The training required to become a nurse is intensive and there’s a lot to remember. Students often feel daunted by the realization that they also need to learn about the law.
Doing so will benefit both you and your patients, however, and it’s not as difficult as it seems. You don’t need to be fluent enough to defend yourself in court. You just need to recognize the rules that apply to your day-to-day work and have a basic understanding of why they’re in place and how they shape nursing practice. This article addresses those issues, beginning with the different kinds of laws that might affect you.
Constitutional And Statutory Law
All US laws derive from the constitution, and where nurses are concerned, the most important amendment is the Tenth, which places a responsibility on lawmakers to protect health. Statutory law derives directly from constitutional law and gives states the power to set up their own health boards and related institutions with the power to make law at the state level.
These include Nursing Regulatory Bodies (NRBs). It also allows the federal government to create laws that regulate aspects of different sectors right across the country. In the case of nursing, this includes things such as the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA). You won’t need to learn about every such law – you just need to make sure that you’re familiar with the ones that apply directly to the type of work you do.
Administrative law is established by federal agencies such as the Department of Health and Human Services, and is much more fluid than constitutional or statutory law, being comparatively easy to update in order to keep up with the times.
Most disciplinary matters are handled according to rules and regulations set up in this way. As a nurse, you will not just be affected by administrative law –you’ll also have the ability to affect it. There is a consultation period of around two months before any major change, during which lawmakers are especially keen to hear from those with experience in relevant fields.
Also described by the term ‘case law’ or simply ‘precedent’, this is the legal framework that has been established by the courts in the process of handling individual cases. It fills in the gaps where other forms of regulation are unclear and helps turn theory into something that works in practice. There is a huge body of common law and even lawyers don’t know all of it, so you won’t be expected to.
It is this law, however, that often makes the difference in disciplinary hearings, which is the reason why you should always ensure that you have professional legal representation instead of just relying on what administrative law says. As an interesting side note, it’s actually through common law that nursing gained much of its present-day professional status, and that legislators came to recognize the importance of the relationship between nurse and patient.
The Nursing Practice Act
Strictly speaking, there are 59 Nursing Practice Acts (NPAs) – one for each NRB and, at the state level, usually overseen by a Board of Health (BoH) – but they all function in essentially the same way, with the exception that some BoHs have as yet failed to recognize the distinct role of clinical nurse specialists, while others don’t cover midwifery, which is handled by separate state-appointed boards.
Because of these exceptions, and because some BoHs differ on the details of which tasks are appropriate for which nursing role, it’s important to familiarize yourself with the NPA as it applies to your state, and to check for possible differences if you move state.
In essence, what the NPA does is delineate different nursing roles and clarify which duties go with which, as well as set out limitations on what different types of nurses are allowed to do.
Most of this is handled at the level of administrative law, but because the profession is always changing, common law is also important. This is published in the form of opinion, and although that word may not sound very important, the opinion of an NRB or BoH carries real legal weight.
The NPA is the single most important piece of legislation for individual nurse practitioners to be familiar with. It applies from the earliest stage of training, establishing the level of education necessary to practice in each state, and it also defines the way that disciplinary procedures work.
Ignorance of the law is not accepted as a legal defense, so the burden is on nurses to ensure that they understand the rules. In general, however, a diligent and professional approach to day-to-day work is sufficient to avoid getting into trouble.
In addition to being responsible for the NPA in each state, NRBs oversee licensing and certification.
Licenses And Certification
In addition to state licensing, nurses often pursue Basic Life Support (BLS) certification. BLS certification equips nurses with essential life-saving skills, including CPR and AED usage. It is typically required by healthcare facilities and is renewed every two years to ensure nurses stay up-to-date with the latest techniques and protocols.
Studying to become a nurse is easier than ever. With an online DNP degree program such as the one at Spring Arbor University, you can get to the very top, fitting your classes around your working hours regardless of your shift pattern and developing strategic leadership skills that will benefit your whole team. You will still need to be licensed, however, before you can make use of any nursing qualification in practice. Exact licensing requirements vary by state.
All nurses need to pass the National Council Licensure Examination (NCLEX) before starting work in the sector. It’s also necessary to be licensed by your state NRB. If you work in more than one state – even if it’s just a matter of providing telehealth services that cross state lines – you will need to be licensed in each one. The exception is if they are members of the Enhanced Nurse Licensure Compact (ENLC), an arrangement that now covers half the nation and is continually growing, making it much easier for nurses to move around.
