Legal and ethical issues in nursing: four duties at the bedside
Scope of practice, unsafe practice, mandatory reporting, and records, consent and refusal: the rule for each, for practical nurses in Canada.
- An order does not make an activity yours.
- Protect the client first, then report with facts.
- The law lists what you must report without consent.
Legal and ethical issues in nursing come up in ordinary requests: an order in the hallway, a colleague who skips a check, a client who asks you to keep a secret, and a favour at the computer. This guide gives the rule for each of the four duties, and links to a lesson on each one.
Four duties a practical nurse meets at work
| Duty | The rule |
|---|---|
| Scope of practice | Authorized, allowed by policy, and competent. One “no” means you say so and get help. |
| Unsafe practice | Protect the client first. Then report it the correct way, with facts. |
| Mandatory reporting | Know what must be reported and who receives it. Report promptly, even without consent. |
| Records, consent and refusal | Open a record only for a client in your care. Respect a capable client's refusal. |
Stay inside your scope
A written order does not make an activity yours. Ask if the law and your regulator authorize it, if your employer's policy allows it on this unit, and if you are competent to do it for this client. An employer can limit what you do and can never add to your legal scope.
Read the full lesson: three questions before you say yes.
Act on unsafe practice
When a colleague is about to make an error, step in before the client is harmed. Report a near miss even when nobody was harmed, because the cause is still there. A pattern goes to your manager with dates, times and what you saw.
Read the full lesson: unsafe practice and near misses.
Report what the law makes you report
Confidentiality is the rule, and the law sets a short list of exceptions. A child who may need protection and a listed communicable disease are on the list. A capable adult who is not on the list decides who is told.
Read the full lesson: when the law overrides confidentiality.
Protect records, consent and the right to refuse
Looking at a record without a work reason is a privacy breach. Consent needs accurate information, so check policy before you interpret. A capable client has the legal right to refuse treatment.
Read the full lesson: records, interpreting and the right to refuse.