Legal and Professional Issues in Nursing

This article discusses the key concepts of accountability and responsibility in nursing and midwifery practices. It explores the ethical guidelines and legal implications in healthcare, with case studies and reflections on legal and professional issues in nursing.

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Legal and professional issues in nursing
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Introduction
The key concepts of accountability and responsibility are often interlinked in an avenue of
determining the scope of nursing and midwifery health care practices. Nurses and midwives
have the sole responsibility and thus are critical in establishing accountable practices. Aspects
of responsibility and accountability are fundamental cornerstones needed in professional
nursing and midwifery practices, as they have been entrenched in the code of professional
conduct and ethics guidelines for both nurses and registered midwives in the profession
(Birks, Davis, Smithson & Cant, 2016). Responsibility refers to the obligation of duty
performances and duties to perform effective judgment in clincila practice and being able to
answer key decision undertaken. As a practicing nurse or midwife, expanding the scope of
practices is geared towards having a greater responsibility. Accountability refers to being able
to give an account of health care practitioner judgments, omissions, and actions.
Accountability entails maintenance of competency and safeguarding outcome of patients
(Harvey et al., 2018).
Nurses and midwives ought to give reasons for decisions they make in health care and justify
them in the contextual legislation, professional standards, and set guidelines, evidence-based
practices, and ethical perspectives. Nurses and midwives need to be both professionally and
legally accountable in their practices, in the manner in which they act and practices in their
decisions (Casey et al., 2017). Accountability begins with nurses and midwives actions on the
patients, the public, their employers and the regulatory set bodies. Accountability often
cannot be achieved without autonomy in the practice. Autonomy refers to the nurses having
the role of making key decisions in the ir professional practices and the right to perform
based on shared decisions.. Professional autonomy entails the usage of wide skills in a
process which offers safe and high-quality service to the patients (Terry, Carr & Halpin,
2017).
In this task, assessment of three case studies is being reviewed about nurses and midwives
both practising and registered categories in the application of professional codes, standards,
guidelines and application of ethical problems and guidelines in solving various challenging
scenarios in health care practice.
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Case study one
In this case study, the patient is due to receive gynecology care procedures and is due for
anesthesia. The patient during consent request form decline to have student practitioner to be
present while undertaking the procedure. The conflict arises when the registered nurse mentor
advice on going to the anesthesia room to observe the procedure.
Under the review, State and Territorial legislation on informed consent to clinical procedures
10.47 Common law, a competent adult can give consent or decline medical treatment process.
In cases where consent is not offered, there are legal outcomes which are bound to arise
among health professionals. In the law, trespassing patient’s rights such as the ones stated do
not permit invasive procedures without the required consent.
Under the law, section 10.48 of common law, refers to informed consent as the medical
consent treatment approval which offers the patient the material risks about the treatment
process. Due to guidance and following duty of care, health professionals need to provide
patient such information as necessary as possible to give consent treatment including
information on the intended treatment process. Failure to adhere to patients consent often
leads to civil liability for adverse effects due to negligence on patient consent.
This case presents a rather challenging and interesting medico-legal dilemma about the
patient refusal to the process. Legally the patients have the capacity and competence to make
decisions by themselves. Under common law practices, adults are often presumed competent
unless proven otherwise (Johnstone & Facn, 2019). The tests being assessed refers to
competence in functionality. This refers to the ability to the key step of decision making
process. The law offers an avenue of being able to understand ad retain key information and
to assess the case before reaching a key decisions.
This thus offers a challenging decision to the health care provider, the registered nurse
mentor. Allowing the student nurse into the anesthesia room in opposite conflict with patient
wishes and consent is subverting the consent rights and will of the patient. Subverting this
amounts to gross misconduct on ethical and consent forms required for health care registered
nurses and practitioners. As much as learning is concerned, the patient's rights outweigh the
overall learning process. The aspect of seeking informed consent on the patient is aimed at
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seeking approval and allowing the following of the ethical codes and regulations which
govern the health care practices (Black, 2016).