If you move to a state with different licensing arrangements, you will not be able to practice until you have received your new license, which can take as little as two weeks or as long as six months to process. This makes it a good idea to do your research and submit your application before actually relocating. There is nothing to stop you from holding several state licenses at the same time. Bear in mind that state licensing requirements differ and that in some cases, you will be fingerprinted or will have to wait for a full background check to be carried out.
Specialty And Workplace Regulations
In addition to the above, there are two other types of regulation that nurses need to be aware of. The first applies to certain kinds of specialty nursing, such as those covered by the aforementioned midwifery boards.
The second applies to specific types of workplaces, such as care homes. When applying for a new position, it’s important to find out if regulations of this sort will apply to you. Again, as long as you are good at your job, you are unlikely to get into difficulty. However, you should know where to look for further information if you find yourself dealing with a situation that you’re uncertain about.
Perhaps the thorniest area for the average nurse – and one central to the nursing profession – is patient advocacy. You have a duty to advocate for your patients, but in doing so, you may come up against relatives and family members who profoundly disagree with the course of action that you feel is appropriate. Where the patient cannot give consent (because they are a child, are unconscious, or lack the necessary mental capacity), this can result in particularly fractious disagreements.
Naturally, it’s important to make sure that you have the law on your side, though as a nurse, you should always be trying to reassure people, explain your decisions, and gently persuade them to accept your proposals. The NPA is the place to look to establish the legal limits of what you can do to protect your patient.
Privacy And Disclosure
Another important principle in nursing, which you’ll be introduced to right at the start of your career, is confidentiality. With rare exceptions, what a patient tells you in confidence must not be shared. This is not only important to building up the trusting relationship on which everything else depends – but it’s also a legal duty.
You must disclose information to the appropriate authorities, however, if you find that a patient you are treating has gunshot wounds, if they have an infectious disease, or if you suspect that a vulnerable person is suffering from abuse or neglect. In this case, it’s important to distinguish between the essential facts and other information or observations that are not directly related and should still be treated as confidential.
Related to this is the patient’s right to bodily privacy. This isn’t absolute because otherwise, you wouldn’t be able to treat them, but it requires you to treat them respectfully and avoid any unnecessary exposure, especially if they are a vulnerable person or in a vulnerable condition (such as under anesthesia).
Good Samaritan Laws
Nursing is a job that doesn’t always stop when you go home at the end of the day. In some states, Good Samaritan laws place a legal duty on nurses to intervene if they encounter accidents or other forms of medical emergency when out and about in public.
These do not oblige you to put yourself in harm’s way – for instance, you would be within your rights to flee in a situation where there was an active shooter at large – but they mean that you can be penalized under the law if you ignore a person in need in normal circumstances. In dealing with such a situation, you still need to be mindful of the limits of your training and what you are permitted to do, and you should summon additional assistance as quickly as possible where it’s necessary.
Negligence And Malpractice
As a nurse, you are under an obligation to provide an appropriate level of care for your patients. If you fail to do so and a patient suffers as a result, you could face a negligence claim. Such claims come in two forms. Ordinary negligence is a simple failure to carry out your duties. If you are under intense pressure – for instance, because you are working on an understaffed hospital ward that is handling a crisis – this can be taken into account in your defense.
Gross negligence is a different matter, and concerns cases in which a patient has been neglected deliberately (for instance, as a result of bias or a personality clash). It can also apply where a nurse has deliberately done something to prevent proper care from taking place, such as claiming that a patient has already been washed when that is not the case. Malpractice is similar but relates not to general duties but to the particular standards of the nursing profession. This is where it becomes useful to look beyond the law and reflect on ethics.
Law And Ethics
The law is a crude instrument with which to regulate day-to-day behavior, and so nursing depends upon a set of ethical standards that are embedded in initial nurse training and revisited at every step. It is the duty of senior nurses to ensure that they are fully understood by junior members of their teams. In certain cases, such as that described above, the law makes reference to these standards. In any instance of legal action being taken against you as a nurse, being able to demonstrate that you were acting in accordance with professional ethics will help your defense.
Having a basic understanding of the law gives you a clearer idea of what’s required from you at each stage of your career development, reduces the risk of you getting into trouble, and helps you to do a more effective job of advocating for your patients. It’s not an incomprehensible subject that’s only accessible to experts, but a tool for you to use in order to enhance your working life.