1
Q
what are the legal & ethical responsibilities of nurses (5)
A
- follow laws & guiding documents
- meet entry lvl competencies
- gain competence in a specific area of practice
- maintain fitness to practice
- continuous learning
2
Q
what is an example of a document that gives direction that is a law
A
- Regulated Health Professions Act: Practice of Registered Nurses
3
Q
what is are 2 example of a document that gives us direction that is a regulation
A
- The Regulated Health Professions Act: College of Registered Nurses of Manitoba General Regulation
- CRNM Practice Direction: Practice Expectations for Registered Nurses
4
Q
what is an example of a document that gives us direction r/t ethics
A
- CNA Code of Ethics for Registered Nurses
5
Q
what is the regulated health professions act
A
- an umbrella act (statute) that governs the practice of 21 different health professions, with profession specific regulations
- sets our consistent rules and processes for all RHP
6
Q
what is the regulated health professions act
A
- an umbrella act (statute) that governs the practice of 21 different health professions, with profession specific regulations
7
Q
what does the regulated health professions act outline (8)
A
- defines the actions that can be done by a HCP (“reserved acts) –> these pose a risk of harm to the public so must be regulated for public safety
- limits the performance of reserved acts to HCP
- defines how professions are designated and governed
- defines how the profession registers its members
- restricts the use of titles such as “registered nurse” or “doctor” to people who are qualified
- establishes the requirements for standards of practice, code of ethics, practice directions, continuing competency programs, professional conduct, a process for managing complaints
- sets out the process for becoming a regulated profession
- defines health professions
8
Q
what is the practice of registered nursing regulation (4)
A
- defines which reserved acts (actions done by a HCP outlined in the RHPA) that can be performed by registered nurses (scope of practice)
- defines the scope of practice of nurses
- describes requirement for licensing
- describes education required
9
Q
the college of registered nurses of manitoba general regulation provides detail on: (7)
A
- the process and requirements to become (and remain) a RN –> licensing requirements
- the use of title (ex, RN)
- reserved acts and the circumstances under which a nurse can perform them
- standards & scope of practice for RN
- sets out its process for dealing w complaints against a RN
- manages complaint & discipline process
- sets Practice Expectations
- maintains lists of RNs (register)
10
Q
what is the designated regulator for RNs
A
- the college of registered nurses of manitoba (CRNM)
11
Q
what is the CRNM’s primary goal
A
- to protect the public
12
Q
as the regulator, the CRNM uses the RHPA, regulation, and code of ethics to: (6)
A
- establish the process & requirements for practice
- set the standards for registered nursing education & practice
- determines entry lvl competencies (things a person needs to be able to demonstrate they know in order to safely practice nursing)
- approves education programs that prepare students to meet the competencies
- support nurses to meet the standards thru practice consultants
- take action when standards are not met
13
Q
the CRNM sets basic requirements for registered nursing practice, including: (3)
A
- completion of an accredited program
- passing the NCLEX-RN exam to demonstrate knowledge of entry lvl competencies for nursing practice
- meeting standards of nursing practice
14
Q
what is a competency
A
- the integrated knowledge, skills, abilities, and judgement required to practice nursing safely and ethically
15
Q
what are 5 categories of competencies
A
- professional responsibility and accountability
- knowledge-based practice (specialized body of knowledge and competent application of knowledge)
- ethical practice
- service to the public
- self-regulation
16
Q
what is the continuing competence program
A
- ensures that nurses are using the most current info to guide their practice & are always learning and improving
- program that every RN must complete
17
Q
what does the continuing competence program include (9)
A
- self assessment
- self-development plan
- learning goals & plan
- jurisprudence learning module
- minimum practice hours
- documentation of learning activities to meet goals
- evaluation of impact of learning activities on your practice
- declaration of completion of various components of program each year
- multi-source feedback
18
Q
what is the minimum practice hours requirements
A
- 1125 practice hours over 5 years
- or 450 hours in past 2 years
19
Q
what are CRNM practice direction (5)
A
- minimum expectations for safe, competent nursing practice
- more detailed than regulations
- written statements on matters relevant to registered nursing practice
- articulates the expectations the public can have of a registered nurse & describe how a RN is to practice, at minimum
- serve as a legal reference to describe reasonable and prudent nursing practive
20
Q
describe the compliance with practice directions
A
- is required
21
Q
what occurs when a pt, family member, colleague, or supervisor feels that a RN is not meeting standards?
