Report on

Legal Aspects of Nursing

Institute Of Management and Technology

Prepared By:
Kamran Khan
Roll No. Smba 13025
Sec-A

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TERMINOLOGIES

 Abuse
 Crimes
 Fraud
 Violence
 Assault
 Defamation
 Law
 Battery
 Delegation
 Malpractice
 Contracts
 Document
 Negligence
 Contracts
 Float
 Torts

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 CONTENTS

1. Introduction-4
2. General Legal Concepts of Nursing-5 to 9
3. Legal Aspect Regarding Restraints-9
4. Regulation of Nursing Practice-10
5. Contractual Arrangements in Nursing-10 to 11
6. Selected Legal Aspects of Nursing Practice-11 to 13
7. Areas of Potential Liability in Nursing-13 to 14
8. Legal Protection in Nursing Practice-14
9. Reporting Crimes, Torts, and Unsafe Practices-14 to 15
10. Legal Responsibilities of Nursing Students-15 to 16
11. Research on nurses ‘knowledge of legal aspects of nursing in
Nigeria.-17 to 27
12. References-28
13. Document Outline-29

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Introduction

Legal Aspects of Nursing

As a nurse it has become an important necessity to be aware of the legal aspects associated with
caring and helping people in the health industry today. Unfortunately, the more and more
negligence cases there are the less and less people want to get into the health care field fearing
legal aspects and the inevitable law suites. The first nursing law created was that of nursing
registration in 1903.
The Tort Law is the legal aspects of the law that most nurses are more familiar with. This
is the law that involved malpractice and negligence cases which many nurses take the time to
learn inside and out as this is one of the biggest fears in the medical community. Basically a Tort
is a wrongful act which produces harm, whether it is unintentional or intentional. Malpractice is a
specific type of Tort where the standards of care are not met. This is one of the most common and
familiar laws to nurses and something that nurses and doctors alike must be familiar with in order
to continue their care efficiently.
Nurses must take as many precautions as they can during their daily shifts. Recording,
documenting and reporting daily routines and decisions is one of the most common ways to make
sure on track with patience and in the right. Nurses learn in school that proper care of a patient is
not only making the right decisions but maintaining and organizing their medical records and
reports efficiently.
The legal aspects of nursing are taught and expected to be kept up on throughout every nurse's
career. A nursing job is something many young people aspire to but without the legal knowledge
behind them, many hospitals will not hire them now that legal issues are becoming more and
more problematic.

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General legal concepts of nursing

Law can be defined as those rules made by humans who regulated social conduct in a
formally prescribed and legally binding manner. Laws are based upon concerns for fairness and
justice.

Functions of Law in Nursing

The law serves a number of functions in nursing:

 It provides a framework for establishing which nursing actions in the care of client are
legal.
 It differentiates the nurse's responsibilities from those of other health professional.
 It helps establish the boundaries of independent nursing action.
 It assists in maintaining a standard of nursing practice by making nurses accountable
under the law.

Types of law
Law governs the relationship of private individuals with government and with each other.

1. Public Law
 One type of law is Public Law which deals with an individual’s relationship to the state.
 Sources include Constitutional, Administrative and Criminal These Sources occur on both
the Federal and State level

1.1. Constitutional Law

 Set of basic laws that defines and limits the powers of government.
 Nurse maintains rights as an individual.
 Constitutional Rights, Civil Rights, State Constitution.

1.2. Administrative Law

 Developed by groups who are appointed to governmental administrative agencies. Food,

Drug and Cosmetic Act; Social Security Act; Nurse Practice Act.

1.3. Criminal Law

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  Acts or offences against the welfare or safety of the public.
 Controlled Substance Act; Criminal Codes.

2. Civil Law

The second type of law is Civil Law which deals with crimes against a person or persons in such
legal matters as:
• Contracts
• Torts
• Protective Reporting Law

2.1. Contract Law is the enforcement of agreements among private individuals

Elements of: Promise, Mutual Understanding, and Compensation Employment Contracts
is an example of contract law under civil law

2.2. Tort Law is the enforcement of duties & rights among independent of contractual
agreements. It is a civil wrong committed on a person or property stemming from either a direct
invasion of some legal

Right of the person, infraction of some public duty, or the violation of some private obligation by
which damages accrue to the person.

Examples of Tort Law include:

• Negligence and Malpractice
• Assault and Battery
• False Imprisonment
• Restraints or Seclusion
• Invasion of Privacy
• Defamation
• Fraud

Negligence and Malpractice

Ethics deals with standards of conduct and moral judgment. The major principles of healthcare
ethics that must be upheld in all situations are beneficence, no maleficence, autonomy, and
justice. Beneficence means promoting or doing good. Nurses work to promote their clients' best
interests and strive to achieve optimal outcomes. No maleficence means avoiding harm. Nurses
must maintain a competent practice level to avoid causing injury or suffering to clients. The
principle of no maleficence also covers reporting suspected abuse to prevent further victimization

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and protecting clients from chemically impaired nurses and other healthcare practitioners.
Autonomy stands for independence and the ability to be self-directed. Clients have the right of
self-determination and are entitled to decide what happens to them; therefore, competent adults
have the capacity to consent to or refuse treatment. Nurses must respect the client's wishes, even
if they don't agree with them. Finally, justice requires that all clients be treated equally and fairly.
Nurses face issues of justice daily when organizing care for their clients and deciding how much
time they will spend with each based on client needs and a fair distribution of resources.

