A nurse administers the wrong medication to a patient. The patient experiences no adverse effects. Which statement is TRUE regarding this situation?

The nurse is not liable for negligence because no harm resulted. All four elements of negligence must be present for a successful claim: duty, breach, causation, and damages (harm). While the nurse breached the standard of care, no damages (harm) resulted. The nurse is not liable for negligence, but the error should still be documented and reported through the facility's incident reporting system. The BON may still investigate regardless of patient harm.

A nurse suspects that a 4-year-old patient is being physically abused by a parent. What is the nurse's legal obligation?

Report the suspected abuse to child protective services. Nurses are mandated reporters for suspected child abuse. The nurse must report to child protective services when abuse is suspected. The nurse does not need definitive proof, only reasonable suspicion. Delaying the report or waiting for others to report violates the legal mandate.

Which action by the nurse could result in a malpractice claim?

Following a provider's order that the nurse knows is incorrect. Nurses are responsible for their own actions and cannot blame the provider for following an order the nurse knew was incorrect. Following an order known to be wrong constitutes a breach of the standard of care. Refusing procedures outside scope, documenting refusals, and reporting safety concerns are all appropriate nursing actions.

2.1 Legal Rights and Responsibilities | NCLEX-RN (Registered Nurse) | Free Exam Prep

Legal Rights and Responsibilities

Registered Nurses operate under a strict legal mandate that defines what they can do, how they must do it, and what happens when standards are not met. The NCLEX tests your ability to navigate the intersection of clinical care and legal liability.

The Nurse Practice Act

The Nurse Practice Act (NPA) is state legislation that defines the scope of nursing practice within each jurisdiction. Every state has its own NPA, and while they share common elements, differences exist.

Component	Purpose
Scope of Practice	Defines what nurses can legally do
Licensure Requirements	Establishes qualifications for RN licensure
Grounds for Discipline	Lists violations that can result in license suspension or revocation
State Board Authority	Grants enforcement power to the Board of Nursing

The State Board of Nursing (BON) enforces the Nurse Practice Act. The BON has authority to:

Grant, renew, or deny nursing licenses
Investigate complaints against nurses
Impose disciplinary actions (reprimand, probation, suspension, revocation)
Establish rules and regulations within the framework of the NPA

Understanding Negligence and Malpractice

Negligence is the failure to exercise the degree of care that a reasonably prudent person would exercise under similar circumstances. In nursing, this becomes malpractice when it involves professional conduct.

The Four Elements of Negligence

To prove negligence, a plaintiff must establish all four elements:

Element	Definition	Example
Duty	The nurse had a legal obligation to the patient	RN assigned to care for the patient
Breach	The nurse failed to meet the standard of care	Failed to check patient allergies before medication administration
Causation	The breach directly caused harm	Patient had allergic reaction due to unverified allergy
Damages	The patient suffered actual harm	Anaphylaxis requiring ICU admission

Key Point: All four elements must be present. If a nurse makes an error but no harm results, negligence has not occurred in the legal sense.

Standard of Care

The standard of care is what a reasonably competent nurse with similar training would do in the same situation. This standard is established through:

Nurse Practice Acts
Professional nursing standards (ANA Standards)
Institutional policies and procedures
Evidence-based practice guidelines
Expert testimony in legal proceedings

Types of Liability

Type	Description	Example
Personal Liability	Individual nurse is responsible for own actions	Nurse gives wrong medication
Employer Liability	Facility is responsible for employee actions (respondeat superior)	Hospital sued for nurse's error
Supervisory Liability	Supervisor liable for failure to properly supervise	Charge nurse fails to verify competency before delegation

Documentation as Legal Protection

Documentation serves as the legal record of care provided. Courts operate on the principle: "If it wasn't documented, it wasn't done."

Essential Documentation Practices:

Document objectively using observable facts
Use approved abbreviations only
Never document in advance of care
Never alter records after the fact (falsification)
Include date, time, and signature
Document refusal of care and patient education

Mandatory Reporting Requirements

Nurses have legal obligations to report certain situations:

Situation	Reporting Requirement
Child abuse/neglect	Mandatory report to child protective services
Elder abuse/neglect	Mandatory report to adult protective services
Communicable diseases	Report to public health department
Unsafe practitioners	Report to supervisor, risk management, or BON
Impaired colleagues	Report to supervisor or peer assistance program

On the NCLEX

Expect questions that test your understanding of:

When nursing actions constitute negligence
Appropriate documentation practices
Mandatory reporting obligations
Scope of practice boundaries

Exam Tip: When a question asks about legal liability, identify whether all four elements of negligence are present. If harm did not occur, negligence is not legally established.

NCLEX-RN

1Introduction

2Chapter 2: Management of Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Chapter 6: Basic Care and Comfort

7Chapter 7: Pharmacological and Parenteral Therapies

8Chapter 8: Reduction of Risk Potential

9Chapter 9: Physiological Adaptation

Key Takeaways