scope of Practice
The authority for the practice of nursing is based upon social
responsibility, which means that the nurse is accountable to the public for
providing culturally sensitive, safe, timely, efficient, patient-centered,
quality, and effective nursing care for individuals, families, and
populations across the continuum of care. Society validates the
existence of the profession through licensure and legislative parameters.
Defining the scope of nursing practice starts when the state legislature
passes a law, known as the Nurse Practice Act. Each state’s Board of
Nursing decides on the rules and regulations governing the practice of
the registered nurse, regardless of education level upon entry into
practice. The nurse must be familiar with how the board defines the
scope of practice, as practicing outside of the scope makes a person
liable for any negligence or harm. While nurse practice acts and
licensure requirements are state-based, there has been momentum over
the last decade to allow states to recognize the license of other states
when a nurse moves to a different geographic location.
The ability for nurses to move and have their license be recognized is
called the State Nurse Compact. For more information about whether
your state has joined, consult the National Council of State Boards of
One of the essential elements of the Nurse Practice Act and an important
legal concept is that of registered nursing delegation to both licensed
practical nurses and unlicensed assistive personnel (UAP) which
includes nursing aides, nursing assistants, or patient care technicians. In
the act of delegation, the registered nurse assumes responsibility for the
care provided and is ultimately legally responsible, as they work under
your nursing license.
It is essential to understand that the RN is responsible for all care given
to the patient. The nurse may not delegate the nursing actions of
assessment, evaluation, and communication about the health status of
the patient. The nurse may delegate specific tasks to the UAP,
depending on their competencies and according to the policies of the
agency, for example, the UAP may take vital signs and note the skin
condition during bathing. It is the nurse’s responsibility to interpret the
vital signs in the context of the patient’s condition and then report to the
physician. The UAP can alert the nurse to changes in the skin; the nurse
assesses and decides on the plan of action.
While the hospital is responsible for making sure that the UAP has the
requisite training, the nurse is the one who observes and validates the
ability of the UAP to perform their duties adequately. The nurse is
responsible for the direct care given to a patient. The UAP is practicing
under the RN license.
Protecting the RN License
Ideally all members of the team act with mutual respect and
communication that is designed to protect and enhance the care of the
patient. Consideration of the patient is the legal responsibility of the
team. The RN must report any concerns about the performance of a
UAP, as they assume the responsibility for total nursing care. Make sure
to get to know your colleagues and establish team responsibilities.
American Nurses Association Principles of Delegation
National Council of State Boards of Nursing
Healthcare assistant. [Photography]. Retrieved from Encyclopedia
Britannica Image Quest.
Policy & Politics in Nursing and Health Care
(7th ed.), Chapters 53 (pp 447-455), 54 (456464)
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