Nurses need to distinguish between their personal values and their professional ethics. Personal
values are what nurses hold significant and true for themselves, while professional ethics involve
principles that have universal applications and standards of conduct that must be upheld in all
situations. Nurses thus avoid allowing personal judgments to bias client care. They are honest and
fair with clients, and they act in the best interest of and show respect for them.

Since nurses address complex ethical and human rights issues on a regular basis, the American
Nurses Association Board of Directors and the Congress on Nursing Practice first initiated the
Code of Ethics for Nurses in 1985 to delineate the code of responsibilities and conduct expected
of nurses in their practice. Nurses are held responsible to comply with the standards of ethical
practice and to ensure that other nurses also comply. The code was revised in 2001 to include
issues of advancing nursing science and is based on the opinions and experience of a wide range
of nurses. The ANA approved nine provisions that address ethical practice issues such as
compassion and respect, the nurse's primary commitment to the patient, patient advocacy,
responsibility and accountability, duties, participation in the healthcare environment,
advancement of the profession, and collaboration. You can read or purchase the ANA Code of
Ethics for Nurses with Interpretive Statements at www.nursingworld.org.

Liability is an obligation one has incurred or might incur thru any act or failure to act.
Malpractice refers to the behavior of a professional person’s wrongful conduct, improper
discharge of professional duties, or failure to meet the standards of acceptable care which result in
harm to another person.

Negligence (breach of duty) is the failure of an individual to provide care that a reasonable person
would ordinarily use in a similar circumstance. Defendant is the person being sued. Plaintiff is the
party who initiates the lawsuit that seeks damages.

Proof of Liability depends on:

 Duty
 Breach of duty
 Damage
 Causation

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 1. Duty: Duty stands for a legal obligation owed by one person to another person. When
nurses care for clients, they assume the duty to care for them in a competent and diligent
manner. Nurses are expected to provide the degree of care ordinarily exercised by other
nurses practicing in the same nursing specialty. Therefore, nurses are expected to adhere
to standards of care—those imposed by the nurse's state board of nursing nurse practice
act, the national nursing specialty standards of care and scope of practice, and the nurse's
hospital, or other agency, protocols.

2. Breach: A breach of duty takes place when there is failure to fulfill the duties established
as being the responsibility of the nurse. In other words, nurses breach their duty when they
do not meet the appropriate standard of care.

3. Causation: Causation is the most difficult element to prove because it is the factual
connection between what the nurse did and the injury to the client. Causation means that
the nurse's breach of duty, or failure to meet the appropriate standard of care, caused the
client's injury or adverse outcome.

4. Damages: Damages are monetary payments designed to compensate the client for the
injury or adverse outcome, and are intended to restore the plaintiff to the condition he or
she was in prior to the injury. To recover damages, the client must establish that he or she
suffered physical, financial, or emotional injury caused by the nurse's violation of the
standard of care. Damages are usually compensatory or punitive.

Nurses and nursing students can be held liable for their actions, and thus can be sued. However,
the majority of nurses are competent professionals who provide a satisfactory level of care.
According to HRSA's 2003 National Practitioner Data Bank (NPDB), only about 1 in 50
malpractice payment reports were for nurses. All levels of RNs were responsible for 4,512, or
1.8%, of malpractice payments over the history of the NPDB. Other classified RNs were
responsible for 63.3%, and included nurse anesthetists, nurse midwives, and nurse practitioners.
Reasons for malpractice payment reports varied depending on the type of nurse, but included
monitoring, treatment, and medication problems.
High-level-need clients and short staffing can increase the chances for error, but nurses can
minimize their liability by focusing on risk management. Healthcare facilities provide various
levels of in-service education on risk management, and nurses can take continuing education
courses on this important topic. Some states require risk management education courses for
license initiation and/or renewal. Florida requires a course on reducing medical errors, while Ohio
requires nurses to take a course to become familiar with their state nurse practice act. Taking a
risk management course can also have some monetary advantage—some nursing malpractice
insurance companies give discounts on premiums to those who complete a risk management

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course.

Assault & Battery

Assault is the intentional & unlawful offer to touch a person in an offensive, insulting or
physically intimidating manner. Battery is the touching of another person without the person’s
consent.
Protective/Reporting Laws are sometimes considered criminal laws based on state classification

Examples include:

 Americans with Disabilities Act

 Good Samaritan Act

Legal Aspect Regarding Restraints

Restraints are protective devices used to limit the physical activity of a client or to immobilize
a client or an extremity.
Physical restraints: restrict client movement through the application of a device.
Chemical restraints: Medications given to inhibit a specific behavior or movement.
Under Omnibus Budget Reconciliation Act: any client or patient has the right to be free from
Physical (such as restraint jackets) and chemical (sedation, psychotropic drugs) restraints
Imposed for the purpose of discipline or convenience and should not be required to treat
medical or psychiatric symptom.

