Ethical and Legal Issues in Nursing
Team C
NUR/391

Ethical and Legal Issues in Nursing Nurses face various ethical and legal issues in the medical setting. As professionals, nurses must be aware of these legal and ethical issues when they occur. Nurses have a legal and ethical obligation to respond to these issues. Being a professional nurse requires a nurse to assess the pros and cons of different situations, but also to withhold their personal beliefs and listen and respect the beliefs and traditions of others. Legally Nursing implications require nurses to maintain licensure, obey state and federal laws and to remain within their scope of practice. Within these legal and ethical issues the American Association Code of Nursing ethics, personal and societal values, legal aspects and legal responsibilities all affect decisions. Two different cases will be discussed and explored; an advance directive case involving a woman by the name of Marianne, and a malpractice case involving a nurse and the involved healthcare organization. The American Nurses Association Code of Nursing Ethics can influence the final decision made in the case study involving Marianne’s family by designating a surrogate. According to "American Nurses Association" (2011), “The nurse supports patients self-determination by participating in discussions with surrogates, providing guidance, referral to other resources as necessary, and identifying and addressing problems in the decision-making process” (1.4). In the case study involving malpractice, the nurse being called upon as a witness, has a duty and responsibility to report the incidents to the employer. The "American Nurses Association" (2011) website further states,” all nurses have a responsibility to assist those who identify potentially questionable practice” (3.5). If the hospital fails to correct the actions, the nurse has an obligation to report to a state agency, such as the State Board of Nursing or a pertinent professional organization. While the hospital employs the nurse, the nurse is bound by the Code of Nursing Ethics. The nurse's responsibilities and obligations are to protect the patient. As a nurse, you learn early in your schooling what it is to be a moral and ethical person. Personal and societal values can influence ethical decision making. One specific personal example that comes to mind is hospice care. Not everyone agrees that the care provided by hospice nurses is moral or ethical. At the age of sixteen, I watched hospice nurses provide palliative care for my mother. She went from a state of complete awareness to complete unconsciousness in a matter of about three days. This was hard to accept for a sixteen year old. I remember the nurses giving large amounts of morphine. I did not know at the time that this was, in a sense, speeding up her dying process. When I came to learn this later, I was mortified and blamed the nurses, not knowing that they were following orders from the doctor and wishes from my father who did not want her to suffer. This stayed with me for years, and I did not fully understand until I was shadowing a nurse on a hospice rotation. She explained to me when and why they do these things during palliative care. In retrospect, I would not have wanted them to treat her any other way, she ended up passing peacefully, and that is how she would have wanted to go. It is personal experiences like these that can affect decisions involving healthcare. Steering away from a personal experience with hospice care, as a nurse, we have to remember that not everyone’s wishes are the same. Personal and societal values differ from person to person. Individual societies and cultures beliefs differ greatly. Some patients would like you to do everything possible to prolong their life while others would rather have palliative comfort care instead of exhausting every clinical avenue to prolong life. It is important from a nursing standpoint that we do not interject our bias on what we think should be done for a certain patient or what we think the families should or should not be doing. Nurses are there as a support system and to provide patients and families with the necessary information. Nurses are not there to provide a personal opinion during a very stressful time. There is a time and a place and nurses need to know that boundary. The inevitability of death must be faced by each human being during a lifetime of living and choosing, relying on culture, belief systems and existing social structures for guidance (Greipp, 1996). The fundamental legal aspects discussed in the case studies involve advance directives, Negligence and malpractice. In the case of Marianne and her family, they face an end of life dilemma. Marianne has no advance directive to inform the family of her end of life wishes. An advance directive should be prepared in advance of when it will be needed. It is advisable for all adults to have one. Generally when a person is unable to make their own decisions, this means you cannot understand the nature and consequences of available health care choices ("Estate Planning- Advance Directives", 2014). The nurse can assist the family by offering to call other family members or a spiritual guide who can offer support to the family in this time of anguish. The doctors and caregiver team can call a family meeting to inform the family of potential outcomes resulting from the surgery. Marianne's family has the right to informed consent as stated by (Blais, & Hayes, 2011, p. 84) "information needs to include the purpose and expected outcomes of the