Key Takeaways
- The Nurse Practice Act in each state defines the legal scope of practice for LPN/LVNs
- Negligence requires four elements: duty, breach, causation, and damages (harm)
- LPN/LVNs are personally liable for their own actions even when working under supervision
- Documentation must be accurate, timely, and never altered after the fact
- Following policies and procedures helps establish that the standard of care was met
Legal Responsibilities and Nursing Practice
LPN/LVNs operate within a legal framework that defines what they can do and holds them accountable for their actions. Understanding these legal concepts helps protect both you and your patients.
The Nurse Practice Act
Each state has a Nurse Practice Act (NPA) that:
| Function | Description |
|---|---|
| Defines scope of practice | What LPN/LVNs can legally do |
| Establishes licensure requirements | Qualifications to become licensed |
| Creates the Board of Nursing | Regulatory authority |
| Lists grounds for discipline | What can result in license action |
The State Board of Nursing (BON) has authority to:
- Issue, renew, or deny licenses
- Investigate complaints
- Impose disciplinary action (reprimand, probation, suspension, revocation)
- Establish rules within the NPA framework
Types of Legal Actions
| Type | Definition | Example |
|---|---|---|
| Criminal | Violation of law, prosecuted by state | Diverting controlled substances |
| Civil | Lawsuit for damages | Malpractice suit for injury |
| Administrative | Board of Nursing action | License revocation for misconduct |
Negligence and Malpractice
Negligence is failure to provide the care that a reasonable person would provide.
Malpractice is professional negligence by a licensed individual.
Four Elements of Negligence:
| Element | Definition | Example |
|---|---|---|
| Duty | Legal obligation to the patient | LPN assigned to provide care |
| Breach | Failure to meet standard of care | Did not check patient allergies |
| Causation | Breach directly caused harm | Patient had allergic reaction |
| Damages | Patient suffered actual harm | Anaphylaxis, hospitalization |
All four elements must be present. If no harm occurred, there is no successful negligence claim.
Standard of Care
The standard of care is what a reasonably competent LPN/LVN with similar training would do in the same situation.
Standard is established by:
- State Nurse Practice Acts
- Professional nursing standards
- Facility policies and procedures
- Evidence-based practice guidelines
- Expert testimony
Personal Liability
LPN/LVNs are personally liable for their own actions, even when:
- Working under supervision
- Following orders
- Acting on behalf of the employer
You cannot delegate liability to others. If you know an action is wrong and do it anyway, you are responsible.
| Scenario | Liability |
|---|---|
| LPN gives medication without checking allergies | LPN is liable |
| LPN follows provider order known to be incorrect | LPN shares liability |
| LPN performs task outside scope of practice | LPN is liable |
| LPN properly performs delegated task that causes harm | Liability may be shared with delegator |
Documentation as Legal Protection
Documentation is the legal record of care. In court: "If it wasn't documented, it wasn't done."
Legal Documentation Requirements:
| Do | Don't |
|---|---|
| Document accurately and completely | Leave blank spaces |
| Use date, time, and signature | Document in advance of care |
| Use objective, factual language | Use opinions or judgments |
| Use approved abbreviations only | Use unapproved or unclear abbreviations |
| Correct errors properly (single line, initials, date) | Use white-out or scribble out |
| Document refusals and patient education | Alter records after the fact |
Common Legal Pitfalls
| Issue | Prevention |
|---|---|
| Practicing outside scope | Know your state NPA and facility policy |
| Medication errors | Follow the rights of medication administration |
| Incomplete documentation | Document as close to the event as possible |
| Failure to report | Report changes, concerns, and incidents promptly |
| Confidentiality breach | Follow HIPAA, protect patient information |
| Abandonment | Never leave assigned patients without proper handoff |
Incident Reporting
Incident reports (variance reports) are used when:
- Patient harm occurs or is narrowly avoided
- Equipment malfunctions
- Medication errors occur
- Falls happen
- Unusual events occur
Incident reports are:
- Internal quality improvement documents
- NOT part of the medical record
- Protected from discovery in many states
- Used to identify system problems
In the medical record, document:
- What happened (objectively)
- Patient's response
- Who was notified
- Interventions performed
Do NOT document "incident report filed" in the medical record.
Abandonment
Abandonment occurs when a nurse:
- Leaves assigned patients without proper handoff
- Ends the nurse-patient relationship without ensuring continued care
- Fails to show up for a scheduled shift without notice
To avoid abandonment:
- Complete proper handoff before leaving
- Report to supervisor if you must leave early
- Document patient status before transfer of care
On the NCLEX-PN
Expect questions about:
- The four elements of negligence
- Proper documentation practices
- When LPN/LVNs can be held liable
- Actions that could result in Board of Nursing discipline
An LPN administers the wrong dose of medication to a patient. The patient experiences no adverse effects. Which statement about liability is TRUE?
Which documentation practice could result in legal problems for the LPN?
A provider orders a medication dose that the LPN knows is too high for the patient. What should the LPN do?