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Patient Rights

1 Contact Hour
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Athletic Trainer (AT/AL), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Nursing Assistant (CNA), Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Home Health Aid (HHA), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Registered Nurse Practitioner, Respiratory Care Practitioner, Respiratory Therapist (RT)
This course will be updated or discontinued on or before Thursday, June 17, 2027

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


FPTA Approval: CE25-467545. Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.
Outcomes

≥ 92% of participants will know about patients’ rights and responsibilities in healthcare, and how to implement them into clinical practice.

Objectives

Upon completion of this course, the participant will be able to:

  1. Outline topics of patient rights covered under the Consumer Bill of Rights and Responsibilities.
  2. Characterize the significance of using plain language when communicating with patients.
  3. Outline at least one important aspect of advance directives.
  4. Identify at least one method to safeguard Electronic Health Records Systems (EHR).
  5. Describe the important components of the Surprise Medical Bills Protection Act.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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To earn a certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Attest that you have read and learned all the course materials.
    (NOTE: Some approval agencies and organizations require you to take a test and "No Test" is NOT an option.)
Author:    Maryam Mamou (BSN, RN, CWOCN)

Introduction

Patients have rights and responsibilities regarding their well-being and the healthcare interventions they agree to. The Patient’s Bill of Rights was initially introduced in the 1970s by the American Hospital Association and the American Cancer Society. The beginnings of the patient rights that we are familiar with today were in the spring of 1997, when President Clinton set up a commission to review individual safeguards and quality standards in the application of healthcare. The President asked the commission to develop a “Consumer Bill of Rights,” but specific to patients and healthcare. This commission published a report entitled ‘Quality First: Better Health Care for All Americans’ in March 1998 (Commission Releases Final Report on Improving Health Care Quality, n.d.). They also created a Consumer Bill of Rights and Responsibilities, which functioned as the basis of systems and processes to protect individuals when interacting with the various facets of healthcare and provide better quality of care (OPM, n.d.). The Consumer Bill of Rights and Responsibilities had three specific objectives:

  1. To improve individual confidence by guaranteeing that the health care system is unbiased and receptive to the needs of each person. Healthcare systems are tasked with providing individuals with dependable and effective avenues to tackle their concerns and promote active individual participation in health maintenance.
  2. To reassert the value of a positive rapport between individuals and their healthcare providers.
  3. To reiterate each person's essential part in preserving their health by creating rights and responsibilities for individuals to improve their well-being.

Later, in 2010, President Obama established new final regulations, the Patient’s Bill of Rights, that included protections that apply to health coverage following the enactment of the Affordable Care Act (U.S. Centers for Medicare & Medicaid Services, 2024a).

Patient Rights

Patients have the right to care, services, and interventions that protect their dignity and consider their cultural and spiritual values. Individual patient beliefs often impact treatment interventions and choices. By acknowledging and showing regard for patients and their values, providers can better meet their treatment requirements while simultaneously protecting their rights. Several healthcare plans, including those subsidized by the Federal government, have implemented these general principles. As part of the Conditions of Participation, the Centers for Medicaid and Medicare Services (CMS) mandates participating facilities to protect and promote patients' rights. Consequently, all patients must be informed of their rights before making treatment decisions. Sometimes, a patient may not be able to communicate their needs. In these circumstances, patient rights should be discussed with the patient's legal representative. It is imperative that patients understand the information presented to them regarding their rights. Some patients may require extra assistance in this area.  For example, patients who are not proficient in English have the right, by law, to access a medical translator or to be provided with the required information in their primary language. Patient rights are divided into seven overall sections and an eighth section that addresses patient responsibilities.

