Management of Care / 07

Make sure to:

  • Understand the role of interpreters in healthcare.
  • Demonstrate an understanding of legal issues that affect clients and nurses.
  • Assess the knowledge of legal considerations in healthcare for both clients and staff.

Registered nurses (RNs) are licensed professionals with a responsibility to deliver safe, effective, high-quality, evidence-based care to clients in diverse settings. Noncompliance with professional practice guidelines, local, state, and federal regulations, as well as organizational policies and procedures, can lead to liability.

In this learning experience, the learner will acquire knowledge about the legal issues affecting nurses and nursing practice. More precisely, the learner will develop the skills necessary to provide care to clients who require an interpreter and safeguard themselves from liability in nursing practice.

6.1 Serve as an Interpreter

Nurses and other healthcare team members need to communicate effectively with all clients, and clients should reciprocate this effort. However, language barriers and the inability to communicate verbally can lead to miscommunication, resulting in subsequent medical errors and poor health outcomes for clients. In-person interpreter can facilitate effective communication between clients and their healthcare team members (PBS Newshour, 2023). Telephonic interpreters can be accessed by telephone if the healthcare facility has a subscription, and an in-person interpreter is not available. If dire situations, an ad hoc interpreter (such as a family member or friend) can be used to interpret if neither an in-person nor telephonic interpreter is available.

Nurses should be knowledgeable about state and federal mandates as well as the healthcare facility’s policies regarding interpreters (Burke, 2023). Healthcare agencies and organizations that receive federal funds have been required to provide interpreters for clients in need since 1999. The Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 mandate that healthcare facilities caring for deaf individuals must offer sign language interpreters (Burke, 2023). The Civil Rights Act of 1964 and Title VI of this law protects clients who were not born within the US and for whom English is a second language (ESL) from discrimination. Therefore, interpreters must be available to individuals with ESL. Once the appropriate interpreter is secured, it is important to position oneself at equal distance from the client and the healthcare provider, ensure privacy during physical examination, and verify the accuracy of the interpretation (Fisher, n.d.).

6.2 Legal Issues that Affect Clients

According to Kaplan Nursing (2023a) nurses should:

  • Familiarize themselves with legal issues that affect clients and understand the appropriate responses to them.
  • Seek assistance for tasks and assignments they are unable to perform.
  • Manage clients’ valuables with care and in an appropriate manner.
  • Comply with reporting mandates.

False Imprisonment

Clients enter healthcare facilities for the management of illness or prevention of diseases. However, there are times when they refuse treatment (Kaplan Nursing, 2023a) and may wish to leave the healthcare facility before discharge. In the latter case, they may feel they are being held against their will if a nurse attempts to prevent their departure from the facility. Instead of doing so, the nurse should adhere to the facility’s policy and procedure for “discharge against medical advice.” According to Kaplan Nursing (2023b), typically, the client is asked to sign a document indicating their understanding of their medical condition and their decision to leave the facility, even if their healthcare provider recommends staying. Clients can lodge complaints of false imprisonment if the nurse prevents them from leaving the facility after a discharge order has been issued or after signing the “discharge against medical advice” document. This can also occur if a nurse applies restraints to a client who does not have a medical need (Kaplan Nursing, 2023b).

Professional License

Nurses hold a legal responsibility to their clients, and their professional license grants them this privilege. To practice as a nurse, they must obtain licensure in the state where they work and adhere to the state laws delineated in their Nurse Practice Act, as well as the regulations established by their state board of nursing, and any relicensure requirements (Burke, 2023). One way to safeguard their license and ensure client safety of clients, is by seeking assistance with tasks or assignments within their job description when they lack confidence in performing them. Additionally, it is crucial to comply with national mandates, such as those set forth by the Centers for Medicare and Medicaid Services, and local regulations, such as those governing the disposal of biohazardous waste (Burke, 2023).

Client Valuables

According to Burke (2023), clients may enter the healthcare facility with valuables such as jewelry, cash, credit cards, and legal documents. Facilities typically prefer not to hold client valuables, but if exceptional circumstances require it, the nurse must:

  • Place the valuables in an envelope that is labeled with the client’s name, room number, and contents. Use precise and appropriate terminology when describing jewelry; for instance, avoid using “gold”, but it is acceptable to use terms such as “yellow.”
  • Document that the client willingly relinquished their valuables.
  • Store the envelope in a secure, locked safe or the designated location.   
  • Have the client acknowledge receipt of the envelope's contents upon the return of their valuables.

Legal Issues

Some legal issues that affect nurses include:

  • Malpractice – This occurs when a nurse either engages in wrongful actions or lacks the expertise to perform their nursing duties. Duty (establishing a nurse-client relationship), breach of duty, causation (injury occurring after the nurse’s action), and actual injury are necessary components for malpractice to be applicable.
  • Negligence - This occurs when a nurse fails to provide care that another nurse in the same situation would typically offer. Negligence is usually unintentional and may involve actions the nurse should have taken but didn't or omissions of necessary care.
  • Battery – A nurse may face a lawsuit for battery if they touch a client in a non-professional manner without their explicit permission.

6.3 Assessment of Client and Staff Knowledge of Legal Issues

According to Burke (2023) and Kaplan Nursing (2023), nurses have a responsibility to educate both their clients and staff about legal issues that can impact clinical practice. The nurse must report:

  • Child abuse or neglect.
  • Adult abuse and/or neglect.
  • Gunshot wounds.
  • Communicable diseases.
  • Dog bite.

Additionally, nurses are also expected to report unsafe practices, such as inadequate staffing, diversion of narcotics by healthcare team members, substance abuse, and “improper” care of clients (Burke, 2023). Finally, nurses are to adhere to their state-specific Nurse Practice Act, scope of practice, and competence when accepting assignments in clinical settings.

Conclusion

Upon concluding this learning experience, learners will acquire a deeper understanding of legal considerations. The provided resources will help learners gain proficiency in medical interpretation and legal issues in nursing practice. The goals are to support success on the NCLEX examination and in the workplace.

After reviewing the resources, take time to reflect and identify specific areas for improvement, and concentrate on those areas.

  • Burke, A. (2023, August 14). Legal Rights and Responsibilities: NCLEX-RN. https://www.registerednursing.org/nclex/legal-rights-responsibilities/
  • Fisher, Y. (n.d.). 3 Useful Positioning Tips for a Healthcare Interpreter. https://interpretertrain.com/3-useful-positioning-tips-for-a-healthcare-interpreter/
  • Kaplan Nursing. (2023a). Next Generation NCLEX-RN Prep 2023-2024: Practice Test + Proven Strategies (9th ed.).  Kaplan Test Prep.
  • Kaplan Nursing. (2023b). NCLEX-RN Content Review Guide (9th ed.). Kaplan Test Prep.
  • PBS Newshour. (2023, May 28).Why Medical Interpreters Can Be a Vital But Scarce Resource [Video]. https://www.pbs.org/video/translating-medicine-1685300019/

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