Lawful Requirements & Nursing Actions for Using Restraints

According to (JCAHO) Joint Commission on ACCREDIATATION OF
HEALTHCARE ORGANIZATIONS

1. RESTRAINTS SHOULD NOT BE USED PRN!!!

2. Informed consent and a Doctors order is needed to use restraints.
3. Doctors’ orders for restraints should be renewed within a specific time frame
According to the agencies policies.
4. Restraints should not interfere with any treatments or affect the client’s health
Problems.
5. Document the following:
 Reason for the restraints
 Method of restraints
 Date and time of application

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  Duration of use and clients response
 Release from the restraints (every 30 minutes) with periodic exercise and
 Circulatory, neurovascular and skin assessment
 Evaluation of client’s response
6. DON’T ASK PERMISSION IF THE PATIENT HAS AN ALTERED LEVEL
OF CONSCIOUSNESS!!!
7. If the client is unable to give consent to a restraint procedure, then consent of proxy
Must be obtained AFTER FULL DISCLOSURE OF ALL RISK AND BENEFITS.
8. Use a clove hitch knot so that restraint can be changed and release easily and
Ensure

Regulation of Nursing Practice

Nursing practice falls under both public law and civil law. In all states, nurses are bound by rules
and regulations stipulated by the nursing practice act as determined by the legislature.
Public laws are designed to protect the public. When these laws are broken, a nurse can be
punished by paying a fine, losing her license, or being incarcerated. For example, a nurse guilty of
diverting drugs, which is a crime against the state, could lose her license to practice and could be
sent to jail.
Civil laws deal with problems occurring between a nurse and a client. For example, if a nurse
catheterizing a client perforates the bladder the client has sustained injury. No law affecting the
population as a whole has been broken, but the client may bring a civil suit against the nurse. The
client may receive compensation for injuries, but the nurse receives no jail time.
The American Nurses Association (ANA) takes the position that definition of the scope of
nursing practice flows out of nursing process, that is, the process of assessment, decision-making
and action that all nursing practice follows. In the document the Single Scope of Clinical Nursing
Practice, the ANA states that the core or essence of nursing practice "is the nursing diagnosis and
treatment of human responses to health and to illness. This core of the clinical practice of nursing
is dynamic, and evolves as patterns of human responses amenable to nursing intervention are
identified, nursing diagnoses are formulated and classified, nursing skills and patterns of
intervention are made more explicit, and patient outcomes responsive to nursing intervention are
evaluated.

Contractual Arrangements in Nursing

A contract is an agreement between two parties as to what will transpire and the rules and
regulations governing the service that will be provided. The legal agreement is enforceable by law

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and those who sign the agreement must be able to legally enter into a contract. This means they
must be of legal age and they must have the mental capacity to sign a contract. Although not all
services are required to have a legal and binding contract, there are many that are governed by
statutory law such as nursing services.

Instructions to Write a Contract for Nursing Services:

 Type the date of the contract and the names of those entering into the nursing contract.
 Type the agreements made by both parties as to what will transpire during the term of
employment. This is the start date and the position and duties of the employee.
 Type in any benefits that will be included in the compensation package. Insurance
coverage, pension payments and any other incentive compensation plans will be covered
here.
 Expiration of the contract will be inserted next. The option of renewing the contract is
included. The terms of different scenarios will be spelled out.
 Insert the reasons the contract would be terminated and what payments would be received
if the termination is enforced. The employee agrees to the confidentiality of the employer.

Selected legal aspects of nursing practice

Nurses need to know and apply legal aspects in their various roles.
As client advocates, nurses should ensure the client’s right to informed consent; identify and
report violent behavior and neglect of vulnerable clients. Also nurses are required to report a
nurse who is a chemically impaired, and should be aware of issues related to delegation.

Informed Consent

 Informed consent is an agreement by a client to accept a course of treatment or a

procedure after being fully informed of it.
 Consents are either express or implied. Express consent could be oral or written. If the
procedure is more invasive and/ or the potential for risk to the client is great, a written
permission is needed.
 Implied consent exists when the client’s nonverbal behaviour indicates agreement such as
in positioning their bodies for an injection or when their vital signs are recorded.

Obtaining an informed consent for specific medical or surgical procedure is the responsibility of
the person who performs the procedure.

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Information to be given to a Client to Make an Informed Decision 1.
Diagnosis or condition that requires treatment.
 Purpose of treatment.
 What the client can expect to feel or experience.
 The intended benefits of the procedure.
 Possible risks.
 Advantages and disadvantages of alternatives to treatment (including no treatment)

What are the Major Elements and Exceptions of Informed Consent?

 The consent must be voluntary

 The consent must be given by a client who is capable and competent to understand. This
means that certain population groups cannot provide consent such as children, whose
appointed guardians must give consent before minors are treated. A second group is
persons who are unconscious or severely injured. A third group is persons who are
mentally ill.
 The client must be given enough information to be the ultimate decision maker.

The Nurse’s Role in Obtaining a Client’s Informed Consent 1.

The nurse is not responsible for explaining the medical or surgical procedure but for witnessing
the client’s signature on the consent form.
The nurse’s signature means:
 -The client gave voluntary consent after receiving enough information.
 -The client’s signature is authentic.
 -The client appears competent to give consent.

3. In the United States, nurses could be liable for interfering with the client-provider
relationship.

Delegation

Delegation is “the transfer of responsibility for the performance of an activity from person to
another while retaining accountability for the outcome”.
In the USA, the process of delegation is governed by laws and regulations such as the Nurse
Practice Act (NPA), the Unlicensed Assistive Personnel (UAP) job description and skill level.
The NPA defines and describes the scope of nursing practice.

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When delegation is to occur, the nurse needs to determine the answers to the following questions:
 Does the NPA permit delegation
 Is there a list of procedure a nurse can delegate?
 Are there guidelines explaining the nurse’s responsibilities when delegate

Violence, Abuse, and Neglect

 Violent behaviour can include domestic violence, human abuse, and sexual abuse.
 Neglect is the absence of care necessary to maintain the health and safety of a client nurses
are in position to identify and assess cases of violence.
 When an injury appears to be present resulting from abuse, neglect, or exploitation, the
nurse must report the situation to the appropriate authority.