A
- a complaint can be made
- CRNM may also initiate an investigation process if it identifies registered nursing practise that falls short of standards
- there is a specific process that is followed to review and investigate complaints
22
Q
what type of issues may result in a complaint (4)
A
- profession misconduct
- incapacity or unfitness to practice nursing
- sufferring from ailment
- conduct unbecoming a registered nurse
23
Q
describe the complaint process (6)
A
- must be transparent and fair (objective)
- hearings open to the public
- complaints and injury committees must include a public representative –> one of the members must not be a nurse (guards against appearance of bias when it is not only nurses adjudicating nurses)
- an investigation gathers evidence from the complainant & the nurse
- complaints investigations and inquiries examine the nurse’s conduct & make determinations based on the Standards of Practice or Code of Ethics
- committee makes a determination about which standards or values were breached, if any
24
Q
what is professional misconduct
A
- an act or omission which falls short of what would be proper in the circumstances
- most serious of the possible charges against a RN
25
what are examples of professional misconduct
- any abuse of a client or health care team member
- falsification of a record
- abandonment
- breaking the law (ex. PHIA)
26
what are examples of professional misconduct
- any abuse of a client or health care team member
- falsification of a record
- abandonment
- breaking the law (ex. PHIA)
27
what is negligence
- conduct that falls below the standard that is considered desirable within the nursing community
- failing to take the care that a reasonable & prudent HCP would take in order to prevent harm to the pt
28
what are common negligent acts (6)
- medication errors
- failure to monitor a pt's condition adequately
- falls resulting in injuries to a pt
- pressure injuries from inadequate repositioning
- failure to remove foreign objects (ex. surgical sponge left in pt after surgery)
- failure to communicate effectively w other members of healthcare team , including poor handoff (ex. didnt mention low BP)
29
what is the tort of negligence
- a civil wrong that occurs (between individuals, or individuals and organizations) and harm results
- the person who was harmed (or their family) seeks redress
30
in order to be found negligent, the following elements must be proved by the plantiff (person who was harmed)
- duty of care *
- breach of duty *
- foreseeable harm caused by breach (presence of injury/damage) *
- causation*
- the pt did not contribute to the negligence and/or accept a risk voluntary
* = essential element of negligence
* all of these must be demonstrated to be found guilty of negligent*
31
in order to be found negligent, the following elements must be proved by the plantiff (person who was harmed)
- duty of care *
- breach of duty *
- foreseeable harm caused by breach (presence of injury/damage) *
- causation*
- the pt did not contribute to the negligence and/or accept a risk voluntary
* = essential element of negligence
* all of these must be demonstrated to be found guilty of negligent*
32
describe duty of care r/t negligence
- to be found guilty of the tort of negligence, the nurse must have had a duty to provide care for the pt
- duty of care is described in law as "the duty to exercise a reasonable degree of skill, knowledge, and care in the treatment of a pt"
33
what is included in duty of care (3)
- a duty to adhere to evidence-informed protocols and procedures that minimize the risks of harm
- a nurse-pt relationship existed, giving the pt reasonable expectation they would receive care (ex. was the assigned nurse)
- the nurse is legally required to act in a manner that meets or exceeds the standards of care of a reasonable prudent caregiver or HCP
34
what is involved with the duty of care (5)
- duty to attend to pt (hands & eyes on pt)
- duty of care & skill (ex. diagnosis & treatment) --> need to be competent to perform the skills required
- duty to keep adequate and accurate records --> timely, accurate documentation
- duty to refer or seek out advice of others --> questions, clarify, confirm
- duty to communicate with others involved in care --> handoffs, effective reports
- duty to supervise colleagues w less experience --> mentorship and practice support
35
what is breach of duty
- when there is a duty of care, the standard of care that a reasonable, prudent nurse would provide was not met
36
breach of duty is based on evidence from: (4)
- the pts medical record (documentation)
- organizational policies
- staffing lvls and policies
- experts
37
what is injury or harm r/t negligence
- the breach of duty must have caused harm to the pt
- must be financially compensable harm or damages to the pt
ex. loss of income or earning potential, property damage, injury, death, disability
38
the degree of harm determines....
