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Incorporating Legal Perspectives into Orientation

Briefings on Evidence-Based Staff Development, March 9, 2010

You probably address legal concepts when talking about documentation, medication administration, and delegation. But most orientation programs do not allot specific time to legal issues in general as there is constant pressure to conduct orientation more efficiently and in less time.

How can you introduce this additional information into an already crowded orientation schedule? One possibility is to develop a basic handout and include some scenarios for general discussion or self-study. Remember that you are not expected to offer a continuing education program on legal issues in nursing. This is beyond the scope of orientation. You are simply introducing some basic concepts and stimulating interest. Let's start with some basic legal concepts and a handout that will guide your discussions.

Laws and regulations
Each state has its own Nurse Practice Act, which contains information about the specific scope of practice and educational requirements. Each act also contains statements that prohibit nurses from performing tasks determined to be within the scope of medical practice.

You cannot review the entire Nurse Practice Act in orientation, but you should encourage nurses to obtain a copy of it from the State Board of Nursing and to become familiar with it. You should also include information about avoiding conflicts with employing organizations and volunteer organizations. Tell orientees that their employers cannot expand the scope of their practice to include actions that are prohibited by the state's Nurse Practice Act. All nurses have a legal obligation to practice within their Nurse Practice Act limits (Follin, 2004).

The first three items on the sample handout (p. 3) deal with your state's Nurse Practice Act and legal obligations pertaining to it. Exceeding those limits may result in disciplinary action by the State Board of Nursing or even loss of license. The next items deal with scope and standards of specialty practice and regulatory bodies. You don't need to go into great detail; simply mention those that are most applicable to your organization, such as The Joint Commission (particularly the National Patient Safety Goals) and American Nurses Association (ANA) Standards of Practice. Individualize the handout so it is applicable to your state and organization.

Delegation
It's a good idea to mention delegation responsibilities, especially to orientees who are newly licensed RNs. RNs may delegate to another RN, an LPN, and/or an unlicensed staff member, such as a nursing assistant. However, the RN may only delegate tasks to persons who are competent to perform them and who are able to perform them as part of their legal scope and standards of practice. The delegating RN is still ultimately responsible for his or her patient's care, even if some tasks are delegated to others (Follin, 2004).

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