Nurses are more accountable than ever to the public, patients, their employers and the profession as a whole, so it is vital you understand the legal, ethical and professional framework that underpins nursing practice.
This book provides a crash course in law for nurses, written in clear and straightforward language. It is filled with insightful case studies and interactive thought provoking activities, helping you to understand the legal obligations you will face and ensuring that you are prepared for life as a practicing nurse.
New to this edition:
·Fully mapped to the latest NMC standards of proficiency for registered nurses (2018)
·New chapter covering death, dying and organ donation
·Updated to take account of the Deprivation of Liberty Act
·New content covering GDPR, Social Media and Safeguarding of Adults and Children
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NMC Standards of Proficiency for Registered Nurses
This chapter will address the following platforms and proficiencies:
Platform 1: Being an accountable professional
At the point of registration, the registered nurse will be able to:
1.2 understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice, differentiating where appropriate between the devolved legislatures of the United Kingdom.
Chapter aims
After reading this chapter, you will be able to:
define the term ‘law’;
identify primary and secondary sources of legal material;
outline the role of Acts of Parliament;
state the role of precedent at common law;
list the key features of a published Act, statutory instrument and case report; and
describe the relevance of law to healthcare.
Introduction
Scenario 1.1 Law and nursing
Mary, a registered nurse, thought it was her lucky day when she put £1 in a vending machine for a can of drink and some 16 cans were deposited by the machine next to the ward where she worked. She took the cans back to the ward and distributed them among her colleagues and some patients and kept some for herself. The incident was recorded on CCTV.
After an investigation, Mary accepted a police caution for theft, giving her a criminal record. The Nursing and Midwifery Council found her behaviour to be unprofessional and contrary to The Code (NMC, 2015a) and issued a three-year caution. She paid compensation to the vending machine owner and received a final written warning about her conduct from her employing trust.
This scenario illustrates the many legal and professional issues that face you as a nurse both in your professional practice and in your day-to-day life. Legal awareness is essential if you are to successfully discharge your obligations as a registered nurse, and this chapter helps to raise your legal awareness by examining how the law influences nursing, as illustrated in Table 1.1.
Table 1.1
The chapter begins by highlighting that The Code (NMC, 2015a), which sets out the standards for professional practice, is underpinned by the law. It then defines the term ‘law’ and considers how laws are made by looking at the role of Parliament and the courts. You are then introduced to the published forms of law and are encouraged to become familiar with the main features of an Act of Parliament, a statutory instrument and a case report.
Mary’s case above demonstrates that law is now fundamental to the study of nursing and underpins your relationship with society, the profession and your patients. It seeks to provide maximum protection for patients by setting the standards for care through the criminal and civil law, applying sanctions for unprofessional behaviour through the Nursing and Midwifery Council, as well as redress to patients who have suffered as a result of your acts or omissions through the civil law. The law informs nursing at every stage, and it is essential that you understand and are able to critically reflect on the legal issues relevant to nursing practice.
You will see in Chapter 3 that the concept of professionalism requires you to be law-abiding, of good character, and to apply the knowledge, skills and values expected of a registered nurse. Failing to discharge that professionalism will result in legal sanctions being applied to protect the public and maintain confidence in the nursing profession.
The professional practitioner
Case study 1.1 Professionalism in action
A children’s nurse who stole insulin and injected herself when she was meant to be looking after sick babies was struck off the NMC’s register and prosecuted for theft as a result of her unprofessional behaviour. The nurse fell so ill after taking the insulin that she had to be treated at the emergency department and was kept overnight for observation.
(Scottish Star, 2013)
In 2018, a nurse was given an interim suspension order of 18 months with a possibility of a full striking off for stealing NHS prescription drugs and giving them to her friends. She was also given a prison sentence in 2017 for three years and eight months for theft.
(Buck, 2018)
To maintain public confidence in the profession of nursing, all registered nurses are legally and professionally answerable for their actions, irrespective of whether they are following the instructions of others or using their own initiative. Healthcare litigation is growing, and patients are increasingly prepared to assert their legal rights. Compensation payments for clinical negligence in the NHS in England amounted to £2.3 billion in 2018–2019, up some 13 per cent on the previous year (NHS Resolution, 2019).
While the financial burden of compensation on the NHS is considerable, the cost of unprofessional behaviour in human terms has been even greater. A public inquiry into the care of patients at the Mid Staffordshire NHS foundation trust found that up to 1,200 patients had died needlessly as a result of staff and management failings between January 2005 and March 2009. The inquiry report (known as the Francis Report) found that:
patients were left in excrement in soiled bedclothes for lengthy periods;
assistance was not provided with feeding for patients who could not eat without help;
water was left out of reach;
in spite of persistent requests for help, patients were not assisted in their toileting;
wards and toilet facilities were left in a filthy condition;
privacy and dignity, even in death, were denied;
triage in A&E was undertaken by untrained staff; and
staff treated patients and those close to them with callous indifference.
(House of Commons, 2013)
The recommendations of the Francis Report (House of Commons, 2013) and of three further inquiries into how unprofessional behaviour resulted in poor care and unnecessary patient deaths (DH, 2012b; National Advisory Group on the Safety of Patients in England, 2013; Andrews and Butler, 2014) have resulted in fundamental changes to the statutory regulation of health services, the professional regulation of nurses and the law protecting patients.
It is little wonder that the NMC insists that as student nurses, you are able to practise in accordance with an ethical and legal framework that ensures the interests of patients are paramount (NMC, 2010). A thorough and critical appreciation of the legal, ethical and professional issues affecting nursing practice is essential if you are to develop the legal and professional awareness necessary to satisfy the NMC that you are an accountable practitioner, competent to practise as a registered nurse.
Activity 1.1 Research
Professional standards of behaviour
The standards imposed on registered nurses by the NMC are contained in The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives (NMC, 2015a). There was a minor update to The Code in 2018 to include nursing associates in England, but the 2015 standards remain effective for all registered nurses.
Read The Code, which can be downloaded from the NMC website (www.nmc-uk.org), and identify the standards that apply to:
your relationship with patients;
your relationship with colleagues;
your relationship with the profession; and
your relationship with society generally.
The Code highlights how the law and legal system underpin the professional standards imposed on nurses. Keep it with you as you work through this book.
The Code requires registered nurses to discharge their professionalism by keeping to and upholding the standards and values set out in The Code, acting with honesty and integrity at all times and keeping to the laws of the country in which they are practising (NMC 2015a, standard 20). To achieve that standard, you must be able to define and apply the law as it relates to your practice.
Defining law
Activity 1.2 Reflection
Defining law
Before reading on, think about the laws you are aware of and what their role is, then write down what you believe the term ‘law’ means.
Read the following for further guidance.
A typical dictionary would define ‘law’ as:
a rule enacted or customary in a community and recognised as commanding or forbidding certain actions.
Or:
a body of such rules.
A key characteristic of law is that it is perceived as binding upon the community. The English word ‘law’ is derived from the O...
