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chapter 3 | Nursing Practice and the Law 27 CikguOnline
The courts have upheld the authority of boards Patient’s Bill of Rights
of nursing to regulate standards. The boards
In 1973 the American Hospital Association
accomplish this through direct or delegated statu-
approved a statement called the Patient’s Bill of
tory language (ANA, 1998; 2004). The American
Rights.These were revised in October 1992.Patient
Nurses Association (ANA) also has specific stan-
rights were developed with the belief that hospitals
dards of practice in general and in several clinical
and health-care institutions would support these
areas (see Appendix 2). In Canada, the colleges of
rights with the goal of delivering effective client
registered nurses and the registered nurses associa-
care. In 2003 the Patient’s Bill of Rights was
tions of the various provinces and territories have
replaced by the Patient Care Partnership. These
developed published practice standards. These may
standards were derived from the ethical principle of
be found at cna-aiic.ca
autonomy. This document may be found at
Institutions develop internal standards of practice.
aha.org/aha/ptcommunication/partnership/index
The standards are usually explained in a specific insti-
tutional policy (for example,guidelines for the appro- Informed Consent
priate administration of a specific chemotherapeutic
Without consent, many of the procedures per-
agent),and the institution includes these standards in
formed on clients in a health-care setting may be
policy and procedure manuals. The guidelines are
considered battery or unwarranted touching. When
based on current literature and research. It is the
clients consent to treatment, they give health-care
nurse’s responsibility to meet the institution’s stan-
personnel the right to deliver care and perform spe-
dards of practice.It is the institution’s responsibility to
cific treatments without fear of prosecution.
notify the health-care personnel of any changes and
Although physicians are responsible for obtaining
instruct the personnel about the changes. Institutions
informed consent, nurses often find themselves
may accomplish this task through written memos or
involved in the process. It is the physician’s respon-
meetings and in-service education.
sibility to give information to a client about a
With the expansion of advanced nursing prac-
specific treatment or medical intervention (Giese v.
tice, it has become particularly important to clarify
Stice, 1997). The individual institution is not
the legal distinction between nursing and medical
responsible for obtaining the informed consent
practice. It is important to be aware of the bound-
unless (1) the physician or practitioner is employed
aries between these professional domains because
by the institution or (2) the institution was aware or
crossing them can result in legal consequences and
should have been aware of the lack of informed
disciplinary action. The nurse practice act and
consent and did not act on this fact (Guido, 2001).
related regulations developed by most state legisla-
Some institutions require the physician or inde-
tures and state boards of nursing help to clarify
pendent practitioner to obtain his or her own
nursing roles at the various levels of practice.
informed consent by obtaining the client’s signature
at the time the explanation for treatment is given.
Use of Standards in Nursing Negligence
The informed consent form should contain all
Malpractice Actions
the possible negative outcomes as well as the posi-
When omission of prudent care or acts committed tive ones. Nurses may be asked to obtain the signa-
by a nurse or those under his or her supervision tures on this form. The following are some criteria
cause harm to a client,standards of nursing practice to help ensure that a client has given an informed
are among the elements used to determine whether consent (Guido, 2001; Kozier, Erb, Blais, et al.,
malpractice or negligence exists. Other criteria may 1995):
include but are not limited to (ANA, 1998):
■ A mentally competent adult has voluntarily
■ State, local, or national standards given the consent.
■ Institutional policies that alter or adhere to the ■ The client understands exactly to what he or she
nursing standards of care is consenting.
■ Expert opinions on the appropriate standard of ■ The consent includes the risks involved in the
care at the time procedure, alternative treatments that may be
■ Available literature and research that substanti- available, and the possible result if the treatment
ates a standard of care or changes in the standard is refused.