NSG 3127 Lecture Notes - Lecture 3: Licensed Practical Nurse, Intentional Tort, Nurse Practitioner
30 Nov 2019
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Ethics – Fall 2019
Class 3 notes
Legal framework for nursing practice
Civil law: refers to body of wiles and principles governing relations among individuals, corporations and institutions.
Deals with private disputes between two sets of individuals.
Criminal law: concerned with relations between the individual and the state.
Administrative law: CNO is created by the Nursing Act and given its power by the Regulated Health Professions Act. The
RHPA sets out a common structure for governing colleges of all professions named within this act. Most administrative
law deals with entities created by statute (CNO, labour board, human rights commission).
Tort law: a tort is a civil wrong committed by one person against another, such as causing that other some injury or
damage (either to person or property). The person wronged can being a lawsuit against the offending party for
damages. This area of law has great significance for nurses.
• Intentional tort: assault – intentional creation of the apprehension of imminent harmful or offensive contact; battery
– actual contact, the touching of another person without consent. In HC settings, any treatment, surgery, nursing
action, diagnostic test, or intervention that occurs without prior consent is forbidden unless the patient is unable to
consent and delay could result in serious bodily harm or death.
• Nonintentional tort: negligence. The failure to provide the care a reasonable nurse would ordinarily provide in a
similar situation. No intent needed. Conduct that falls below a standard of care. If nurse loses licence and case
involved civil or criminal wrongs, legal consequences may follow. If not documented, it is not done. Must have the
following elements to constitute negligence:
o There must be a duty of care owed to the plaintiff (patient)
o Breach of duty of care by the defendant (doctor or nurse), by failure to administer treatment or provide health
care in accordance with a particular standard of care
o Patient suffers damage as a direct result of the breach of the duty of care
Professional misconduct: term not synonymous with malpractice. Examples include failure to meet a standard of
practice, improperly delegating a controlled act, directing a nurse or student to perform an act he is she is not prepared
or competent to perform, improperly discontinuing professional services, practicing nursing while impaired, verbally,
physically or sexually abusing a patient, failing to keep records.
Catch all clause: engaging in conduct or performing an act, irrelevant to the practice of nursing that, having regard to all
the circumstances would reasonably be regarded by members as disgraceful, dishonorable, or unprofessional.
Malpractice: does not always involve misconduct. Involved performing lawful acts in a careless manner, or a manner
that does not meet the standards of care. Offences are generally dealt with in civil courts.
Professional liability: facilities carry malpractice insurance. If a nurse exceeds bounds of acceptable practice or is self-
employed, full liability for own practice. Now law that every nurse has own insurance. Legal support and liability
protection via ONA, RNAO membership.
Student responsibilities: liable if actions cause harm- generally shared by student, teacher and in some cases the RN
working with the student, HC facility, educational institution. Students are expected to perform as professional nurses
would in practicing safe care.
RHPA (1991) Scope of practice: The practice of nursing is the promotion of health and the assessment of, the provision
of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative
means in order to attain or maintain optimal function. No person other than a member shall use the title “nurse”, “nurse
practitioner”, “registered nurse” or “registered practical nurse”, a variation or abbreviation or an equivalent in another
language.
Ethics – Fall 2019
• All provinces and territories restrict the practice of nursing and use of titles to members in good standing. A member
who is under suspension or whose certificate has been revoked may not use a title or practice nursing. Continuing
to practice while under suspension constitutes professional misconduct.
Controlled acts:
1. Performing a prescribed procedure below the dermis or a mucous membrane.
2. Administering a substance by injection or inhalation.
3. Putting an instrument, hand or finger
a. beyond the external ear canal,
b. beyond the point in the nasal passages
c. where they normally narrow,
d. beyond the larynx,
e. beyond the opening of the urethra,
f. beyond the labia majora,
g. beyond the anal verge, or
h. into an artificial opening into the body.
4. Dispensing a drug.
5. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s
serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously
impair the individual’s judgement, insight, behavior, communication or social functioning.
The RHPA provides several exceptions that allow persons who are not authorized as members of a regulated profession
to perform controlled acts, including:
• when providing first aid or temporary assistance in an emergency;
• when, under the supervision or direction of a member of the profession, a student is learning to become a member
of that profession and the performance of the procedure is within the scope of the profession’s practice;
• when treating a member of a person’s household and the procedure is within the second or third controlled act
authorized to nursing;
• when assisting a person with his/her routine activities of living and the procedure is within the second or third
controlled act authorized to nursing; or
• when treating a person by prayer or spiritual means in accordance with the religion of the person giving the
treatment
Initiation of controlled acts: some nurses may independently decide that a specified procedure is required and initiate
the procedure in the absence of a specific order or medical directive from a physician. If initiating is within the scope of
his/her role and competence, the initiating RN may perform the procedure or may write the order for another nurse to
perform it; RPNs may initiate a procedure but not write an order for another nurse to perform. ONLY WHEN:
• The nurse has the knowledge, skill and judgement to perform the procedure safely, effectively and ethically
• The nurse has the knowledge, skill and judgement to determine whether the client’s condition warrants
performance of the procedure
• The nurse determines that the client’s condition warrants performance of the procedure having considered the
known risks and benefits to the individual, the predictability of outcomes of performing the proceduere, the
safeguards and resources available in the circumstances to safely manage the outcomes of performing the
procedure, and other relevant factors specific to the situation, and the nurse accepts sole accountability for
determining that the client’s condition warrants performance of the procedure.
Can be initiated by RPN:
• Care of a wound below the dermis or the mucus membrane by cleansing, soaking or dressing
