Legal Scope and Accountability Flashcards

A practical nurse (PN) is working in a long-term care facility when a resident's family member, who is also a physician, verbally orders a change in the resident's medication dose outside of the facility. The PN cannot reach the resident's attending physician. What is the most legally defensible action?

Answer: Decline to administer the changed dose, document the situation, and continue to attempt to reach the attending physician or supervisor

A PN must only follow orders from authorized prescribers within the established care relationship and institutional protocols. A family member who is a physician has no prescribing authority over a patient who is not their patient, and a verbal order given outside institutional channels is not legally valid. The PN's accountability requires declining the change, continuing safe care under existing orders, documenting thoroughly, and escalating appropriately.

A PN discovers that a colleague has been documenting assessments for clients they have not actually seen. The PN initially says nothing but later is named in a regulatory complaint because the false records were associated with a client who suffered harm. Under the concept of accountability, which statement BEST describes the PN's legal and professional exposure?

Answer: The PN may face professional consequences for failing to report a known unsafe or unethical practice

Professional accountability under provincial nursing legislation and codes of ethics requires nurses to report known unsafe or unethical practices. Silence in the face of known misconduct is itself a professional and potentially legal breach. The PN's failure to act on knowledge of falsified documentation — which contributed to patient harm — can result in disciplinary action by the regulatory body, even though the PN did not falsify the records themselves.

A PN working in an outpatient clinic performs a procedure that is within their competency and scope but was not explicitly listed in the facility's approved nursing procedures manual. A complication arises and the client is harmed. Which legal doctrine is MOST likely to be applied to evaluate the PN's conduct?

Answer: The reasonable nurse standard — whether a reasonable PN with similar training would have performed the procedure in the same circumstances

Negligence in nursing is assessed using the reasonable nurse standard: what a reasonable, prudent nurse with comparable training and in similar circumstances would have done. The absence of a procedure from an institutional manual does not automatically establish negligence, nor does it assign liability exclusively to the employer. The court would examine whether the PN's decision and technique met the standard of a reasonable PN. Res ipsa loquitur applies only when negligence is obvious from the harm itself, which is not the standard default.

A competent adult client who is being treated for a serious infection refuses a prescribed IV antibiotic and asks to be discharged against medical advice (AMA). The PN believes the client will likely die without treatment. What is the MOST legally and ethically correct response?

Answer: Ensure the client has decision-making capacity, provide information about risks, document the informed refusal, and facilitate the AMA discharge

A competent adult has an absolute legal right to refuse treatment, including life-sustaining treatment. The PN's role is to confirm the client's decision-making capacity, ensure they have received complete information about the consequences of refusal (informed refusal), document thoroughly, and ensure the AMA process is followed per institutional policy. Administering treatment without consent constitutes battery. Court orders and public health detention are not applicable in this context (infectious diseases with public risk follow separate legislation).

During a home care visit, a PN notices signs consistent with elder financial abuse perpetrated by the client's legal power of attorney (POA). The client, who has mild cognitive impairment, states they do not want anyone notified. Under most Canadian provincial legislation, what is the PN's obligation?

Answer: Report suspicions of elder abuse to the appropriate authority as mandated by provincial adult protection legislation, even without the client's consent

Most Canadian provinces have mandatory reporting legislation for vulnerable adult abuse (e.g., Ontario's Long-Term Care Homes Act, Nova Scotia's Adult Protection Act). When a PN has reasonable grounds to suspect abuse of a vulnerable adult, they are legally required to report it to the designated authority regardless of the client's consent or wishes. Mild cognitive impairment may also affect the client's capacity to protect themselves, further reinforcing the duty to report. Failure to report is itself a legal violation.

A PN is employed by a staffing agency and is placed at a hospital where they are asked by the charge RN to perform a task that falls within RN scope but outside PN scope in that province. The charge RN asserts that the hospital policy permits PNs to perform this task. What is the MOST appropriate action?

Answer: Decline the task, explaining that provincial nursing legislation and PN scope of practice take precedence over hospital policy

Scope of practice is defined by provincial nursing legislation and the PN's regulatory body — not by employer or facility policy. A hospital cannot expand a PN's legal scope of practice through internal policy, nor can a supervisor's instruction override provincial law. Performing a task outside one's legislated scope exposes the PN to regulatory discipline and civil liability regardless of who directed them. The PN must decline and escalate appropriately. Contacting the staffing agency is a secondary step, but does not change the legal obligation to decline.