⚖️ New Lesson 27
Legal Aspects & Leadership
Malpractice (DBIC), informed consent, advance directives, delegation 5 rights, leadership styles.
Legal Basics
Malpractice vs Negligence — DBIC
| Concept | Definition | Key Fact |
|---|---|---|
| Negligence | Careless act by ANYONE that causes harm | Not limited to professionals |
| Malpractice | Professional negligence — failure to meet standard of care | Requires nurse-client relationship |
⚖️ 4 Elements of Malpractice — ALL must be present (DBIC):
Duty — nurse owed a duty to the client
Breach — nurse failed to meet standard of care
Injury — client was harmed
Causation — the breach CAUSED the injury
Remove ANY one element = malpractice cannot be proven!
Duty — nurse owed a duty to the client
Breach — nurse failed to meet standard of care
Injury — client was harmed
Causation — the breach CAUSED the injury
Remove ANY one element = malpractice cannot be proven!
Informed Consent — 5 Required Elements
✅ Competent and of legal age
✅ Voluntary (no coercion)
✅ Risks, benefits, alternatives explained
✅ Opportunity for questions
✅ The HCP performing the procedure obtains consent
⚠️ The PN WITNESSES the signature only — does NOT obtain consent
⚠️ Sedated patients CANNOT give valid consent
✅ Voluntary (no coercion)
✅ Risks, benefits, alternatives explained
✅ Opportunity for questions
✅ The HCP performing the procedure obtains consent
⚠️ The PN WITNESSES the signature only — does NOT obtain consent
⚠️ Sedated patients CANNOT give valid consent
Advance Directives
| Document | Purpose | When Active |
|---|---|---|
| Living Will | Directs treatment if incapacitated | Only when patient CANNOT make decisions — alert patients = LW nonbinding |
| Health Care Proxy | Person appointed to make decisions | When patient is incapacitated |
| Durable POA for HC | Legal authority for healthcare decisions | When patient lacks decision-making capacity |
Delegation
Five Rights of Delegation
🎯 Right TASK — appropriate to delegate
🎯 Right CIRCUMSTANCE — safe situation
🎯 Right PERSON — competent delegatee
🎯 Right DIRECTION/COMMUNICATION — clear instructions given
🎯 Right SUPERVISION — PN maintains oversight
🎯 Right CIRCUMSTANCE — safe situation
🎯 Right PERSON — competent delegatee
🎯 Right DIRECTION/COMMUNICATION — clear instructions given
🎯 Right SUPERVISION — PN maintains oversight
| UAP CAN Do | UAP CANNOT Do |
|---|---|
| Take vital signs (stable patients) | Perform initial or ongoing assessment |
| Bathe, groom, feed patients | Administer medications |
| Record intake and output | Sterile procedures (Foley, wound irrigation) |
| Collect specimens | Provide patient teaching |
| Apply compression stockings | Care planning or clinical judgment |
⚠️ The nursing PROCESS and any activity requiring nursing JUDGMENT may NOT be delegated to a UAP. The PN retains ACCOUNTABILITY for all delegated tasks.
Leadership
Leadership Styles — Match the Verbal Example!
| Style | Communication | Example Phrase |
|---|---|---|
| Authoritarian | Aggressive | "Do it my way." |
| Laissez-faire | Passive | "Whatever, as long as you like me." |
| Democratic ✅ | Assertive (PREFERRED) | "Let's consider the options available." |
Restraints — Legal Requirements
📋 Written MD/HCP ORDER required
🕑 Reassess every 2 hours MINIMUM (circulation, skin, ROM, comfort)
📝 Document all less-restrictive alternatives tried first
🔗 Quick-release knots (never full knots or tied to side rails)
👆 2-finger breadth of space between restraint and skin
⏰ Order reassessed every 8-24 hours per facility policy
🕑 Reassess every 2 hours MINIMUM (circulation, skin, ROM, comfort)
📝 Document all less-restrictive alternatives tried first
🔗 Quick-release knots (never full knots or tied to side rails)
👆 2-finger breadth of space between restraint and skin
⏰ Order reassessed every 8-24 hours per facility policy
Abuse — Mandatory Reporting
🚨 Two most important elder abuse indicators:
1. Frequent unexplained crying
2. Unexplained fear or suspicion of a specific person
Red flag: injury that does NOT match the story.
Nurses have a LEGAL MANDATORY REPORTING obligation — never delay.
1. Frequent unexplained crying
2. Unexplained fear or suspicion of a specific person
Red flag: injury that does NOT match the story.
Nurses have a LEGAL MANDATORY REPORTING obligation — never delay.
📖 Notes for Dummies
📖 Legal Concepts Explained Simply
🏥 Malpractice in Plain English:
Imagine you're the nurse and you forget to check a patient's wristband. They fall and break their hip. That's malpractice — you had a duty (your job), you breached it (didn't check), the patient was injured (broken hip), and YOUR failure caused it. All 4 = lawsuit.
📝 Informed Consent in Plain English:
The patient must be sober, awake, and not pressured. The DOCTOR explains the risks. You just watch them sign. If they got pain meds before signing — STOP. A medicated person cannot legally consent. Call the surgeon.
📋 Living Will in Plain English:
A Living Will only activates when someone is unconscious or can't speak for themselves. If the patient walks in awake and alert waving their Living Will — their current verbal wishes trump the document. They can change their mind anytime they can still speak.
🤝 Good Samaritan Law in Plain English:
You're off duty, you see a car accident — you help. The law protects you as long as you acted in good faith and stayed within your training. You can't be sued for trying to help. But don't be reckless.
Imagine you're the nurse and you forget to check a patient's wristband. They fall and break their hip. That's malpractice — you had a duty (your job), you breached it (didn't check), the patient was injured (broken hip), and YOUR failure caused it. All 4 = lawsuit.
📝 Informed Consent in Plain English:
The patient must be sober, awake, and not pressured. The DOCTOR explains the risks. You just watch them sign. If they got pain meds before signing — STOP. A medicated person cannot legally consent. Call the surgeon.
📋 Living Will in Plain English:
A Living Will only activates when someone is unconscious or can't speak for themselves. If the patient walks in awake and alert waving their Living Will — their current verbal wishes trump the document. They can change their mind anytime they can still speak.
🤝 Good Samaritan Law in Plain English:
You're off duty, you see a car accident — you help. The law protects you as long as you acted in good faith and stayed within your training. You can't be sued for trying to help. But don't be reckless.