Potter and Perry’s Canadian

Fundamentals of Nursing, 7th Edition

Barbara J. Astle, RN, PhD

Wendy Duggleby, RN, PhD
 Chapter 10

Legal Implications in Nursing

Practice
 Learning Objectives

 Differentiate between the governance

roles of the four “pillars” of the nursing
profession.
 Demonstrate the application of legal

concepts that apply to nurses.

 Identify legal responsibilities and

obligations of nurses.

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 Learning Objectives

 List sources for standards of care for

nurses.
 Define legal aspects of nurse–patient,

nurse–physician, nurse–nurse, and

nurse–employer relationships.
 List the elements needed to prove

negligence.

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 Legal Limits of Nursing
 Nurses have a fiduciary relationship with
patients
 Sources of law
 Constitution of Canada
 Civil law (Quebec) and common law (rest of
Canada)
 Statute law
• Federal, provincial, and territorial statutes
• Created by elective legislative bodies (Parliament,
provincial/territorial legislatures)
 Precedent
 Public law and private law
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The Profession of Nursing

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 Legal Limits of Nursing

 Professional regulation at the provincial or

territorial level
 Regulation of Nurse Practitioners
 Standards of care

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 Professional Regulation

 Provincial/territorial legislation grants

authority to a nursing regulatory body
 Regulatory body is accountable to the public
for ensuring safe, competent, and ethical
nursing care
 Regulatory bodies exist for
 Registered nurses
 Practical nurses
 Registered psychiatric nurses (in some provinces)

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 Quick Quiz!

In Canada, nurses need to maintain their

registration with:
A. Their hospital professional organizations
B. Their provincial association or college of nursing
C. Their provincial/territorial nursing union
D. Their provincial/territorial government

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 Regulation of Nurse Practitioners

 Regulation of NPs varies across the country

 Protected title in some provinces; some have
RN extended practice or RN/NP
 May affect career mobility

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 Standards of Care

 Legal guidelines for nursing practice

 Establish an expectation of nurses to provide
safe and appropriate patient care
 Nursing practice acts
 Provincial/territorial laws regulating health
care agencies
 Professional and specialty nursing
organizations
 Written policies and procedures

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 Legal Liability Issues
in Nursing Practice
 Tort
A civil wrong committed against a person
or property
 Intentional tort
 Willful act that violates a person’s rights

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 Legal Liability Issues
in Nursing Practice
 Examples of intentional torts
 Assault: physical or verbal threat
 Battery: intentional physical contact without
consent
 Invasion of privacy: unwanted intrusion into private
affairs, release of confidential information,
computers and confidentiality, social media
 False imprisonment: loss of individual liberty and
basic rights

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 Legal Liability Issues
in Nursing Practice
 Unintentional torts
 Negligence
 Preventing negligence
 Communication and documentation
 Criminal liability
 May involve civil suit and criminal charge

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 Consent
 Informed Consent
 A signed form is required for all routine treatment, all
hazardous procedures, and some other treatments.
• The person must have the legal and mental capacity to make a
treatment decision.
• The consent must be given voluntarily without coercion.
• The person must understand the risks and benefits of the procedure or
treatment, the risks of not undergoing the procedure or treatment, and
any available alternatives.
 Provisions are made for hearing-impaired, illiterate, or
foreign-language patients.

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 Quick Quiz!

When do nurses have an ethical and legal

responsibility to maintain confidentiality?
A. When they enter into a therapeutic relationship
with a patient
B. When they collaborate with other health team
members
C. When they refer a patient to another health care
provider
D. When asked information by the person who holds
a proxy directive

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Nursing Students and Legal Liability

 Students must know their own capabilities

and competencies and must not perform a
nursing action unless competent to do so.
 Students are liable if their actions cause harm
to patients, as is their instructor, the hospital,
and students’ college/university.
 Students must separate their nurse role from
their work as unregulated care providers.

