Wesleyan University of the Philippines

LEGAL ASPECTS IN NURSING SCHOOL AND HEALTHCARE MANAGEMENT

Professor: Dr. Adahlia Basco

Submitted by: Jacy Mynette F. Salazar, RN
Batch 10 - Section A6, MAN-DL

ASSIGNMENT 2

 Elaborate this statement.

Nurses are more accountable than ever to the public, patients, their employers, and the profession, so they
must clearly understand the legal, ethical, and professional dilemmas they will face.

In an article by Ballard, K. (2003), she defined Patient Safety as an essential and vital component of quality
care. However, healthcare providers face many challenges in keeping patients safe in today's healthcare
environment. She believes that safety is a shared responsibility among all stakeholders, who are
responsible for ensuring that no harm occurs to patients. These stakeholders include society in general,
patients, individual nurses, nursing educators, administrators, researchers, physicians, governments,
legislative bodies and regulators, professional associations, and accrediting agencies.

Individual Nurses

Nursing is a knowledge-based profession. The basis for the scientific practice of nursing includes nursing
science; the biomedical, physical, economic, behavioral, and social sciences; ethics; and philosophy. A
nurse's ability to be a critical thinker and to use this knowledge in the delivery of nursing care is essential to
the well-being and safety of those for whom nurses care (ANA, 2003b; Ballard, 2002). Early in nursing
history, Florence Nightingale advocated for safe care. She proposed that nurses, through their practice,
had to put the patient in the best condition possible for nature to act upon the patient. In discussing
contemporary nursing practice, ANA states that an essential feature of nursing is providing a caring
relationship that facilitates health and healing (ANA, 2003a). Nurses must work to continue these traditions
by strengthening the nurse-patient relationship and diligently using research findings to provide safe care
for patients. Laws, rules, and standards can also enhance safe care. Nurses are held accountable for
following the laws, regulations, and rules of the licensing authority and the standards and ethics of the
profession as promulgated by the various nursing associations. These laws, rules, and standards include
meeting educational requirements, maintaining competence in practice, and refraining from engaging in
any acts of

professional misconduct, such as abusing a patient, practicing incompetently, fraudulently, or while

impaired, failing to document appropriately, revealing personally identifiable information about a patient,
and inappropriately delegating professional acts (Ballard, 2002).

Nurses can also enhance safe care by serving as competent team leaders. Delivering nursing care to
patients is often a team effort in which RNs direct non-registered nurses. RNs must know the
competencies, legal parameters, and tasks others can perform, such as licensed practical nurses (LPNs)
and unlicensed assistive personnel (UAPs).

In 1990, the American Association of Critical Care Nurses (AACN) developed a list of six risk factors
(potential for harm; condition/stability of the patient; the complexity of the task; level of problem solving or
innovation that might be needed; unpredictability of the outcome, and level of interaction required with the
patient to complete the task successfully) for an RN to

Consider whether a UAP could perform a specific task on a patient (AACN, 1990).

RNs must provide the appropriate levels of direction and supervision when nursing care is being delivered
by others so that the patient receives safe and competent care. A nurse's professional responsibility is to
remain safe and competent by being a lifelong learner. Making informed choices about educational and
clinical advancement and specialty certification is essential. Educational choices can include continuing
education courses or advanced degree programs. Clinical advancement can consist of becoming an
advanced practice registered nurse (APRN), such as a nurse practitioner, clinical nurse specialist, nurse
anesthetist, or nurse midwife, or deciding to specialize in a particular nursing field through continuing
education and clinical practice.

A nurse's professional responsibility is to remain safe and competent by being a lifelong learner. Identifying
potential risks and learning the proper terminology to identify and describe healthcare errors promotes safe
care. These activities will likely occur in a non-punitive environment where nurses feel safe and supported
when reporting errors or identifying needs. The impact of nurse staffing on patient safety has been studied
and demonstrated to be significant (Needleman & Buerhaus, 2003). Practice settings that support
professional practice with responsive nursing management, creative staffing, and scheduling, adequate
salaries and benefits, availability of clinical preceptors, adequate ancillary and technical support, and
access to staff development and education provide the environment where nurses can identify threats to
patient safety (NYSNA, 1997).