Patient Rights (OPM, n.d.)
  1. Information Disclosures
  2. Choice of Providers and Plans
  3. Access to Emergency Services
  4. Participation in Treatment Decisions
  5. Respect, Safety, and Nondiscrimination
  6. Confidentiality of Health Information
  7. Grievances, Complaints, and Appeals
  8. Patient Responsibilities

Information Disclosure

The premise of informed consent is that patients have a moral, legal, and ethical right to understand and agree with all aspects of their care, including all potential consequences of accepting or refusing care. Patients must have sufficient information to make decisions related to their healthcare that align with their values and preferences. The principle underlying informed consent is that a person has the right to decide what is done to their body. Outcomes associated with a procedure must be laid out to be understandable to the patient, outlining the risks and benefits the patient can anticipate after undergoing the procedure. With the ongoing advancement in medical care, treatments have become more complex, and so has fully inclusive, informed consent for these treatments. The use of technology and the involvement of multimodal therapies pose new challenges to the informed consent process. The four principles related to informed consent are defined as follows (American Medical Association [AMA], 2025b; Shah et al., 2024; Wagner, n.d.):

  1. The individual must have the capacity to make the decision.
  2. The healthcare provider must provide adequate information on the benefits and risks of a given procedure, test, or treatment, including the likelihood that the given benefits or risks will occur.
  3. The individual must understand the information provided.
  4. The individual's consent must be voluntary, with no coercion or duress applied.

Patients in healthcare facilities have the right to accurate and easily understandable information about their health plan, healthcare professionals, and healthcare facilities. If they speak another language or have physical or mental disabilities, appropriate information must be given to the patient to enable them to make informed decisions about their healthcare. Patient rights include knowledge concerning the following:

  • The facility in which they receive care
    • The facility's policy on limiting and removing life-supporting care and interventions
    • Proficiency with various interventions and treatments
    • Certification status
    • Standard adherence and consumer satisfaction rankings, obtainable on the internet
    • The process for filing complaints
  • Information on the health professionals providing their care
    • Provider’s name
    • Professional qualifications
    • Experience
    • Patient satisfaction ratings
    • Comprehension of their rights and obligations as healthcare consumers

Regulatory organizations require proof that each facility provides this to patients through direct observation and facility policies. Each facility has its own methods for ensuring patients know and understand their rights. Most facilities display patient rights at points of admission to the facility. Many facilities also include a description of patient rights in handbooks given to patients during the admission process. Facilities may also require that the patient, or their legally responsible guardian, sign a document stating they were provided with patient rights. It has become a common practice for facilities to display a copy of patient rights and responsibilities in communal areas where they are easily accessible to patients, family members, and visitors. Still, a written listing of patient rights may not be sufficient. The facility is responsible for ensuring that patients adequately understand their rights and can exercise them. All information presented to patients must be in a format that is easily understandable to them (OPM, n.d).

Facilities must recognize that although a patient may speak English fluently as a second language, it may not be their preferred language for communicating and understanding health care information. According to The Joint Commission, adverse medical events happen more often to those with less-than-optimal English proficiency (The Joint Commission, 2021). Patients for whom English is not their first language need to be asked what language they want to use when discussing their healthcare. Their choice needs to be documented and adhered to. When the patient does not speak English, it is advisable to use a professional interpreter, rather than a family member who may speak English, to translate. A qualified medical interpreter knows medical terminology, ethics, and how to maintain patient confidentiality. Medical interpreters have completed extensive training programs; many professional interpreters hold master's degrees. If possible, the best scenario is to match the patient with a professional interpreter with a similar cultural background. In many cultures, patients will find it difficult and embarrassing to discuss intimate healthcare details with those of the opposite sex. Clinicians need to consider this when utilizing professional interpreters. Data indicates that the United States has between 350 and 430 spoken languages, including over 150 Native American languages (Allen et al., 2020). This country is one of the leading linguistically diverse regions in the world (Dietrich & Hernandez, 2022). This data emphasizes healthcare providers and clinicians' challenges when communicating with patients. Family members may feel unduly pressured if asked to interpret and may have valid worries about their ability to do this; however, they may be hesitant to voice their concerns. This means that patients may require extra assistance if they do not speak English, have hearing problems, or psychological or physical challenges that impede their understanding. Instances of special assistance that may be needed include:

