Every medical professional has or will face some ethical and legal issues in the Medical Field, the Nurse Practitioners (NP) are no different. Fant stated that in an ethical dilemma there are no right answers or solutions; however, in these dilemmas there are no wrong answers either. Sule feels that the ethical issues for NPs are in consent and capacity, confidentiality and autonomy, and in the non-compliance on part of patient. Offredy and Townsend both feel that a breech in clinical governance and management can cause quite a few legal issues.
As physicians are susceptible to malpractice lawsuits, NPs can be charged for the same as well. Pozgar defined Nurse Practitioners as, “…a registered nurse who has completed the necessary education to engage in primary health care decision making. The NP is trained in the delivery of primary health care and the assessment of psychosocial and physical health problems, such as performing routine examinations and ordering routine diagnostic tests.
The NP provides primary health care services in accordance with state nurse practice laws. ” Croke found that between 1998 and 2001 there was an increase of, “… the number of malpractice payments made by nurses increased from 253 to 413 (see Figure 1, page 55). The trend shows no signs of stopping, 1-3 despite efforts by nursing educators to inform nurses and student nurses of their legal and professional responsibilities and limitations.
A charge of negligence against a nurse can arise from almost any action or failure to act that results in patient injury—most often, an unintentional failure to adhere to a standard of clinical practice—and may lead to a malpractice lawsuit. ” Croke also stated that one of the issues was, “Early discharge. Patients are being discharged from hospitals at earlier stages of recovery and with conditions requiring more acute and intensive nursing care. Nurses may be sued for not providing care or not making referrals appropriate to the patient’s condition.
Throughout her research Croke found 350 trials, 350 trial, appellate, and supreme court case summaries, which were drawn from legal research sources such as the NPDB; regional reports and digests; the LexisNexis database; the Internet portals FindLaw and MedLaw; secondary sources such as nursing malpractice insurance information; and professional newsletters, journals, and books, including Medical Malpractice Law & Strategy, Legal Eagle Eye Newsletter for the Nursing Profession, Journal of Legal Nurse Consulting, Journal of Nursing Law, Legal and Ethical Issues in Nursing, Nurse’s Legal Handbook, and Nursing Practice and the Law.
Fant wrote that every NP will face some sort of Ethical Dilemma in the work place on a daily bases due to, “…quality versus quantity of life, pro-choice versus pro-life, freedom versus control, truth telling versus deception, distribution of resources, and empirical knowledge versus personal beliefs. ” One of the most important things that a medical professional to deal with is determining whether or not a patient will have quality of life and/or quantity of life, a patient can live a long life, but may not be able to have the best quality of life.
For example, a patient may be able to live a long life but would be unable to wake from a coma. Another dilemma would be pro-choice versus pro-life, Fant described this best as, “This issue affects nurses personally. Many of the positions nurses assume in this dilemma are influenced by their own beliefs and values. How does a nurse care for a patient who has had an abortion, when the nurse considers abortion murder? Can that nurse with very opposing values support that patient’s right to choose, her autonomy? There are more dilemmas that nurse face everyday quality versus quantity and pro-choice versus pro-life are just two of them.
For Sule, two of the issues, she mention, areas were ethical issues rise in are consent and capacity, and confidentiality and autonomy. Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’.
However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment. ” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy.
According to Sule, “This is another ethical issue erupting from the conflict of patient’s rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient’s health and treatment.
This can cause conflicting issues in the NP’s judgment in a patients care could possibly cause issues for the NP and/or hospital. Offredy and Townsend’s research found that, “This study highlights the variation in how patients are allocated for NP consultation and in NP autonomy, prescribing and referral, which raises issues for clinical governance of protocols and risk management. ” This means that somewhere in the line someone was making calls that he/she had no place in doing so. This also means that there can and will be ramifications on a legal scale for the medical facility(s) involved.
They started their research with the idea that, “Recent policy emphasizing the role of primary care has increased the workload of general practitioners (GPs) while simultaneously placing nurse practitioners (NPs) as key providers in the delivery of health care. There is need to examine the latter’s work practices. The purpose of this article is to explore the role and practice of NPs in general practice. ” What they found was that, “Over the last 15 years there has been a shift in health care management to one in which nurses have taken on some roles previously undertaken by doctors and support workers have taken over some nursing roles.
This has occurred in the UK, the USA and Australia, driven by efforts to reduce cost and by increased specialization, advances in technology and reallocation of care functions from secondary to primary settings. ” This means that those with no prior knowledge are going into “roles” that actual surgeons and doctors would normally man. With this information there is a shortage of personnel with actual knowledge of the field.
Offredy and Townsend both stated that, “In practice 1, the NP reported that patients learned of her role through open access surgeries held each morning by a GP or herself; surgery consultations with her via receptionist triage; and through her daily 1 hour telephone consultations with patients needing advice, also triaged via the receptionist. In two other practices patients were informed of the NP’s role by leaflets displayed on the surgery noticeboard (NP2 and NP3), and the NP in the fourth surgery ‘educated the receptionists about the role of nurse practitioners, including a list of what nurse practitioners can do’ (NP4).
This ‘practice’ can definitely cause issues if something went wrong, i. e. a patient dying, for the facility and for the NPs involved. Ethical and legal issues arise when there are breaches in protocol, patient care, and management. Fant, Sule, Offredy and Townsend have made excellent points in their articles about ethical and legal issues. Ethical problems will always rise; however, a patient’s health should be the first thing on a medical professional’s mind. As for legal issues, document everything and know the medical laws of your city and state.