The American Nurses Association (ANA) (http://www.nursingworld.org/) has directed nurses by developing
practice standards and guidelines, ethics statements, a model nurse practice act, and models for workplace
collective bargaining agreements. Specifically, in collaboration with the National Specialty Nursing
Associations, ANA has established standards of practice for generic and specialty nursing areas. The
various standards describe a competent level of nursing care that

1. reflects the values and priorities of the profession,

2. provides direction for professional practice and
3. forms a basis of accountability for all nurses regardless of practice setting.

ANA's Nursing: Scope and Standards of Practice focuses on the processes of providing care (Standards of
Care) and performing professional role activities (Standards of Professional Performance) (ANA, 2003b).
Nursing's Social Policy Statement, the social contract between nursing and society, also addresses
providing quality care (ANA, 2003a). Another document that directs the care provided by nurses is the
ANA's Code of Ethics for Nurses. It explicitly expresses the profession's primary goals, values, and
obligations. Provision Three states that "the nurse promotes, advocates for, and strives to protect the
health, safety, and rights of the patient" (ANA, 2001, p. 12). The accompanying interpretative statement
notes that nurses are expected to participate in activities, such as review mechanisms designed to
safeguard patients and nurses, and also to develop policies and review mechanisms that promote patient
safety, reduce errors, and address both system and human factors that contribute to increased risks to
patients. It is an ethical expectation that the nurse will appropriately report errors according to institutional
policy, assure disclosure of the error to the patient, and, under no circumstances, participate in any
attempts to hide an error. The Code also expects the nurse to remedy any harm that might come to a
patient and seek to correct the conditions that led to the error in a positive, non-punitive manner (ANA,
2001).

In conclusion, Nurses have a huge accountability and responsibility to everyone in general. To always
remain up to date, Nurses need to be lifelong learners. It is part of our oath to protect our patients and be
familiar with rules and regulations, especially healthcare laws and the Code of Ethics, to protect ourselves
and the public. Being knowledgeable about healthcare laws in the state of our practice makes us more
confident, especially in ethical situations or dilemmas. Nurses can also consult their ethics committee when
working in an organization should the need arise. Another case in point is that several factors affect patient
safety, such as low staffing ratios, inadequate training, stress, and fatigued nurses who cannot think
critically. It is a shared responsibility as Nurses must collaborate with other stakeholders such as (Nursing
administrators, Nursing Research, Patients, Individual nurses, and Government and Legislative bodies)
who play an essential role in helping nurses maintain safety in their practices. Nursing administrators and
managers can also increase patient safety by fostering an environment where nurses control their nursing
practice. Nursing research has significantly contributed to patient safety by identifying adequate staff
needs. Adequate nurse staffing is critical to delivering quality patient care because it allows time for
appropriate nursing assessment of patients. Informed patients can do much to increase the safety of their
care. Government and Legislative bodies (States) establish practice acts, rules, and regulations regarding
professional nursing practice to authorize and protect the public from harm by strengthening safe practices.
This authorization is contained in each state's Nurse Practice Act (NPA). Such acts can be general in the
description of nursing practice or very specific, listing authorized tasks or acts. Nurses are playing, and will
continue to play, an ongoing role in the movement to promote safe care. Nurses remain a crucial strand in
the healthcare safety net.

REFERENCES
American Association of Critical Care Nurses. (1990). Delegation of nursing activities in critical care – A
framework for decision-making. Alsio Viejo, CA: ACCN.

American Nurses Association. (2001). Code of ethics for nurses with interpretative statements.
Washington,
DC: ANA.

American Nurses Association. (2003a). Nursing’s social policy statement. Washington, DC: ANA.
American Nurses Association. (2003b). Nursing: Scope and standards of practice. 3rd edition.
Washington,
DC: ANA. [Available late October 2003].

Ballard, K. A. (2002). The world of nursing practice. In A. Vallano, Your Career in Nursing. New York:
Simon
and Schuster.

Ballard, K. (September 30, 2003). "Patient Safety: A Shared Responsibility". Online Journal of
Issues in Nursing. Vol. 8 No. 3, Manuscript 4. Available:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/
Volume8
2003/No3Sept2003/PatientSafety.aspx

Needleman, J., & Buerhaus, P. (2003). Nurse staffing and patient safety: Current knowledge and
implications for action. International Journal for Quality in Health Care, 15(4), 275-277.

New York State Nurses Association. (1997). Assessing your nursing practice environment: A guide for
nurses
seeking employment in health care settings. Latham: NYSNA, 1-4.