Areas of potential liability in nursing

Nurses need to know the differences between malpractice (unintentional tort) and intentional tort.
Nurses must also recognize nursing situations in which negligent actions are most likely to occur
and take measures to prevent them.
Many aspects relating to nursing practice and areas of nursing are subject to liability, including
physician's orders, floating, inadequate staffing, critical care, and pediatric care.

Physician's Orders

The physician is in charge of directing the client's care, and nurses are to carry out the physician's
orders for care, unless the nurse believes that the orders are in error or would be harmful to the
client. In this case, the physician must be contacted to confirm and/or clarify the orders. If the
nurse still believes the orders to be inappropriate, the nursing supervisor should be immediate
contacted and why the orders are not being carried out put in writing. A nurse who carries out an
erroneous or inappropriate order may be held liable for harm experienced by the client.
Nurses are responsible for their actions regardless of who told them to perform those actions.

Floating
 Nurses sometimes are asked to "float" to an unfamiliar nursing unit.
 The supervisor I should be informed about a float nurse's lack of experience in
caring for the type of clients on the new nursing unit.

The nurse should be given an orientation to the new unit and will be held to the same standards of

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care as are the nurses who regularly work on that unit.

Inadequate Staffing

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established

guidelines for determining the number of staff needed for any given situation (staffing ratios).
When there are not enough nurses to meet the staffing ratio and provide competent care,
substandard care may result, placing clients at physical risk and the nurse and institution at legal
risk. The nurse in this situation should provide nursing administration with a written account of
the situation. A nurse who leaves an inadequately staffed unit could be charged with client
abandonment.

Critical Care
Because the monitors used in critical care units are not infallible, constant observation and
assessment of clients are required. This makes a 1:1 or a 1:2 nurse-client ratio imperative.
Furthermore, equipment must be checked regularly and on a schedule by the bio-medical
department.

Pediatric Care

Legislation in each state requires that suspected child abuse or neglect be reported. Legal
immunity is provided to the person who makes a report in good faith. When suspected child abuse
or neglect is not reported by health care providers, legal action, civil or criminal, may be filed
against them.

Legal protection in nursing practice

Nursing practitioners, according to Medismart: Nursing Educational Resources can protect
themselves from most legal problems by following five basic guidelines: obtain an informed
consent signature before treatment begins; document all actions regarding a patient's care; report
any allegations of abuse toward a vulnerable population; protect the patient's right to privacy; and
pay strict attention to avoid medication dosing errors.

Reporting crimes, torts, and unsafe practices

Nurses may report colleagues or other professionals if for practices that endanger the health and
safety of clients. This may include alcoholism, drug use, theft and unsafe nursing practice.
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Reporting a colleague is not easy, as the reporting person may feel disloyal, disapproved by
others, or risks promotion.

Legal responsibilities of nursing students

As a nursing student your only legal responsibilities are to not do any patients intentional harm.
Your preceptor or instructor will be responsible for you. If you do a procedure it will be under
their supervision/assistance only (never by yourself). Plus your nursing college will make you buy
liability insurance before starting clinical.
 When you become a nurse you are responsible for almost everything
 You will be responsible for patient care, teaching students, supervising, calling doctors if a
patient needs attention, documenting and that is just to name a few.

Legal Responsibilities in Nursing

 Safeguards for the nurse and student

Although as a practical nurse likely to work under the direction of other nurses and
physician, personally liable for any harm a client suffers as a result of own acts. Healthcare
facilities may also be legally liable for their employee’s acts of negligence. Legal action involving
negligent acts by a person engaged in a profession may become malpractice lawsuits.

 Common-Sense precautions

Follow accepted procedures. Protect from possible lawsuits by always performing

procedures as taught and as outlined in the procedure manual of healthcare facility. If these
policies are incorrect or inadequate, work to improve them through the proper channels.

 Be competent in practice

Always responsible for own behaviour. Refuse to perform procedures for which have not
been prepared. Ignorance is not a legal defence.
Neither will lack of sleep or overwork be accepted as a legal reason for carelessness about
safety measures or mistakes.

 Ask for Assistance

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 Always ask for help if unsure about how to perform a procedure. Do not assume
responsibilities beyond those of level. Admitting that do not know how to perform a procedure is
always better than attempting to do it and injuring someone. Also question any physician’s order
that do not understand, cannot read, or in which believe an error exists.

 Document well

The importance of keeping exact records of all treatments and medications, as well as a
record of a client’s reactions and behaviour, cannot be overemphasized. The health record is the
written and legal evidence of treatment. The record is to reflect facts only, not personal
judgments. Careful and accurate documentation is vital for each client’s welfare.
Careful documentation is perhaps the most important thing can do to protect against an
unjustified lawsuit. If do not document a treatment or medication, legally the measure is
considered not to have been done.

 Do not give legal advice to clients

The laws governing personal and property rights of an individual are many and complex.
Never attempt to advise a client on legal rights or financial matters. Encourage clients to confer
their families and to consult an attorney.

 Do not accept gifts

Accepting gifts from the client is unwise for several reasons. Some clients are considered
vulnerable adults (e.g., mentally ill, retarded, or confused individuals) exchange of gifts could
compromise professional position, and could be accused of coercing the client.