  • Translators
  • Specialists in sign language
  • Case management services and social worker involvement
  • Braille resources
  • Magnifying glass or materials in a large font (U.S. Department of Health and Human Services, 2025b)

Choice of Providers and Plans

Patients have the right to choose their healthcare providers, including specialists, and to choose from a range of providers within their insurance network (OPM, n.d.). If they are dissatisfied with their care, they can switch to another provider. Patients also have the right to continuity of care. Patients should be able to expect that their physician will cooperate in coordinating medically indicated care with other health care professionals, and that the physician will not discontinue treating them when further treatment is medically indicated without giving them sufficient notice and reasonable assistance in making alternative arrangements for care (AMA, 2025a).

Access to Emergency Services

A patient and their healthcare insurance may not always agree on the necessity for emergency care. For example, a person develops sudden chest pain and goes to the Emergency Department because they think they have a heart attack. Tests reveal that the cause is heartburn, and the managed care plan refuses to cover the cost of the ER visit. The healthcare insurance stance is that they are not responsible for covering emergency care when the episode of illness is not life-threatening. These disagreements have resulted in healthcare facilities rejecting patients, refusing treatment, and transferring patients to other facilities. Now, healthcare companies have to utilize a standard definition of the requirements for ER care. This definition follows the example of a prudent layperson. Under the requirements of this definition, an individual requires ER care if they exhibit signs or symptoms that a rational NON-MEDICAL individual would believe to be an emergency. This definition of the actions of a prudent layperson is found in the Consumer Bill of Rights and Responsibilities, which was passed by Congress for Medicare and Medicaid in 1997 (U.S. Centers for Medicare & Medicaid Services, 2024b).

“Individuals have the right to receive emergency health care as required, regardless of the location of those services. Healthcare insurance plans are obligated to reimburse for emergency department care when an individual comes to the ED with acute symptoms of a serious nature that would lead a ‘prudent layperson’ to believe that ignoring these symptoms could have serious consequences for the person’s life and wellbeing.”

If a person develops severe pain, sustains an injury, or is struck with something that causes them to believe that their health is seriously threatened, then that person has the right to receive emergency care without the need for prior authorization or incurring a financial penalty. The patient also has the right to ask for a transfer to a different facility, assuming that such a transfer is medically feasible and that the other facility is willing to accept the patient (U.S. Centers for Medicare & Medicaid Services, 2024c).

The Emergency Medical Treatment and Active Labor Act (EMTALA) also safeguards the right to emergency medical treatment. This act prevents patient dumping and is commonly called the anti-dumping law. EMTALA was enacted in 1986 as a section of the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under EMTALA, a facility must assess a patient who presents for medical care. The assessment must be sufficiently thorough to determine if the patient has a condition that requires emergency medical care. An appropriately qualified healthcare professional must do the assessment. It must be clearly stated that a triage exam does not qualify as a complete medical assessment and diagnosis. If it is determined by the medical professional that the person does not have an urgent health condition, the facility has no additional responsibility under EMTALA. However, if a condition requires urgent care, the facility is obliged to provide the care needed to stabilize the person. Care must be provided without consideration of the patient’s capacity to pay. Before stabilizing the patient, a transfer to another facility may only be undertaken if the second facility is better equipped to meet the patient’s needs. A facility cannot transfer an unstable patient based on financial considerations (U.S. Centers for Medicare & Medicaid Services, 2024c).

Annually, 4%-5% of hospitals in this country are accused of an EMTALA violation. It has been found that sizable, for-profit metropolitan facilities with a substantial Medicaid population and large emergency department patient numbers are most likely to incur violations. Hospitals and doctors that contravene EMTALA rules can be fined $50,000 for each breach, and this is not covered under malpractice insurance (Warby et al., 2023).

