Legal Scope and Accountability Flashcards

A practical nurse (PN) is working in a long-term care facility. A resident with moderate dementia has a valid advance directive refusing tube feeding. The resident's adult daughter arrives and insists the PN initiate enteral nutrition, stating she holds power of attorney for her mother's finances. The PN should:

Answer: Honour the advance directive, as financial power of attorney does not extend to healthcare decisions

A financial (property) power of attorney grants authority over financial matters only and does not confer the right to make healthcare decisions. A valid advance directive reflects the resident's autonomous wishes regarding medical treatment and must be honoured. A healthcare proxy or personal care power of attorney would be required to override or interpret a directive. The PN has a professional and legal obligation to understand this distinction and act accordingly.

A PN administers a medication that was correctly transcribed from a physician's verbal order. The patient suffers a serious adverse reaction. An investigation reveals the original verbal order itself was inappropriate for the patient's documented allergy, which was clearly visible in the chart. Regarding professional accountability, which statement is most accurate?

Answer: The PN shares accountability for failing to apply independent clinical judgment before administering the medication

Professional accountability is not absolved simply by following an order. Each nurse has an independent, non-delegable duty to exercise clinical judgment before administering any medication, including verifying allergies, appropriateness of dose, and contraindications. The documented allergy was accessible; the PN's failure to identify this conflict constitutes a breach of the standard of practice. Regulatory bodies across Canada hold nurses accountable for their own independent assessment, regardless of the order's source.

A PN is employed by a home care agency and is visiting a client in a private residence. During the visit, the PN observes a framed photo that strongly suggests the client's spouse may be engaging in criminal activity unrelated to the client's health. The PN should:

Answer: Maintain confidentiality about the observation unless it meets the threshold of a serious and imminent threat to an identifiable person

Canadian privacy legislation and professional ethics permit — and in some cases require — disclosure only when there is a serious, foreseeable, and imminent risk of harm to an identifiable individual. Mandatory reporting obligations for health professionals are specific (e.g., child abuse, certain communicable diseases, gunshot wounds) and do not extend to general suspicion of unrelated criminal activity. Reporting based solely on a photograph would violate privacy and exceed the PN's professional role. The PN should consult the agency and, if applicable, legal counsel if the threat threshold appears to be met.

A PN is floated to an unfamiliar unit and is asked to perform a specific wound care procedure they have not performed in over two years and were never formally assessed on in that practice setting. The charge nurse states there is no one else available. What is the most professionally and legally defensible course of action?

Answer: Clearly communicate the competency gap to the charge nurse, seek any available supervision or resources, and document the circumstances if asked to proceed

Scope of practice includes self-assessment of individual competence. A PN is legally and professionally required to practise only within the limits of their individual knowledge, skill, and judgment — not merely within the broad scope of the profession. The appropriate response is transparent communication of the competency gap to the responsible decision-maker (charge nurse/supervisor), followed by seeking supervision, a skills review, or other resources. Abandoning the patient or unit without ensuring coverage creates patient safety and abandonment liability. Documenting the request and response protects the PN in the event of an adverse outcome.

A PN working in a correctional facility is instructed by the facility administrator — not a regulated health authority — to withhold prescribed pain medication from an inmate as a disciplinary measure. The PN should:

Answer: Refuse and report the instruction through the appropriate professional and regulatory channels, as this constitutes potential patient abuse and violates the standard of care

Prescribed medications must be administered in accordance with the prescribing order and the standard of care. A non-regulated administrator has no authority to override a prescriber's order or direct a nurse to withhold treatment as punishment — this constitutes a serious ethical and legal violation potentially amounting to deliberate infliction of suffering (a form of abuse). The PN's professional regulatory obligations supersede institutional administrative directives when those directives require unsafe or unethical practice. The PN must refuse, document, and escalate through regulatory and professional reporting mechanisms. Inmates retain the right to receive medically indicated care.

A PN documents in the electronic health record (EHR) that a dressing change was completed at 1400h. At 1430h, the PN realizes the dressing was actually applied incorrectly and a second nurse redressed the wound. The PN should:

Answer: Add a late entry or addendum with the correct information, the time of correction, and a brief explanation — never alter or delete the original entry

Altering or deleting health record entries — even to correct a genuine error — constitutes falsification of a legal document and is a serious professional offence in all Canadian jurisdictions. The legally and professionally correct approach is to make an addendum or late entry that clearly identifies the error, the correction, the time, and the author's credentials, while leaving the original entry intact and visible. This preserves the integrity of the record, ensures continuity of care, and demonstrates transparency. Asking another clinician to record under their credentials to obscure the original nurse's involvement would be an additional ethical and regulatory violation.