- the size of the award
| - more harm = more money
39
what is causation
- the injury or harm must be caused by the nurse's action or inaction
- a clear link must be demonstrated
40
describe the requirement of absence of contributory negligence and/or voluntary assumption of risk r/t negligence
- the pt's conduct may be partially or completely defeat their claim if the pt did something to contribute to the harm they experienced
- or if the pt provided informed consent to the event that cause harm
41
describe an imp consideration r/t absence of contributory negligence and/or voluntary assumption of risk
- there can still be a finding of negligence even if it is demonstrated that the pt contributed to the harm or voluntary assumed the risk
- the degree to which the pt contributed impacts on the extent or amt of damages paid out
42
see slides for examples of criminal negligence, not much point memorizing this for an open book exam
...
43
preventing complaints & legal action requires: (3)
- meeting standards (the minimum acceptable care (ex. freq of assessments, evidence-informed interventions)
- communication (oral, written, timely & effective reports)
- documentation (clear, timely of everything assessed & done)
44
what are the purposes of documentation (6)
- communicate client health info with other members of the care team
- provide continuity of care --> ensure each shift knows what happened previously
- demonstrate how care met standards
- hold nurses accountable for compliance w professional standards of care
- provide quality assurance thru chart audits; accreditation
- facilitate research (allows the connection of various factors, illness, pt condition, care provided, etc., to outcomes)
45
in the context of a nursing negligence lawsuit, documentation provides: (4)
- a chronological record of events ( from admission to discharge, including plans, assessments, interventions)
- evidence to show that nursing process was reasonable & prudent (demonstrates rationale for care decisions)
- evidence of compliance w professional nursing standards
- evidence of the "bigger picture" of communication
46
what is the most reliable defense against allegations of negligence and violation of nursing standards
- the medical record (documentation)
47
what is the most reliable defense against allegations of negligence and violation of nursing standards
- the medical record (documentation)q
48
the frequency and amount of documentation is dictated by: (4)
- facility/agency policy & procedure
- complexity of health problems & pt situation
- degree to which pt's condition puts him at risk (more acute = more documentation)
- degree of risk involved in the treatment of care (higher risk interventions need more detail)
49
what does the acronym FACT stand for r/t documentation
```
college documentation guidelines suggest the following principles should guide documentation:
Factual
Accurate
Complete
Timely
```
50
describe the Factual aspect of documentation
- descriptive
- objective
- directly observed or measured
51
describe the Accurate aspect of documentation
- exact measurements
| - as precise as possible
52
describe the Complete aspect of documentation
- all appropriate or relevant info including status changes, interventions, pt's response, communication w pt, family & team
53
describe the timely aspect of documentation
- as close to when it happened as possible to ensure a clear record of what happened when
54
what are 3 examples of errors in documentation
- info required for care & treatment of pt is omitted from record (ex. allergy or assessment not recorded)
- incorrect/inaccurate/vague info recorded in chart (wrong dose of drug, wording unclear)
- HCP fail to read the chart (info present but not acted upon)
55
what are rules for documenting (15)
- write legibly
- write accurately (with clarity, without error, or ambiguity)
- record concisely
- record events chronologically (or ASAP after they occur)
- regular entries
- person involved in events records entry (only chart what you do)
- entries signed by person who wrote them w designation
- write in permanent ink
- use uniform & professional terms
- avoid abbreviation
- record date & time
- use uniform system of recording throughout facility
- do not leave blank spaces
- correct errors opening and honestly (cross out but leave visible, date and time, initial)
- avoid editorial comments