Participating in Treatment Decisions

Patients have the right to take a leading role in making decisions about the type and quantity of treatment they will receive. To do this, they must have complete and accurate information. It is essential that a patient have detailed information about their diagnosis, treatment options, and prognosis (OPM, n.d). Healthcare professionals must review all treatment choices with patients, including not pursuing treatment. Patients must also be made aware of each treatment option's risks, benefits, and potential medical consequences.

Reviewing clinical information with a patient is an integral part of informed consent. Informed consent is an ongoing communication process between healthcare providers and patients. It allows the patient to make intelligent decisions about a proposed course of treatment; however, information is only beneficial to a patient when they can understand it. When reviewing diagnosis and treatment choices with the patient, the healthcare professional must make a concerted effort to minimize the use of medical jargon and terminology as much as possible. The services of a translator or interpreter may be required. If the patient would like a second opinion before deciding on their care, this should be facilitated. The procedure for obtaining informed consent must provide the patient with adequate opportunity to think through their options and diminish the likelihood of a pressure-induced decision (Moran, 2024).

Health literacy has recently become a primary healthcare focus and is crucial in obtaining informed consent. Health literacy has evolved from focusing solely on what the patient understands to emphasizing the clinician's responsibility to impart knowledge that is easily understood. However, data indicates that only 12% of adults in this country have competent health literacy, with around 36% having basic or below basic health literacy capabilities (International Medical Aid, 2024). Plain language has become a pivotal part of all healthcare communication. Simple language is not about 'dumbing down' healthcare information, but using words that are part of everyday speech. If medical terminology must be used, it is adequately defined and explained. Most people find healthcare services and treatment interventions difficult to understand. Clinicians should remember that in stressful situations, everyone, regardless of their level of education, can have difficulty comprehending what they are reading or hearing. Even healthcare providers who suddenly find themselves as the patient and need to make an informed decision may have difficulty comprehending the situation before them. The informed consent procedure must include the following components:

  • Complete information about diagnosis and treatment
  • A description of the proposed intervention
  • Probable benefits and dangers
  • Recuperation time
  • Likelihood of success or possible outcomes
  • Possible side effects of medication and treatment
  • Costs, including what insurance may and may not cover
  • Realistic alternatives to the suggested intervention (including dangers associated with the intervention, advantages, and side effects of these other options)
  • Any restrictions associated with confidentiality

Obtaining informed consent is about more than obtaining a signature on paper. Ideally, an unhurried collaborative discussion that considers the patient's beliefs and culture. The clinician must verify that the patient understands the information provided. This should not be done by simply asking if the patient understands, since most patients will automatically answer yes. The best option is 'teach-back,' where the clinician asks the patient to repeat the information in their own words(Agency for Healthcare Research and Quality [AHRQ], 2024). The clinician needs to be careful how they phrase this request so that the patient is not 'put on the spot' and made to feel that they are being quizzed. The clinician can begin by saying, "I want to make sure that I have given you all the information needed for you to make a decision. Can you repeat back to me what you have heard?" A survey of patient preferences and evaluation found that patients had no objections to being asked questions concerning their understanding of the information provided (AHRQ, 2024).

After a patient has been provided with all relevant information, they agree to have the proposed treatment or to decline it. The clinician should anticipate questions the patient may hesitate to ask and provide the information. A good way to approach this is by saying, "Many patients who have to decide on treatment like yours often wonder about . . .". After all the information has been explained to the patient and their questions are addressed, the patient should be provided sufficient time to think about their decision and not asked to sign the consent form immediately. Except in an emergency, patient consent must be obtained before any treatment can begin. The medical record must include the patient’s signed consent or an explanation as to why the patient cannot provide consent. Apart from the right to refuse treatment, a patient may at any time withdraw their consent. In this event, the treatment must cease. When patients decline treatment or withdraw consent once treatment has started, they have the right to know the consequences of their decision. The healthcare professional must inform the patient of the possible medical and other outcomes resulting from a lack of treatment. Parents, guardians, family members, or others designated as the patient's representative must be provided with the same information if the patient cannot make an independent decision (AMA, 2025b).