The implication herein thus puts the student nurse and the registered nurse mentor in an
awkward position bearing in mind the clear guideline guiding ethics and regulations for
health care professionals. Subverting this norms and guidelines is fundamental and leads to a
direct bridge of trust and will of the patient. going contrary to the patient rights and wishes
will further jeopardize the health facility status, which will be likely be sued by the patient
thus impacting negatively putting into focus its operations with regarding patient care
practices. The legal procedure has significant ramifications such as license withdrawal and
penalty fees which may be awarded to the patient (Driscoll & Masters, 2018).
Case study two
The second scenario depicts infection control practices at the health care facilities. In
Australia, it is estimated there are about 200,000 healthcare-related associated health care
infections. This leads to health associated infections to affect the majority of the patients.
Having a clear understanding of the modes of infections and organisms of infections is
essential towards applying the underlying principles of infection prevention. Thus prevention
control is critical in the infection management program.
Understanding how infection occurs is critical towards the management of transmission and
further understanding of how to apply the principles of infection and prevention management
is essential in managing the infections. This sole responsibility applies to all health care staff.
Successful approaches have been linked to the reduction of infection among the patients.
These practices entail actions of hand hygiene which is essential in managing and reducing
the spread of infections.
Guidelines and recommendations outline key aspects which guide the prevention of infection
control. The primary national infection control has offered the Australian guidelines for the
prevention and control of infection in the health care arena. These guidelines are crucial in
safety and quality health care practices and provide a basis for the health care staff to develop
protocols for infection control at local settings such as hand hygiene practices.
Effective hand hygiene practices are an essential aspect and most efficient strategy in the
prevention of healthcare-associated infections. Infectious agents can be potentially
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transmitted by touch. Majority of microorganisms are either present or acquired during
various activities in the health care leading to transient flora. Hands can be a source of
frequent contamination due to cross-transmission from the environment (Grayson et al.,
2018).
Hand hygiene often becomes contaminated with infectious substances in the patient
surroundings; further, cross-contamination can occur at these instances. Practising hand
hygiene practices before any patient episode contact is critical towards potential
contamination to other patients.
Strongly recommended hand hygiene and washing guidelines entail washing of hands before
patient contact, any procedure, after body activity, while having contact with the patient and
after touching the patient environment. Increasing hand hygiene practices in health care is an
essential aspect and a key strategy in improving and minimizing the spread of antibiotic and
resistant organisms. Poor hand hygiene practices are linked to health care infections. Hand
hygiene has been prioritized by the Australian Commission on Safety and Quality in Health
Care. Thus as a matter of legal requirements, there is a need for health care practitioners to
adhere to hand hygiene guidelines which state critically instances of hand hygiene practices.
The hand hygiene manuals followed by health care institutions offer guidelines for the 5 key
moments for hand hygiene, (Atkins et al., 2017).
The overall implication of neglecting this aspect in practice is the spread of infectious
diseases in the facility. Increased levels of infection at the hospital setting increases the health
care costs and increased length of stay at the facilities. There is needed to be compliant with
the national health hygiene initiative which is tasked with ensuring that there is hand hygiene
adherence among the health care staff. The key aim of this initiative is to increases hand
hygiene practices among health care staff to reduce infections.
Case study three
Nursing students in practicing health care settings can increase risks associated with
consumers if they can practice safely. Australian based organization AHPRA and the
National Boards have introduced testing procedures for all practitioners. Mandatory testing
for all registered practitioners on substance abuse-related under screening protocol
procedures is essential. In this protocol, health practitioners have restrictions linked to drug
abuse. As an ethical aspect, there is a need to adhere to set regulations and guidelines
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concerning drug abuse management in health care. AHPRA has introduced clear guidelines
in reviewing and managing interim drug screening protocol introduced in 2014 for managing
practitioners concerning drug-related impairment.
The role of AHPRA is to regulate and accredited practitioners which in turn protects the
patients and to manage risks to patients. As a health care practitioner, following strict
guidelines on codes of practice is essential. Ethically it is not an appropriate form of decorum
among health care staff (Delaney & Helyard, 2018).
