Legal and Ethical Consideration

Legal Considerations

As discussed earlier in this chapter, nurses can be reprimanded or have their licenses revoked for not appropriately following the Nurse Practice Act in the location they are practicing. Nurses can also be held legally liable for negligence, malpractice, or breach of patient confidentiality when providing patient care.

Negligence and Malpractice

Negligence is a “general term that denotes conduct lacking in due care, carelessness, and a deviation from the standard of care that a reasonable person would use in a particular set of circumstances.”^[1] Malpractice is a more specific term that looks at a standard of care, as well as the professional status of the caregiver.” ^[2]

To prove negligence or malpractice, the following elements must be established in a court of law:

• Duty owed the patient
• Breach of duty owed the patient
• Foreseeability
• Causation
• Injury
• Damages^[3]

To avoid being sued for negligence or malpractice, it is essential for nurses and nursing students to follow the scope and standards of practice care set forth by their province’s regulatory body; the Canadian Nurses Association; and employer policies, procedures, and protocols to avoid the risk of losing their nursing license. Examples of nurses breach of duty that can be viewed as negligence include:^[4]

• Failure to Assess: Nurses should assess for all potential nursing problems/diagnoses, not just those directly affected by the medical disease. For example, all patients should be assessed for fall risk and appropriate fall precautions implemented.
• Insufficient monitoring: Some conditions require frequent monitoring by the nurse, such as risk for falls, suicide risk, confusion, and self-injury.
• Failure to Communicate:
  • Lack of documentation: A basic rule of thumb in a court of law is that if an assessment or action was not documented, it is considered not done. Nurses must document all assessments and interventions, in addition to the specific type of patient documentation called a nursing care plan.
  • Lack of provider notification: Changes in patient condition should be urgently communicated to the health care provider based on patient status. Documentation of provider notification should include the date, time, and person notified and follow-up actions taken by the nurse.

• Failure to Follow Protocols: Agencies and states have rules for reporting certain behaviors or concerns. For example, a nurse is required to report suspicion of patient, child, or elder abuse based on data gathered during an assessment.

Code of Ethics *Note we will talk extensively in Nurs 207 about this topic.

In addition to legal considerations, there are also several ethical guidelines for nursing care.

There is a difference between morality, ethical principles, and a  code of ethics. Morality refers to “personal values, character, or conduct of individuals within communities and societies.”^[5] An ethical principle is a general guide, basic truth, or assumption that can be used with clinical judgment to determine a course of action. Four common ethical principles are beneficence (do good), nonmaleficence (do no harm), autonomy (control by the individual), fidelity (doing what is expected of you), and justice (fairness). A code of ethics is set for a profession and makes their primary obligations, values, and ideals explicit.

You can read more about the four ethical principles here

The Canadian Nursing Association (CNA) guides nursing practice with the Code of Ethics for Registered Nurses (2017). This code provides a framework for ethical nursing care and a guide for decision-making. The Code of Ethics for Registerd Nurses serves the following purposes:

• It is a succinct statement of the ethical values, obligations, duties, and professional ideals of nurses individually and collectively.
• It is the profession’s nonnegotiable ethical standard.
• It is an expression of nursing’s own understanding of its commitment to society