Advance Directives

The Patient Self Determination Act became effective in December 1991. This law requires that all hospitals receiving Medicare or Medicaid funding ask whether the patient has an advance directive or provide information about advance directives upon admission. Competent individuals 18 or older can sign an advanced directive (Familydoctor.org Editorial Staff, 2024). Advance directives can be used from admission to admission; however, they should be reviewed with the patient at each admission to verify accuracy. If the patient is incompetent at admission, the information should be given to their substitute or proxy. If the patient is temporarily incapacitated, the information should be provided when decisional capacity returns. A patient's right to make healthcare decisions remains valid even beyond when the patient can no longer convey their decisions directly. Advance directives can protect people in extreme conditions. These people may be unable to communicate due to a condition such as irreversible brain damage or a disease that affects the ability to think and communicate.

Advance directives can limit life-prolonging measures when there is little or no chance of recovery. For example, they may enable patients to express their feelings about cardiopulmonary resuscitation (CPR), intravenous (IV) therapy, feeding tubes, ventilators, and dialysis. Advance directives can also address pain relief, either requesting or refusing it.

An advance directive is a legal record that permits a patient to take part in future decisions related to their healthcare. There are two types of advance directives:

  • Living Will: This is a document in which a patient writes down their future treatment requests if a terminal illness occurs. A ‘living will’ takes effect once a patient is subjected to a terminal illness that prevents them from communicating their healthcare decisions in person. They are termed ‘living wills’ because what they stipulate can be carried out during the patient’s lifetime.
  • A ‘Durable Power of Attorney’ for Health Care: A legal document where the patient designates someone to make health care decisions on their behalf. A power of attorney takes effect when patients can no longer convey their personal decisions. The patient names a person called a proxy to make decisions (Mayo Clinic Staff, 2025).

Another option that patients have that allows them to participate in their future healthcare choices is the do-not-resuscitate (DNR) order. A DNR order stipulates that a person does not wish to have CPR performed if they go into cardiac or respiratory arrest. After discussing it with the patient or their legal representative, the healthcare provider writes a DNR order. Depending on the State law where the patient resides, a DNR order is only lawful if a doctor or other stipulated healthcare provider writes it. Depending on State laws, other variations of DNRs may be accessible to patients, these include:

  • Do Not Intubate (DNI): The patient does not wish to have a breathing tube placed or be put on a ventilator if they cannot breathe independently.
  • Allow Natural Death (AND): If this order is in place, only treatments that prevent suffering during death may be used (Cleveland Clinic, 2025).

Healthcare professionals have an essential role in safeguarding patient rights regarding advance directives. Healthcare personnel must empower patients to complete advance directives. They must provide information on the mechanisms of advance directives to every adult patient in a language/manner they can understand, and they need to assist patients who want to put an advance directive in place. Healthcare professionals must accept the choices in a patient's advance directive. Patients frequently have concerns about advance directives. The information presented to them must lay out what advance directives are and how they will benefit the patient, and not relinquish control over their healthcare as soon as they sign an advance directive. All patients must understand that advance directives give them autonomy over their healthcare and end-of-life choices. A copy of the advance directive is placed in the patient's record. If a copy of the directive cannot be obtained, the essential facts contained in the directive are detailed in the patient’s medical record. Healthcare providers must abide by the directive once it takes effect.

An advance directive only becomes effective when a patient is no longer able to communicate their wishes.
Until then, the patient's direct communication is what counts.