treatment, benefits, risks, and alternative procedures." A designated family member needs to sign the surgery consent if surgery is the route the family decides to take. At this stage, the decision for a code status can be discussed with the family. If a person does not have any type of advance directive the decision to withdraw treatment is made by the family, your doctor or the hospital; if unable to reach an agreement a court will resolve the conflict ("Estate Planning- Advance Directives", 2014). It is Important to provide care and comfort for Marianne while maintaining her dignity. Careful documentation of all interventions, family's reactions, behaviors, discussions and decisions are further important. When a nurse is accused of failure to perform within hospital standards he/she is negligent. The second case study discussed involves this issue. Negligence and malpractice is an obligation one has incurred or might incur thru any act of failure to act. Malpractice involves a professional’s wrongful conduct, improper discharge of professional duties, or a failure to meet the standards of care resulting in the harm of another person; Negligence is the failure to provide care that a reasonable person would ordinarily use in a similar circumstance (Abbas, n.d.). The nurse violated According to Board of Registered Nursing (2013), “Standardized procedures," developed by the healthcare institution (para. (c)). The nurse violated hospital-nursing standards as witnessed and reported by a coworker. Nurses by law may report colleagues for practices that endanger the health and safety of clients. Unfortunately, in this case a patient sustained injury, and the hospital is on trial. The nurse who witnessed the negligence and the hospital had a responsibility to protect the patient (public) from any unethical actions performed by healthcare members. When a lawsuit is in progress, any omissions if discovered later will be detrimental to the case. The nurse shall testify the true according to the notes taken at the time of the incident. If the hospital loses the case, and the nurse is found guilty of malpractice, a "Tort Law" (Blais, & Hayes, 2011, p. 76) law-suit by the patient or the hospital can be initiated against the nurse. When an incident occurs, a case may be opened against a nurse and the involved healthcare organization. Nurses need to be aware of their legal responsibilities in an increasingly changing health care setting. The law expects a certain competence and standards of practice to assure the public that the nurse is capable of providing safe patient care services. In end-of-life choices involving advance directives, the nurse should be advocating the patient’s and the patient’s family’s decision, even though it may conflict with the nurse's values. A nurse has a duty to honor these choices, to ensure safety to patients. Nurses are bound to practice within the scope of the nurse practice acts where the nurse is employed. According to Blais & Hayes (2011), the American Nurses Association has developed standards of nursing practice for specific areas such as maternal-child, medical-surgical, geriatric, psychiatric, and community health nursing” (p. 79). When asked to be a witness regarding negligence by another nurse, the nurse is compelled by law to provide an accurate and truthful statement (Blais & Hayes, 2011). In cases where there is a question of negligence, the nurse is held accountable by law for his or her actions. Failure of the nurse to comply with federal and state laws and in accordance with the nurse practice acts may have detrimental consequences to the patient and the nurse. Ethical and legal issues in nursing are dealt with on a daily basis. As a nurse, it is necessary to be aware of legal aspects involving health care. Legal aspects involving nursing care in the discussed case studies require legal knowledge. The involved legal issues affect decisions by patients and their loved ones and the court of law. The law serves different legal functions in nursing. It provides the framework for establishing which nursing actions are legal, it differentiates the nurse’s responsibilities from those of others, it helps establish boundaries, and it assists in maintaining a standard of nursing practice by making nurses accountable by law (Abbas, n.d.). The American Nurses Association Code of Ethics influences the final decisions of the discussed cases. Personal and societal values also have to be considered. The fundamental legal aspects and responsibilities of nurses all involve legal issues. Both the case of Marianne and the case involving the negligent nurse require a nurse to be both prepared and knowledgeable in regard to ethical and legal issues of nursing.

References
Abbas, A. D. (n.d.). Legal Aspects of Nursing. Retrieved from http://www.conursing.uobaghdad.edu.iq/

American Nurses Association. (2011). Retrieved from http://www.nursingworld.org/Mobile/Code-of-Ethics/code-of-ethics.html?

Blais, K. K., & Hayes, J. S. (2011). Professional nursing practice: Concepts and perspectives (6th ed.). Upper Saddle River, NJ: Pearson.
Board of Registered Nursing. (2013, January). California nursing practice act: Scope of regulation, excerpt from Business and profession code division 2, chapter6. article 2. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-i-15.pdf
Estate Planning- Advance Directives. (2014). Retrieved from http://www.hg.org/advance-medical-directives.html

Greipp, M. E. (1996, September). The hospice choice: Ethical Decision Making. American Journal of Hospice and Palliative Medicine, 13(5), 28-34.