Guide to Legal & Ethical Issues in Nursing

Nursing operates within a complex framework of statutory laws and ethical principles. Every clinical action—from administering medication to documenting care—navigates legal boundaries and ethical duties. For students and practitioners, distinguishing between law (mandatory compliance) and ethics (moral obligation) is critical for license protection and patient advocacy. This guide details the legal pitfalls and ethical dilemmas inherent in modern nursing practice.

Law vs. Ethics: The Distinction

While interconnected, law and ethics serve different functions in healthcare regulation.

• Legal Standards: External rules enacted by government bodies (e.g., Nurse Practice Acts). Violations result in civil liability (fines), criminal charges, or licensure revocation. Compliance is mandatory.
• Ethical Standards: Internal values and moral principles guiding conduct. Violations result in moral distress, professional censure, and loss of trust. Compliance is a professional expectation.

The ANA Code of Ethics provides the non-negotiable ethical standard for the profession.

Regulatory Framework: Nurse Practice Acts

The Nurse Practice Act (NPA) in each state is the supreme law defining nursing scope.

• Scope of Practice: Defines what a nurse can and cannot do. Performing tasks outside this scope (e.g., prescribing medication without APN licensure) constitutes practicing medicine without a license.
• Standards of Care: The legal benchmark for practice—what a reasonably prudent nurse would do in similar circumstances. Malpractice claims hinge on proving a breach of this standard.

The 4 Pillars of Medical Ethics

These principles guide decision-making when values conflict.

1. Autonomy

The patient’s right to self-determination. They may refuse treatment, even if the choice results in death.
Dilemma: A competent adult refusing a blood transfusion due to religious beliefs versus the nurse’s desire to save a life.

2. Beneficence

The duty to promote good and act in the patient’s best interest.
Action: Advocating for adequate pain management or holding a hand during a frightening procedure.

3. Non-maleficence

The duty to “do no harm.” This encompasses preventing harm (safety protocols) and removing harm.
Action: Checking allergies before administration to prevent anaphylaxis; reporting an impaired colleague.

4. Justice

Fairness in the distribution of resources and care.
Dilemma: Allocating ICU beds or organs for transplant during shortages without bias regarding social status or ability to pay.

Legal Concepts: Torts

A tort is a civil wrong committed against a person or property.

Unintentional Torts

• Negligence: Failure to act as a reasonably prudent person (e.g., leaving a spill on the floor).
• Malpractice: Professional negligence. Failure to meet the standard of care resulting in harm.
  4 Elements Required for Liability: Duty, Breach of Duty, Causation, Damages.

Intentional Torts

• Assault: Threatening harm (e.g., “If you don’t eat, I will force the tube down”). No contact required.
• Battery: Unconsented touching (e.g., performing a procedure the patient refused).
• False Imprisonment: Unlawful restraint (e.g., using restraints without an order or medical necessity).

Informed Consent

Consent is a process, not just a form. The provider explains the diagnosis, risks, benefits, and alternatives.

• Nurse’s Role: Witness the signature, verify patient competency, and ensure understanding.
• Patient’s Role: Give voluntary consent without coercion.
• Exception: Emergency situations where life is in immediate danger and consent is implied.

Advanced Directives & End-of-Life

Legal documents specifying care preferences when a patient cannot communicate.

• Living Will: Specifies treatments to accept/refuse (e.g., ventilators, tube feeding).
• Durable Power of Attorney for Healthcare (DPOA): Designates a proxy to make decisions.
• DNR/DNI (Do Not Resuscitate/Intubate): A provider order prohibiting CPR. Without this order, full code is the default.

Professional Integrity

Moral Distress: Occurs when a nurse knows the ethically correct action but is prevented from taking it by institutional constraints.
Whistleblowing: Reporting unsafe or illegal practices. Protected by law, but often carries professional risk.

Documentation: The Legal Record

The medical record is the primary defense in malpractice suits. “If it wasn’t documented, it wasn’t done.”

• Objectivity: Record facts (“Patient shouting obscenities”), not opinions (“Patient is angry”).
• Timeliness: Chart care immediately. Late entries raise suspicion.
• Accuracy: Falsifying data constitutes fraud and grounds for license revocation.

For help with clinical documentation assignments, see our Nursing Assignment Services.

Social Media Hazards

Online posts can end careers. Even without names, specific details can identify patients, violating HIPAA.
Rule: Never post photos of patients or workplace situations. Breaches lead to expulsion and legal action.

Mandatory Reporting

Nurses have a legal duty to report specific situations to authorities, overriding confidentiality:

• Child abuse or neglect (suspected).
• Elder/Vulnerable adult abuse.
• Gunshot wounds/violent crimes (varies by state).
• Communicable diseases (to Public Health).
• Impaired colleagues (substance abuse).

FAQs on Nursing Law & Ethics

Conclusion

Legal and ethical competence equals clinical skill in importance. Adhering to standards of care, respecting autonomy, and maintaining confidentiality protects patients, licenses, and professional integrity.