A patient with the capacity to make decisions can change the stipulations in their advance directive at any time. If a patient wants to alter a directive, the healthcare professional must facilitate this. At no time is patient care determined by whether a patient has an advanced directive in place or by the decisions outlined in the directive. Every patient must be treated impartially, irrespective of advance directives. Patients may often have concerns about this aspect of advance directives – will I still get the same level of care? If I’m in pain, will I get the pain medication I need? Sometimes patients may be hesitant about asking these questions, and healthcare professionals need to anticipate these concerns and address them, even if the patient does not directly verbalize them.

If an advance directive is not in place when a patient is no longer able to communicate directly, the patient's treatment wishes should still be respected as much as possible. Florida State Statute 765.401 provides for the appointment of healthcare representatives. To make decisions about the patient's treatment, the representative should consult with the providing healthcare professional and consider the patient’s wishes. The hierarchy of healthcare decision-makers for a patient without an advance directive depends upon state law.

Power of attorney means one person authorizes another person to act on their behalf. Some important points regarding a power of attorney include the signatures of the principal party, two adult witnesses, and a notary public. A power of attorney may be used immediately. A power of attorney does not need to be filed in court except for real estate transactions. A power of attorney is in effect until revoked by the principal, participant's death, or revoked by the court. A power of attorney may have more than one agent – all agents must concur when making decisions. There are several types of power of attorney.

  • General: The power of attorney allows an agent to act on behalf of the person in various situations.
  • Limited: The power of attorney is limited to a specific transaction.
  • Health care: In place for the agent to make healthcare-related decisions when the individual is incapacitated.
  • Springing: The power of attorney becomes effective at some future time (e.g., illness or disability of the principal).
  • Durable: All of the above can be made "durable" by adding text that enables the agent to act when the principal is incompetent and physically unable to make decisions.

A health care surrogate or proxy is a competent adult explicitly chosen in writing by an individual to make their health care decisions once they can no longer do that themselves. A healthcare surrogate or proxy must be 18 or older in nearly all states. However, they must be 19 years or older in Alabama and Nebraska. States may have other requirements on who can serve as a proxy, and a patient and their family should connect with their state legal aid office or state bar association to review proxy/surrogate requirements (National Institute on Aging, 2022). The surrogate, or proxy, has no authority to act until the primary care physician determines that the principal cannot make informed health care decisions.

Research Participation

Patients have the right to participate in research studies or educational activities. Health and Human Services (HHS) regulation 45 CFR part 46 requires that investigators obtain legally effective informed consent from participants who want to participate in human research studies. This informed consent process has three factors (Human Research Protection Program [HRPP], 2024):

  1. Disclosure of all required information to potential research candidates to make an informed decision.
  2. Ensuring that a candidate fully and accurately understands the information provided.
  3. Safeguarding the completely voluntary nature of the decision.

A patient's refusal of experimental treatment should not affect their regular care. If the patient wants to participate in a research study, they must sign a written consent that clarifies that the planned treatment is experimental. The consent form for participation in experimental treatment must include the nature of the experimental treatment, procedures involved, possible risks and benefits, other available options, and confirmation of interrupting patient care. The process of informed voluntary consent may be ongoing throughout the research study and remains in place until the participant decides to end their involvement or until the research is concluded. The person obtaining consent must be qualified to explain all factors of the research activity to a potential participant and to answer their questions. If a person indicates that they are not interested in participating, no additional effort should be made to obtain their consent (HRPP, 2024).

Organ Donation

A patient has the right to decide if they want to be an organ donor. If they wish to donate their organs, they must sign an informed consent to this effect. If the patient cannot give informed consent, the patient's representative may make this decision.

Respect, Safety, and Nondiscrimination

Patient Respect

Every patient has the right to kind, respectful, unbiased care from all they encounter in the healthcare system. Respect includes being considerate of the patients' needs, wishes, emotions, and thoughts. Patients have a right to courteous treatment, regardless of the setting. An everyday example of this is to knock on the patient’s door, pause before entering the patient’s room, and use the most appropriate term to address them: Ms. Brown, Mr. Ross. Never assume you should call the patient by their first name unless they ask you to. Respond politely to patient comments and questions, practice empathic listening with all patients, and stay compassionate.