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 Professional Liability Protection
 Malpractice insurance: may be carried by
employer
 Not applicable to employee working outside
normal scope of employment
 Provides a defence when a nurse is in a lawsuit
involving negligence or malpractice insurance
 Canadian Nurses Protective Society

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 Abandonment, Assignment, and
Contract Issues
 Short staffing:
 Can cause legal problems to occur because of
inadequate number of nurses to provide care
 Abandonment
 Floating:
 Based on census load and acuteness of patients’
conditions
 Prescriber’s orders:
 Must be followed unless nurse believes an order is
in error, violates agency policy, or is harmful to
patients
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 Abandonment, Assignment, and
Contract Issues
 Dispensing advice remotely (e.g., over the
phone)
 High-risk activity and nurse is legally accountable
 Contracts and employment agreements
 Nurse expected to perform competently, adhering
to policies and procedures of agency

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 Legal Issues in Nursing Practice
 Abortion
 Prescription medications and controlled
substances
 Communicable diseases
 End-of-life issues
 Advance directives and health care proxies
 Organ donation
 Mental health issues
 Public health issues

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 Abortion

 R v. Morgentaler (1988)
 Unregulated by law
 Problems with accessibility

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 Prescription Medications and
Controlled Substances
 Nurses are not legally entitled to prescribe
medications.
 Nurses administer medications with
physician’s/prescriber’s orders.
 Nurses:
 Must know the purpose, effect, potential adverse effects, and
contraindications of any medication administered
 Are responsible for questioning any prescriber’s orders that
may be incorrect or unsafe
 May be found negligent if they follow a prescriber’s order
that is unclear or incorrect
 Cannabis
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 Communicable Diseases

 The COVID-19 pandemic, and outbreaks of

other communicable diseases have raised
legal implications for nurses.
 Nurses have an ethical and legal obligation to
provide care to all assigned patients.
 Employers have an obligation to provide their
employees with necessary protective gear.
 Nurses must balance the rights of protecting
themselves with protecting the patient’s
rights.
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 End-of-Life Issues

 Definition of death
 Legal right to refuse life-prolonging treatment
 Euthanasia
 Medical assistance in dying (MAID)

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Advance Directives and Health Care
Proxies
 Advance directive: a mechanism enabling a
mentally competent person to plan for a time
when mental capacity is lost
 Living will
 Instructional directive
 Proxy directive
 Psychiatric advance directive
 Nurses required to follow the wishes of a validly
appointed proxy

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 Quick Quiz!
Which of the following is an INCORRECT procedural
safeguard for MAID:
 A written request must be made and signed by an

independent witness.
 A doctor or nurse practitioner must provide an

assessment and confirm that all of the eligibility

requirements are met.
 The person must be informed that they can withdraw

their request at any time, in any manner.

 The person must be given an opportunity to withdraw

consent and must expressly confirm their consent

immediately before receiving MAID.

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 Organ Donation

 Legally competent people are free to donate

their bodies or organs for medical use.
 Legislation varies between provinces.
 Legislation for both inter vivos (live donor) and
post-mortem (cadaveric) donations

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 Mental Health Issues
 A patient can be admitted to a psychiatric unit
involuntarily or on a voluntary basis.
 Patients admitted on a voluntary basis have
the right to refuse treatment and the right to
discharge themselves from hospital.
 If the patient may cause harm to self or
others, provincial/territorial mental health
legislation permits police officers to bring the
person for examination and treatment without
the person’s consent.
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 Public Health Issues
 Public health acts assist in the prevention,
treatment, and suppression of communicable
diseases.
 Nurses have the legal responsibility to follow
the laws enacted to protect the public health:
 Reporting suspected abuse and neglect
 Reporting communicable diseases
 Reporting other health-related issues to protect
the public’s health
 Some provinces/territories have legislation
regarding mandatory immunizations.
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 Risk Management
 A system of ensuring appropriate nursing
care by identifying potential hazards and
preventing harm from occurring
 Tools include incident report (adverse
occurrence report)
 Steps involved:
 Identify possible risks
 Analyze risks
 Act to reduce risks
 Evaluate steps taken

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 Summary

 Legal limits of  Consent

nursing  Students and legal
 Professional liability
regulation  Professional liability
 Standards of care protection
 Intentional torts  Contract issues
 Unintentional torts  Risk management
 Criminal liability

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