Adherence on scientific based approaches towards evidence based application of medicine is
observed to enhance the relationship between the doctor and the patient. Offering medical
knowledge has observed the recognizance on the improvement of interpersonal skills and
improving professional skills and attitudes which promote safe health practices. Research has
shown that about 15% of medical practitioners are impaired at a certain point in time. During
this process, they end up making incorrect diagnoses leading to failure to treat patients
effectively. The medical practitioner can be inclined to offer medical needs to the patients
based on their emotional states. In other cases in an extreme situation, sexual exploitation is
often observed as a most serious problem leading to violation of boundary leading to
compromising of the patient care (Satchell et al., 2016).
Substance abuse in health care practice can lead to flawed problems leading to depressions.
Depressions among health care staff can lead to suicidal thoughts. Risk factors have been
linked to a younger age, drug abuse, personal loss and another adverse event on the
individual health care practitioner. In scenarios where the medical students are faced with
suffering they often survive through emotional distress or dehumanizing the patients. This is
further promoted by the aspect of the promotion of devotion of work despite the inherent
personal problems facing them (Lynn & Brownie, 2015).
Thus the implication of allowing this state is beyond the norm of ethical care principles and
needs not to be allowed to care for any patients at this point. Thus ethically it is not right to
allow the student nurse to continue offering care services at the state. Code of ethics does not
allow for medical misconduct (McDonald & Then, 2019).
According to NMBA, standards of practice for nurses allows for professional boundaries
when dealing with patients. This practice guide allows nurses in health care practice to
engage safely and effectively in enhancing professional relationships. Adherence to
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professional boundaries allows for promotion of person-centered care and protecting both
parties involved. Thus following the standards of practice is essential in this context (Nursing
and Midwifery Board of Australia -NMBA, 2018).
Reflections
In my reflection of these three scenarios I encountered in the nursing practice has been met
with challenging scenarios. In the previous experience, the case study of an elderly patient
admitted at the hospital. Clinical assessment showed stridor occurrence and diffuse
symmetrical at the large goiter. The patient assessment revealed recommendation for
thyroidectomy which necessitates surgical procedure. However, upon requests for surgical
consent approval, the patient declined. The patient proved to be incapable of making a
competent decision despite several instances of conviction. The patient refused till legal
consent was sought which allowed for the medical process to be done based on the ethical
principle of o harm and beneficence. This case presented a challenging situation and offered
social dilemmas in health care.
Merging the experiences in these case studies displays challenges which happen in health
care practice. In my assessment, failure to adhere to set guidelines and procedures can lead to
significant effects on the overall process in health care practice. There is a need to adhere to
set guidelines in my practice in ensuring that the set legal requirements in student nurse
practice and code of ethics for health care practitioners adhere. The above scenarios have
offered me critical thinking into this perspective by enhancing and ensuring that proper
guidelines and the norms of practice are followed when dealing and enraging with patients in
health care practice.
As health care practitioners, guidelines and rules of engagement on patient care ought to be
followed. There is a need to adhere to all binding laws as set out by territorial laws and other
practice guidelines and accrediting institutors. Failure to adhere to these aspects leads to
breach of patient safety and can lead to the increased cost of health care and implications on
the general health care practice arena.
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Conclusion
Registered nurses in Australia get their registration in line with the inception of nursing and
midwifery board of Australia. This entity forms part of the Australian Health Practitioners
Regulation Agency – AHPRA. Registered nurses qualify in the sense they have certified the
board for completion of causes in the field of nurses. Registered nurses are further obliged to
meet certain standards and stipulated registration standards as outlined by NMBA.
Thus to provide safe and quality health care, there is a need to be cognisant of legislation and
regulation adherence. Adherence of various nursing policy regulations such as the Health
Practitioners Regulation National Law Act 2010 and other regulations are vital as a nursing
practitioner.
Hence following the key outline of accountability and responsibility is a key avenue of
promoting positive health care practice in health care. As nurse patient safety is of critical
importance in the nursing arena. Promoting the safety of patients is one of the fundamental
standards of practice for registered nurses. Adhering to these regulations and set guidelines to
ensure patient safety and overall improvement of quality of health care and the promotion of
health. The case scenarios have offered an opportunity for enhancing the overall skills and
scope of practice to entrench in health care practice as a registered nurse. The critical lessons
learned offers an opportunity for further improvement and promotion of health care to the
patients and overall improvement of service delivery among health care service providers.
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