The Nursing Voice - March 2021

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Page 14 March 2021 The Nursing Voice PRACTICE CORNER Illinois Law & Nursing Practice Nancy J. Brent, MS, JD, RN If you have a legal question for Nurse Attorney Nancy Brent, please send it to susan@sysconsultingsolutions. com. The INF has the right to review and publish selected questions and responses. Question: An RN who has worked at the bedside for over 30 years writes that she has always gotten a second nurse to witness getting consent from a parent over the phone for a patient who is a minor. A younger staff nurse told her that witnessing a consent for a minor is not done anymore. The RN thought it was a law, and if not, it seems to be best practice. Have things changed, she asks? Response: No. State statute or administrative rule requires you to have a second RN witness a parent's phone consent for his or her minor child who is being treated in your healthcare facility. This RN's practice most likely stems from working in hospitals whose own policies and procedures required that this occurs. The RN's comments that the procedure seems to be "best practice" are noteworthy from a risk management perspective. Risk management is an essential internal component of a health care delivery system. It is a precise process that attempts to reduce preventable injuries and accidents and also prevent financial loss for the institution. The four main components of reducing risks to the health care entity are "risk identification, risk analysis, risk treatment, and risk evaluation." For this RN, the risk management policies and procedures that governed the requirement to get a second RN to confirm consent were obtained from a parent likely emanated from these components. In applying these elements to the RN's question, one can identify several risk factors in not obtaining a witness to the phone consent: What if the parents are divorced? Who has the legal right to consent for the minor child? What if the parent who is legally able to provide consent later has doubts and changes his or her mind, saying consent was never given? How many incident reports have been received by the risk management department from nurses that document these and other issues? The consent risk analysis would most probably be seen as relatively high and, therefore, the importance of identifying how to treat the risk is to avoid its occurrence. Treating this particular risk apparently appeared to the RN's employer reasonably simple: get a second person to hear the consent given and document it according to adopted policy and procedure. Evaluating the treatment instituted for the risk includes the frequency of occurrence and the severity of outcomes, if any, after the treatment is instituted. Although not a legal requirement, such a practice might help you—and your employer—if a later challenge to the consent given is raised. You can learn more about risk management in the article, "Steps in the Process of Risk Management" @ researchgate.net/publication/308888285_Steps_in_the_ Process_of_Risk_Mnagement_in_Healthcare. A discussion of parental consent for a minor is not complete without a brief conversation about when a parent's consent is unnecessary for a minor's care. A minor in Illinois is defined as an individual who is 17 years of age and under. The law sees such individuals as not having the legal capacity to provide the required consent. Generally speaking, then, as the RN's submitted question illustrates, it is the parent(s) of the minor who provide consent for treatment. Others that can give consent for a minor include a guardian or person standing in the parents' place (in loco parentis doctrine). There are specific exceptions to this mandate in many states and specifically in Illinois under the Consent by Minors to Health Care Services Act. They include: Medical Emergency When the minor's condition is an emergent one, meaning that the minor's health or very being is such that waiting to obtain consent for treatment would "adversely affect the condition of the minor's health," parental consent is not needed. Whether the minor's condition requires immediate emergency care rests solely with the health care provider, including an advanced practice registered nurse (APRN). Pregnant or Married Minors Regardless of age, a married or pregnant minor can consent to healthcare services, including those from an advanced practice registered nurse (APRN). Primary Health Care A minor between the ages of 14 through 17 who is not living with parents or a legal guardian or unable or unwilling to return to his parents' home, and is managing his personal affairs, may consent to primary care (including screening, medication, and immunizations in an out-patient setting) under specified conditions (including the minor being