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Legal & Ethical Practice
and Confidentiality

Master the nurse's legal duties, the principles of ethical practice, and how to protect patient confidentiality under HIPAA.

NCLEX-RN

Why Legal & Ethical Practice Matters

Nurses are held to professional, legal, and ethical standards that protect patients and the public. A nurse who violates these standards risks license suspension, civil lawsuits, and harm to patients.

Key Terms to Know

Negligence
Failure to act as a reasonably prudent nurse would in similar circumstances.
Malpractice
Professional negligence by a licensed provider that causes patient harm.
Tort
A wrongful act causing harm, leading to civil legal liability.

The Four Ethical Principles

Ethical Practice Autonomy Respect patient choice Beneficence Do good for patient Nonmaleficence Do no harm Justice Fair, equal treatment

Core Rule: HIPAA & Confidentiality

The Health Insurance Portability and Accountability Act (HIPAA) requires nurses to protect Protected Health Information (PHI). PHI may only be shared with those directly involved in the patient's care, on a strict need-to-know basis.

Informed Consent

Informed consent must be obtained before procedures. The provider explains the procedure, risks, benefits, and alternatives. The nurse's role is to witness the signature and confirm the patient understands voluntarily.

1
Voluntary: consent given without coercion.
2
Informed: patient understands risks and benefits.
3
Competent: patient is legally able to decide.

Negligence vs. Malpractice

Negligence Malpractice
Who commits it Anyone Licensed professional
Standard violated Reasonable person Professional standard
Example Wet floor, no sign Wrong medication dose

Four Elements of Malpractice

For a malpractice claim to succeed, all four elements must be proven: \( \text{Duty} + \text{Breach} + \text{Causation} + \text{Damages} \).

1
Duty: the nurse owed a duty of care to the patient.
2
Breach: the nurse failed to meet the standard of care.
3
Causation: the breach directly caused the harm.
4
Damages: the patient suffered actual injury or loss.

Worked Example: Confidentiality

Scenario: A nurse's friend asks about a celebrity admitted to the unit. What should the nurse do?

1
Identify the issue: the friend is not involved in patient care.
2
Apply HIPAA: no PHI may be shared on a non-need-to-know basis.
3
Action: politely decline to confirm or share any information.

Worked Example: Consent

Scenario: A patient signs a surgical consent form but then says, "I'm not sure what they're going to do." How should the nurse respond?

1
Recognize: consent is invalid if the patient does not understand.
2
Act: stop the process and notify the provider to re-explain.
3
Document: the patient's statement and the action taken.

Worked Example: Exceptions

Scenario: A nurse suspects child abuse. Does confidentiality apply?

Mandatory Reporting
Abuse, gunshot wounds, and reportable diseases.
Duty to Warn
Threats of harm to identifiable third parties.

Common Mistakes

✕ Sharing in public
Discussing patients in elevators or hallways risks PHI exposure.
✕ Nurse explains procedure
The provider, not the nurse, must explain consent details.
✕ Ignoring competence
Consent from a sedated or confused patient is invalid.

Summary: Key Concepts

Concept Key Point
HIPAA / PHIShare only on a need-to-know basis
Informed ConsentVoluntary, informed, competent
MalpracticeDuty, breach, causation, damages
Mandatory ReportAbuse overrides confidentiality
Ethical PrinciplesAutonomy, beneficence, nonmaleficence, justice

Advance Directives

Advance directives let patients state their wishes for future care. The nurse must ensure these documents are honored and present in the chart.

Living Will
States treatment preferences if incapacitated.
Durable POA
Names a person to make decisions for the patient.

Question 1 of 5

A visitor asks the nurse to confirm whether their neighbor is a patient on the unit. What is the nurse's best response?

Question 2 of 5

Whose responsibility is it to explain the risks and benefits of a surgical procedure to a patient?

Question 3 of 5

Which situation overrides patient confidentiality and requires reporting?

Question 4 of 5

A nurse gives a medication to the wrong patient, causing harm. Which legal concept best describes this?

Question 5 of 5

A patient who signed a consent form says, "I don't understand what they will do." What should the nurse do first?

You're Ready!

You now understand the nurse's legal duties, the four ethical principles, HIPAA confidentiality rules, informed consent, and the exceptions that require reporting.