Legal Considerations for the DNP-Prepared Nurse Leader

Legal Considerations for the DNP-Prepared Nurse Leader

Introduction

For the DNP-prepared
nurse leader, it is essential to have an understanding of the legal issues that can impact
nursing practice, patients, staff, and the sustainability of the organization. The nurse
leader is obligated to comply with both ethical and legal tenets that guide how nurses
practice and how nursing staff are led.

The Influence of Legal and Regulatory Issues on

the Nurse Leader

Many legal and regulatory issues can impact nursing practice and healthcare
organizations. Nurse leaders are often responsible for developing policies and
processes to safeguard professional standards, regulatory compliance, and the integrity
of the organization. It is important to have a strong underpinning and awareness of
these requirements to mitigate risk and protect patients and staff from harm.
Administrative policies of the organization should be frequently and systematically
reviewed and revised in accordance with changing evidence and best practices. There
are also specific legal and regulatory requirements that must be followed to protect the
organization from legal liabilities. These could include federal regulations, accreditation
standards, nursing practice standards, or organizational policies or procedures.
Review the following list and click on the tabs for more information. How comfortable
are you in administering these laws and regulations in your workplace? Are there ones
that are unfamiliar to you or that you need to understand better?
Americans with Disabilities Act of 1990 (Amended 2008)
Age Discrimination and Employment Act of 1967 (Amended 1978)
Civil Rights Act of 1964 (Amended 1972)
Civil Rights Act of 1991
Equal Employment Opportunity Commission and Affirmative
Action—1981
Equal Pay Act of 1963
Fair Labor Standards Act of 1938 (Amended 1946-2010)
Family Medical Leave Act of 1993 (Amended 2008)
Health Insurance Portability and Accountability Act of 1996
Occupational Safety and Health Administration—1970
Rehabilitation Act of 1973
As a nurse leader, you should be aware of potential areas of liability in the workplace.
Common areas for liability in the clinical setting include treatment, communication,
medications, and supervising. During the early months of COVID-19, hospitals and
clinics faced substantial liability due to supply shortages, diminished ability to triage and
care for patients, and the lack of availability of personal protective equipment (PPE) for
staff (Neil, 2020). Nurse leaders sought guidance from a variety of sources to abate
legal risks and protect the health of patients and staff. When faced with any potential
liability, seeking council from the organization’s risk management department is an
important action.
Warning Signs

It is equally important to encourage staff to review policies and procedures frequently to
ensure compliance with organization and practice standards. Deviation from nursing
practice standards and scope of practice can result in harmful consequences. As the
nurse leader, you are responsible for the delegation and supervision of nursing staff and
must ensure patients receive safe and quality healthcare services. Some of the warning
signs that could be an indicator of potential liability issues include the following:

 Suspicion of substance use or abuse
 Competency deficiencies
 Low and inefficient staffing ratios
 Bullying or harassment of peers or others
 Increased rate of sentinel events
 Increased rates of infections on a unit(s)
 Decreased patient satisfaction
Any of these concerns or other issues expressed by a team member should result in a
pause and prudent evaluation to determine the underlying causality. The nurse leader
must promote a positive work environment that encourages compliance with
organizational ethics and values. Corporate compliance includes the reporting of any
acts that are illegal or unethical, done so without fear of retaliation or negative
employment consequences.
Today’s Changing Family Structure and Legal

Considerations

Today’s family structure can be more diverse than it was several decades ago. The
nurse leader and the nursing team may encounter family structures that are different
from their own life and experiences. When encountering what is sometimes referred to
as a “non-traditional” family, it is important to remember that personal beliefs or
convictions should not impact the nurse-patient-family relationship. Contemporary
technologies in reproductive health have made it possible for same-sex and single-

parent families to reproduce. Additionally, progressive legislation at the state and
federal levels has provided a path for same-sex marriage.
Unexpected challenges, such as having an infant, child, or partner admitted to the
hospital, can give rise to questions on how to best support single-parent families or
same-sex couples. Under these circumstances, families may face unique cultural and
legal barriers not experienced by heterosexual and traditional two-parent families
(Logan, 2020). Parents and children also frequently live in different dwellings due to
divorce and childbirth outside of marriage, which can additionally be a source of conflict
or communication challenges.
The following graph shows the historical trend of children under 18 years of age, living
in homes with a father only. It can be noted that there has been a rise in this family
structure, primarily among those who have experienced divorce or never been married.

Census Trends Image Description

With extended life expectancies, the structure of families may be expanded beyond the
parents and children. Family dynamics can be impacted as well as the decision-making
process within the family unit when grandparents, great-grandparents, aunts, and
uncles are actively engaged in the healthcare of families. It is critical to follow all ethical

nursing practices and legal requirements when caring for patients, regardless of their
family structure. The nurse leader should guide staff on how to support the diverse
demographics that comprise a family in the 21st century.
There may be times when the nurse leader is faced with both ethical and legal
responsibilities that require them to utilize knowledge of legal statutes in guiding nursing
staff. One of these situations is mandatory reporting. As a nurse leader, understanding
the mandatory reporting requirements of a professional nurse and within the state of
licensure is crucial.
Types of Reporting Law
There are primarily three types of reporting law:
 Mandatory reporting
 Permissive reporting
 No reporting requirement
By understanding organizational policies and legal responsibilities, the nurse leader can
effectively guide staff and ensure the safety of patients and families.

Lesson 2

Influencing Interorganizational Practices and Policies
Asserting Leadership Power to Accomplish the

Organizational Mission

The complexity of the current healthcare environment requires nurse leaders to think
differently about organizational hierarchies and management practices. Today’s nurse
leaders must build relationships to share a vision for the future and inspire others to
embrace that vision. Nurse leaders should continually seek innovative alternatives to
current practices and processes to improve outcomes and the value of healthcare
services.

The DNP-prepared nurse
leader can utilize their power and authority by creating a work environment that
supports a culture where employees' concerns and opinions matter, communication is
forthcoming and timely, and a productive work environment flourishes. The healthcare
setting is one in which a nurse’s work is defined by the policies and processes
designated by the organization and professional licensing boards. The nurse leader can
shape the healthcare environment through advocacy for patients and staff during the
policy development and review process. By asserting leadership power and advocating
for issues such as better staffing ratios, career ladders, merit increases, and overtime
restrictions, the nurse leader can influence organizational practices and policies.
Additionally, supplementing support for employee benefits with a recognition of the
value of empowering nurses to be autonomous can further demonstrate the leader’s
commitment to the nursing team and the profession. Nursing leaders should recognize
that empowering others builds trust and enhances collaboration within a team and the
larger organization.
Nurse leaders of the 21st century are faced with many ethical and legal challenges.
Through a practice of continuous reflective learning, leaders and organizations can be
better prepared for the rapid and vast changes taking place. Practicing reflective
learning during team meetings can provide opportunities for sharing experiences and
celebrating successes. By role-modeling reflective learning, the nurse leader can guide
staff towards the accomplishment of the organizational mission and vision and
ultimately improve outcomes.
Example
As an example, during individual or team meetings, the nurse leader can share with
staff how they reflect on sentinel events to identify and mitigate patient risk and improve
outcomes.