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ORIGINAL RESEARCH

Nurses’ Knowledge of Legal Aspects of Nursing Practice in Ibadan,

Nigeria

Abstract

Knowledge of law that establishes a profession is essential for the professional. Nurses practice
within an environment in which accountability is demanded by the professional body as well as
the communities they serve. This implies that the very nature of nursing practice requires nurses
to be vigilant about understanding of the law. However, there is paucity of empirical evidence of
nurses’ knowledge of legal aspects of nursing. This paper presents a report of a survey of nurses’
knowledge of legal aspects of nursing in Nigeria.
The descriptive study utilized a 39-item questionnaire developed by the researchers to gather
information from 161 nurses from different categories of hospitals in Ibadan. A simple random
technique was used in selecting respondents in each ward of the settings. Data were analyzed
using descriptive statistics.
The sample consisted of 20 males (12.4%) and 141 females (87.6%) with varying years of
experience. Nurses have knowledge of general law of the land (58.4%) but the majority had
knowledge deficits of laws governing nursing practice (77.6%). About 57 %( 91) of nurses
indicated that their hospitals have institutional policies that govern how nurses practice but only
50% knew the content and intent of the policies.
The hallmark of professionalism is accountability. The best way to practice nursing effectively is
being highly knowledgeable about the science and art of nursing coupled with sound knowledge
of the laws that establish; control and promote nursing practice. It is therefore recommended that
the stake holders in nursing be more involved in ensuring adequate knowledge of legal aspects of
nursing practice to achieve the Nursing goal of quality care.

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INTRODUCTION
Nursing encompasses autonomous and collaborative care of individuals of all ages, families,
groups and communities, sick or well and in all settings. Nursing includes the promotion of
health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion
of a safe environment, research, participation in shaping health policy and in patient and health
systems management, and education are also key nursing roles. Nursing also includes the use of
clinical judgment in the provision of care to enable people to improve, maintain, or recover
health, to cope with health problems, and to achieve the best possible quality of life, whatever
their disease or disability, until death]. Nursing involves the protection, promotion, and
optimization of health and abilities; prevention of illness and injury; alleviation of suffering
through the diagnosis and treatment of human responses; and advocacy in health care for
individuals, families, communities, and populations. The nurse assists the individual, sick or well,
in the performance of those activities contributing to health or its recovery (or to peaceful death)
that s/he would perform unaided if s/he had the necessary strength, will or knowledge.

Nursing practice varies both through its various specialties and countries; however, the authority
for the practice of nursing is based upon a social contract that delineates professional rights and
responsibilities as well as mechanisms for public accountability. In almost all countries, nursing
practice is defined and governed by law, and entrance to the profession is regulated at the
national or state level.
From all the perspectives of nursing above, it is evident that nursing is highly interactive. It then
becomes an important necessity for the nurse to be aware of the legal aspects associated with
caring and helping people in the health care industry today. Unfortunately, more negligence cases
are occurring and in western societies, less people want to get into the health care field, fearing
legal aspects and the inevitable law suits.

The first nursing law created was that of North Carolina in the US (permissive licensure for
nurses) in 1903 and it has evolved and expanded over the years to become a thick book which
every aspiring nurse must study today to understand their scope of practice.
This is because every nursing specialty has legal considerations/implications for the practitioner.
Apart from the interactions, documentation of such activities/interactions is very important.
Documentation is legal tender for any nursing interaction and care. It is usually treated as a legal
issue which the nurse must take very seriously.

In Nigeria, the regulation of nursing profession is by legislation and this is based on the code of
ethics of the International Council of Nurses. The Professional Association of Trained Nurses of
Nigeria succeeded in convincing the Nigerian government to regulate Professional Nursing by

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legislation as in other countries and the first law was in 1946. The Nurses’ Act was reviewed in
1970. The Act translated the basic principles of the Nurses’ code of ethics to enforceable rules of
law. However this Act was reviewed and re-written in 1979 under the then Federal Military
Government and is cited as the Nursing and Midwifery decree 1979. It is also known as the
Nursing and Midwifery Principal Act. The Act was further amended in 1988 and 1992
respectively. The Decree established the Nursing and Midwifery Council of Nigeria and saddled
it with the responsibility of regulating and controlling the practice of the profession in its entire
ramification as put in paragraph (d) subsection 2 of section (1) of the decree. In addition to the
above, the Council is also to maintain discipline, establish and maintain a register of those
entitled to practice the profession.
Employment as a nurse requires a nursing degree as well as knowledge of the Nursing laws that
will apply should there be a misunderstanding or challenge by a patient or their family. Many
hospitals are not willing to hire nurses without the legal knowledge now that legal issues are
becoming more problematic. In order to avoid liability and guard against negligence or
malpractice suits, the nurse must be aware of the legal responsibilities of each aspect of the
nursing role. The primary goals of professional accountability in nursing are to maintain high
standards of care and to prevent the patients from harm. Nurses should be aware of and be
responsible for each action taken, be able to defend their actions and be willing to accept the
consequences of their actions. Personal accountability increases with the degree of autonomy, the
higher the degree of autonomy, and the greater the accountability. The public trust in a profession
increases proportionately to the degree in which the professional members guard and protect the
public’s interest. Therefore it is imperative for nurses to be accountable to themselves for proper
use of their knowledge and skill in providing care. The Tort Law is the aspect of the law that
most nurses are more familiar with. This is the law that involves malpractice and negligence
cases. Basically a Tort is a wrongful act which produces harm, whether it is unintentional or
intentional. Malpractice is a specific type of Tort where the standards of care are not met.
Common ground for torts is invasion of privacy; assault; battery; false imprisonment; fraud and
defamation either as libel or slander. Nurses are affected by law as citizens; as employees and as
service providers.