identified in writing by an attorney licensed to practice law in Illinois or a school social worker). If you provide care to minors in any capacity in any setting, following your facility's requirements for obtaining consent for those 17 and under is essential to avoid potential liability for both you and your employer. You also need to be knowledgeable about and follow Illinois law applicable to consent for health care by, or for, minors. Potential liability for you would rest in being named a defendant in a civil case brought by the minor's parents for not obtaining consent as Illinois law requires. Potential culpability for you may also be alleged in a professional disciplinary action for a violation(s) of the Illinois Nurse Practice Act and its Rules that apply to obtaining proper consent. For example, a parent might allege that your failure to obtain their consent is a failure to conform to practice standards. A regular reading, then, of the Act and its Rules is vital. Refreshing your memory about consents for minors can easily be done through a 2019 Illinois Health and Hospital Association's summary of applicable Illinois' law at team.iha.org/files/non-gated/legal/consent-by-minors. aspx?ext=. THIS INFORMATION IS FOR EDUCATIONAL PURPOSES ONLY AND IS NOT TO BE TAKEN AS SPECIFIC LEGAL ADVICE BY THE READER. IF LEGAL OR OTHER ADVICE IS NEEDED, THE READER IS ENCOURAGED TO SEEK SUCH ADVICE FROM A COMPETENT PROFESSIONAL. EARLY REPRESENTATION IS KEY TO A GOOD DEFENSE Lillian Walanka and the attorneys at Crick Walanka Law Group have decades of combined experience defending LPNs, RNs, and APNs in investigations and disciplinary prosecutions before state and local administrative agencies related to various allegations, such as: Failure to Report a Conviction, Termination, or Out-of-State Disciplinary Action Drug and/or Alcohol Abuse • Mental or Physical Impairment Unprofessional Conduct • Drug Diversion • Patient Abuse Boundary Violations • Standard of Care Issues • Falsification of Information We also represent and consult with nurses regarding Petitions, Appeals, and Applications. Crick Walanka Law Group, Ltd. 111 W. Washington St., #1820 Chicago, IL 60602 (312) 335-8860 • www.crickwalankalaw.com
The Nursing Voice March 2021 Page 15 Nurses want to provide quality care for their patients. The Nurses Political Action Committee (Nurses- PAC) makes sure Springfield gives them the resources to do that. Help the Nurses-PAC, help YOU! So. . . . . . . if you think nurses need more visibility . . . . . . . . . if you think nurses united can speak more effectively in the political arena . . . . . . . . . if you think involvement in the political process is every citizen’s responsibility. Become a Nurses-PAC contributor TODAY! ❑ ❑ ❑ ❑ I wish to make my contribution via personal check (Make check payable to Nurses-PAC). I wish to make a monthly contribution to Nurses- PAC via my checking account. By signing this form, I authorize the charge of the specified amount payable to Nurses-PAC be withdrawn from my account on or after the 15th of each month. (PLEASE INCLUDE A VOIDED CHECK WITH FORM) I wish to make my monthly Nurses-PAC contribution via credit card. By signing this form, I authorize the charge of the specified contribution to Nurses-PAC on or after the 15th of each month. I wish to make my annual lump sum Nurses-PAC contribution via a credit or debit card. By signing this form, I authorize ANA-Illinois to charge the specified contribution to Nurses-PAC via a ONE TIME credit/debit card charge. ❑ Mastercard ❑ VISA ________________________ ____________ _________ Credit card number Expires CVV Signature:______________________________________ Date:__________________________________________ 779-529-2012 Printed Name:___________________________________ E-Mail:________________________________________ Address:_______________________________________ City, State, Zip Code:_____________________________ Preferred Phone Number:__________________________ ONLINE convenience, QUALITY education Please mail completed form & check to: ANA-Illinois Atten: Nurses-PAC PO Box 636 Manteno, Illinois 60950 We offer over 30 continuing education programs for health professionals From anticoagulation therapy to wound management. Designated contact hours for pharmacology for APRNs! Learn your way with live, independent study, online interactive, and hybrid programs. Education in Your Own Time and Place http://www.usi.edu/health/center-for-healthprofessions-lifelong-learning/certificate-programs/ 877-874-4584 In support of improving patient care, the University of Southern Indiana Center for Health Professions Lifelong Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
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The Nursing Voice - March 2021

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