As important as the law appears to be in nursing practice, experience in Nigeria has shown that
nurses in the health care institutions (i.e. Primary, Secondary and Tertiary) behave as if they are
above the law and carry out nursing care as they deem fit. They have created an environment of
power relationship (i.e. superior-inferior relationship). A literature search revealed quite a lot of
information on nursing and the law but no studies were found on nurses’ knowledge of legal
aspects of nursing.
Presently, in Nigeria, there is an ongoing campaign on the National Health Insurance Scheme
(NHIS). This will further put demands on nurses because if the scheme is finally and fully
embraced it will create room for litigation by the consumers of health care. It is against this
background that it becomes imperative to find out what knowledge practicing nurses in Nigeria
possess on legal aspects of nursing practice.
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AIM AND OBJECTIVES
The general aim of the study was to examine Nigerian nurses’ knowledge of the legal aspects of
nursing practice. To achieve this aim, the following objectives were pursued.
 Assess Nurses’ knowledge of general law of the land.
 Examine Nurses’ knowledge of law which establishes and governs nursing
practice in Nigeria.
 Examine Nurses’ knowledge of the functions of law in Nursing practice.

METHODOLOGY

The study was a descriptive survey on nurses’ knowledge of legal aspects of nursing practice in 4
settings. The choice of hospitals was informed by the ownership and types of services rendered
by each of the hospitals. The hospitals were as follows: University College Hospital (UCH),
Ibadan; Jericho Nursing Home (JNH), Jericho, Ibadan; Adeoyo Maternity Hospital, Ibadan; Ring
Road State Hospital, Ring Road, Ibadan; Alaafia Hospital, MO kola, Ibadan; and Catholic
Mission Hospitals, Oluyoro & Oke-Ofa. The study was intended to cover at least 30% of the
1,260 (target population) nurses who were in these settings. However, a total of 161 respondents’
questionnaires were finally analyzed due to incomplete responses of the target population. This
figure eventually constitutes 13% of the target population. A simple random sampling technique
was employed in each ward at the various settings. One out of every three nurses whose names
appeared on the duty roster was selected in each ward. A table of random numbers was used in
selecting the nth nurse after the first nurses had been selected using the same instrument.
The survey instrument was a 39-item questionnaire designed by the researchers after a series of
literature reviews. The questionnaire was divided into two major sections, A and B. Section A
dealt with the socio-demographic characteristics of respondents and it consisted of 6 questions.
Section B consisted of 33 questions addressing the three study objectives. Each item in section B
was assigned one mark, this mean that the total obtainable score is 33. The instrument was pre-
tested among twenty (20) nurses at the General Hospital Ogbomoso. The pre-test was followed
by a test re-test after four weeks using the same sample and a correlation coefficient ratio r = 0.7
was obtained.
Ethical approval was obtained from the UI -UCH IRB. Permission to carry out the study was also
obtained from each of the participating hospitals. Ethical issues such as informed consent:
freedom to participate or not to participate; anonymity of person and confidentiality of
information of participants were given due considerations and attention. At the individual level,

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participation was voluntary based on informed consent. There was 100% retrieval rate even
though so many questionnaires were not completed thus limiting sample size. Data were analyzed
descriptively using Statistical Package for the Social Sciences (SPSS) version 16.

RESULTS
The below table shows the socio-demographic characteristics of respondents. The majority
(87.6%) of the respondents were females thus reflecting the preponderance of women in nursing.
The majority (87%) had more than five years of experience as nurses and only a few (8.1%) had a
single nursing qualification as against the practice in Nigeria where a nurse should have
additional qualification either as a registered midwife (RM) or registered in any other nursing
specialty.

Table 1. Socio-Demographic Characteristics of respondents

Variables Male Female Total

1. Age NO % NO % NO %
< 30 yrs. 2 10.0 12 8.51 14 8.70
31 – 40 yrs 1 5.0 49 32.75 50 31.06 41-50 yrs 11 55.0 51 34.17 62 38.51 > 50 yrs 6 30.0
24 17.02 30 18.63 Age- unknown - - 5 3.55 5 3.1
Total 20 100.0 141 100.0 161 100.0
2. Religion
Christianity 11 55.0 115 81.6 126 72.3
Islam 9 45.0 15 10.6 24 14.9
Others - - 11 7.8 11 6.8
Total 20 100 141 100 161 100
3. Marital status F % F % F %
Single 5 25.0 33 23.4 38 23.6
Married 15 75.0 103 23.4 38 23.6
Out of Marriage - - 5 3.5 5 3.1
Total 20 100 141 100 161 100
4. Years of
experience
< 5 yrs - - 21 14.89 21 13.04
6-10 yrs 2 10.0 14 9.93 16 9.94
11-15 yrs 3 15.0 34 24.11 37 22.98

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 16-20 yrs 7 35.0 35 17.73 32 19.88
21-30 yrs 8 40.0 42 29.79 50 31.06
Unknown - - 5 3.5 5 3.1
Total 20 100 151 100 161 100
5. Professional
Qualification
RN only 6 30.0 7 5 13 8.1
RN, RM - - 115 81.5 115 71.4
RN with others 14 70.0 19 13.5 33 20.5
Total 20 100 141 100 161 100
6. Work place
Teaching 3 15.0 72 51.1 75 46.6
hospital
State hospital 12 60 48 34 60 37.3
Mission hospital 4 20 12 8.5 16 9.9
Private hospital 1 5.0 9 6.4 10 6.2
Total 20 100 141 100 161 100

Table 2. Respondents’ knowledge of general law

Characteristics of Good knowledge Poor knowledge Total

Variable tested
NO % NO % NO %
Law defined 149 92.5 12 7.4 161 100
Sources of law 103 64 58 36.1 161 100
Right to punish violation 147 91.3 14 8.7 161 100
No Ignorance in law 133 82.6 28 17.4 161 100
Public law 38 23.6 123 76.4 161 100
Common law 10 6.2 151 93.8 161 100
Administrative law 52 32.3 109 67.7 161 100
Criminal law 33 20.5 128 79.5 161 100
Civil law 94 58.4 67 41.6 161 100
Nursing Council 31 19.2 130 80.8 161 100
(N&MCN)
Statutory law 45 28.0 116 72.0 161 100
Tort law 99 61.5 62 38.5 161 100
Assault 70 43.5 91 56.5 161 100
Slander 98 60.9 63 39.1 161 100

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 Defamation 85 52.8 76 47.2 161 100
Negligence 120 74.5 41 25.5 161 100
Malpractice 104 64.6 57 35.4 161 100
Law from N&MCN 26 16.1 135 83.9 161 100

The table shows that respondents have varying knowledge of the concept of law. However,
respondents demonstrated poor knowledge in common law (93.8%); Nursing and Midwifery
Council of Nigeria as an established administrative agency (80.8%); criminal law (79.5%);
statutory law (72.0%); and Administrative law (67.7%).

Table 3. Knowledge of law establishing Nursing in Nigeria

Characteristics Good knowledge Poor knowledge Total

Variables tested NO % NO % NO %
Legal foundation of nursing 41 25.5 120 74.5 161 100
Registration act 136 84.5 25 15.5 161 100
Years of Nursing & Midwifery 14 8.7 147 91.3 161 100
decrees
The principal Act 47 29.2 114 70.8 161 100
Schedule of the Act 32 19.9 129 80.1 161 100
Amendment of the Act 22 13.7 139 86.3 161 100
Awareness of Institutional policies 91 56.5 70 43.5 161 100
Knowledge of contents of 81 50.3 80 49.7 161 100
institutional policies

The above table shows respondents knowledge of law establishing nursing in Nigeria. The
majority of the respondents had poor knowledge of the legal foundation of nursing in Nigeria
while almost all respondent (91.3%) did not know the years the nursing and midwifery decrees
were promulgated.

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Table 4. Function of law in Nursing

Characteristic Good knowledge Poor knowledge Total

Variable tested NO % NO % NO %
Protection of the society against 114 70.8 47 29.2 161 100
malpractice
Framework for nursing actions 115 71.4 46 28.6 161 100
Delineation of nursing actions 66 41.0 95 59.0 161 100
Ensures standard of practice 134 83.2 27 16.8 161 100
Protection of the professional nurse 55 34.2 106 65.8 161 100
Regulation of inter professional 126 78.3 35 21.7 161 100
interaction
Enhancement of professionalism 120 74.5 41 25.5 161 100

This table shows nurses’ knowledge of the function of law in nursing. Respondents showed good
knowledge in the following areas: standards of practice (83.2%); regulation of inter professional
interaction (78.3); enhancement of professionalism (74.5); framework for nursing actions (71.4);
and protection of the society against malpractice (70.8%).

Table 5. Summary of result of the study

Characteristics Good knowledge Poor knowledge Total

Variables F % F % F %
Knowledge of general law 94 58.4 67 41.6 161 100
Knowledge of law governing 36 22.4 125 77.6 161 100
nursing
Knowledge of function of law in 127 78.9 34 21.1 161 100
nursing

This table shows the summary of the results of the study. About 58.4% of respondents
demonstrated good knowledge of general law while 78.9% had good knowledge of the function
of law in nursing. Poor knowledge of law governing nursing was demonstrated by 77.6% of the
respondents.

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DISCUSSION
This study was designed to elicit how much nurses know about the laws that affect their practice.
The discussion will be treated according to the objectives of the study.

Knowledge on General Law

The law affects the nurse in many ways and ignorance is not an excuse in law. In the summary of
this section of the study, about 58.4% of the respondents have knowledge of the general law of
the land; while 41.6% have knowledge deficit on general law. However, the various scores on the
variables tested are shown in Table 2. If more nurses are knowledgeable about the laws of the
land and apply them, there will be little or no problems in nursing practice since laws guide
human conduct. Though there are various claims that nurses are not assertive enough to influence
legislative process in favour of nursing with this result, one is hopeful that since the majority
know the law of the land, the next step is for nurses to strive towards influencing legislation in
favour of nursing profession.
In the U.S., many pleas have gone to nurses to be politically inclined to vote for people who have
the interest of nursing in mind and also to be voted for. This is done because the law enacted by
the legislators become the laws of the land and such is binding on every citizen including nurses.
It is important also to state here that the percentage of those who have knowledge deficits about
the law of the land is very high and this confirms the observations of other scholars.

Law Governing Nursing Practice

One expects a professional to have vast knowledge of the laws that governs his or her practice.
The Nigerian situation shows clearly that this is not so. Adelowo asserts that the backbone or
taproot of any profession is the law that establishes and governs it. Probably, if nurses were
interested and knowledgeable about this law, or being able to understand the intent of the laws,
nursing would have achieved a great deal more than it has in Nigeria. In a situation where about
77.6% have significant knowledge deficits, one is apt to think that such topics were not duly
emphasized in the nursing school curriculum. However, with reference to the result of knowledge
of general law of the land, one expects that more nurses should have knowledge of laws
governing nursing practice.
One of the most important safe tools against litigation is strict adherence to the institutional
policy. The study shows that only 56.5% claimed that their institutions have policies. This result
creates a concern about nurses’ vulnerability to litigation and could justify the increase in
malpractice litigation. If there are no policies or where the policies are not known or well
understood, the nurses may not know what to do in particular circumstances and this will affect
their decisions and jeopardize the care of clients. Protection against malpractice begins by

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understanding terms and concepts that are essential in instituting legal action against the nurse
and incorporating the appropriate risk reduction practices into daily practice.

Knowledge of Functions of Law in Nursing

Law has been described as that which guides human conduct [27]. The study result (see Table 4)
shows that about 90% of the nurses know the functions of law in Nursing. Nursing care involves
great interaction and the ethics of nursing stressed the need to respect individuals for whom they
are, keep information confidential and always act to protect the clients. This may account for why
there is good knowledge of function of law in nursing. This could further explain the low rate of
malpractice litigation in Nigeria. When a nurse knows the function of law in nursing, abides by
the code of conduct for nurses, and then s/he is bound to practice safely. Although it has been
argued that ethical codes are not law, if they are not observed, it may result in situations where
the client may seek redress in the law court. In most cases, the professional tribunal uses the
ethical code and standards of practice as the basis for which a professional is liable to disciplinary
acts or not, but when they fail such is referred to the law court.

CONCLUSION

This study surveyed nurses’ knowledge of legal aspects of nursing practice; it presented the
results and discussed the findings. The results showed that Nigerian nurses have varying
knowledge of the legal aspects of nursing. Essentially, there were knowledge deficits on laws that
govern nursing practice and the various hospital or institutional policies among the nurses under
study. The results of the study imply that Nigerian nurses have left what should be the foundation
stone and built on a weak structure. There is no way one can practice nursing effectively without
being knowledgeable on the laws that establish, control and promote nursing practice. A nurse
with sound knowledge of the legal aspects of nursing will remain an asset to the profession.

Implications for Nursing

Nursing practice is highly interactive; hence it’s increasing vulnerability to litigation. In a related
concept, nursing’s quest for quality care, patients’ satisfaction and dignifying care implies that
the profession ensures that members are knowledgeable on their rights and privileges, patients’/
clients’ rights; and conformation to the standards of practice. This becomes very important
because every individual wants his/her rights protected and would do anything should such be

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infringed upon. With the advent of new technology, changing state and federal laws, and new
court decisions, the ethical and legal issues nurses will encounter when taking care of patients
will not remain the same. Continuing education will be essential if nurses are to remain current,
lower their malpractice liability, and deliver quality care. This is even more important in this era
of multinational nursing practice resulting from recruitment of nurses from different parts of the
world as part of the efforts to reduce nurse-shortage. It is with the achievement of litigation–free
service that nursing practice can be seen to be achieving its purpose in society.

RECOMMENDATIONS
In view of the findings of this study, the investigators recommend the following:
1) Emphasis should be placed on legal aspects of nursing in the first year of nursing
education and much attention should be paid to its understanding.
2) Nurses should participate in Continuing Education Programmes Organized by the
Professional body for retraining on contemporary issues in Nursing such as legal aspects
of nursing.

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References

Alkaissi, A.: Legal Aspects of Nursing, 2011, Available from:

www.najah.edu/file/Essays/english/Aidah%20Kaisi/25.doc, last update Jul. 2011.
Amanda, B.: Legal Aspects of Nursing, 2008, Available from:
http://EzineArticles.com/?expert=Amanda_Bog, last update Feb.
2008.
Amsale, C.; Ato M., and Tsehay S.: Introduction to Professional
Nursing and Ethics, Ethiopia Public Health Training Initiative, Addis Ababa
University, 2006.
Belal, H.: Legal Aspects of Nursing, 2009, Available from:
www.highlands.edu/.../nursing/Legal%20Aspects.ppt, last update Jul. 2010.
Cummings, D.: How to Write a Contract for Nursing Services, Demand Media, Inc.,
2011, Available from: http://www.ehow.com, last update Aug. 2011.
Dewitt, S.: Fundamental concepts and skills for nursing, W.B.Saunders Company
2001. ISBN: 0-7216-6923-9. USA.
Kozier, B., et al.: Fundamentals of nursing: Concepts process and
Practice, 17th ed., Pearson Prentric Hall, 2004. ISBN0-13-122878-1.
Mustard, F.: The Scope of Nursing Practice: A review of Issues and
Trends, Canadian Nurses Association, 1993, P.14.

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DOCUMENT OUTLINE
A contract is an agreement between two parties as to what will transpire and the rules and
regulations governing the service that will be provided. The legal agreement is enforceable by law
and those who sign the agreement must be able to legally enter into a contract. This means they
must be of legal age and they must have the mental capacity to sign a contract. Although not all
services are required to have a legal and binding contract, there are many that are governed by
statutory law such as nursing services. A contract is an agreement between two parties as to what
will transpire and the rules and regulations governing the service that will be provided. The legal
agreement is enforceable by law and those who sign the agreement must be able to legally enter
into a contract. This means they must be of legal age and they must have the mental capacity to
sign a contract. Although not all services are required to have a legal and binding contract, there
are many that are governed by statutory law such as nursing services. Instructions to Write a
Contract for Nursing Services:

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