Patient Nondiscrimination

Every patient has the right to the best care services possible, irrespective of the following (U.S. Office of Personnel Management [OPM], n.d):

  • Racial identification
  • Background
  • Country of origin
  • Religious beliefs
  • Political association
  • Educational attainment
  • Residential or business location
  • Time of life
  • Gender identity
  • Relationship status
  • Individual appearance
  • Psychological or physical incapacity
  • Sexual inclination
  • Hereditary data
  • Imbursement source

Patient Safety and Security

Safety and security are basic patient rights. They have the right to select health care professionals who are best qualified to provide them with state-of-the-art care. All caregivers must do their part to maintain a safe environment for patient care. All employees are responsible for knowing facility policies regarding environmental safety, infection control, and security. The Joint Commission (TJC) has been concerned about patient safety over the past few years and has issued its Patient Safety Goals (The Joint Commission, n.d.).

All patients must be assessed for possible abuse. All facilities need to have in place policies and procedures for the identification, reporting, and treatment of victims of abuse. All staff working in a facility must be trained on abuse policies relevant to their level of patient interaction. Patients have the right to the full assistance of protective services in cases of abuse. Sometimes patients need to be kept safe from themselves, and restraints are needed. The use of restraints is a decision made by a healthcare professional and considers all the factors in the patient’s care, including less restrictive means to keep the patient safe. Restraints must not be used as a form of discipline or for the convenience of the facility and staff. Protecting the patient's rights, safety, comfort, and dignity is important when a patient must be restrained (The Joint Commission, n.d.).

Confidentiality of Health Information

Patients have the right to reasonable visual and auditory privacy. A private area must be provided for all healthcare interactions, examinations, and treatments. The patient has the right to receive and review their medical record. They also have the right to request that the healthcare provider correct any inaccuracies in the record and add any missing information. The medical records are shared only with providers who directly participate in the patient's care, regulatory personnel evaluating the quality of care provided in a facility, and other persons with legal or supervisory authority to examine records. Protected healthcare information (PHI) cannot be given to anyone without a legal right to see it. This latter group can include immediate family and other relatives if the patient or the patient’s surrogate has not given written permission for PHI to be shared with them. Only authorized staff should be allowed access to areas where medical records are stored. This same rule applies to access to electronic health records. The patient should be made aware whenever their PHI is disclosed. Patients may be prohibited from viewing specific information in circumstances where this information could be injurious to the patient or another individual, or could be inspected by an oversight committee.

The HIPAA (Health Insurance Portability and Accountability Act) privacy rule is a federal regulation that sets standards for patient privacy and confidentiality. It also sets severe civil and criminal penalties for people who violate a patient's privacy. To comply with HIPAA, organizations should ensure that protected patient information is only shared with people directly involved in the patient’s care. The patient's case must only be discussed with people who are directly involved. Particular attention should be taken when talking in communal spaces such as elevators, bathrooms, corridors, cafeterias, etc. No aspect of patient care should ever be discussed in public areas. Patient charts should not be left out where unauthorized persons might see or access them. Since many facilities use electronic patient records, clinicians must be aware of facility policies for 'locking' their computers whenever they are not in use. It is essential to observe the surroundings when discussing patient care (Tariq & Hackert, 2023; U.S. Department of Health and Human Services, 2025a).

Electronic Health Record Systems (EHR)

Electronic health records (EHRs) are growing in popularity. The main advantage of EHR systems is that they allow the exchange of healthcare information across the continuum of care in the most coordinated system possible. However, clinicians must know that an EHR can be subjected to several security threats, including phishing and malware attacks, inadequate encryption, and employee negligence. All employees using EHRs should have sufficient training, including credentials and password protection, and the facility protocol for accessing it. The advent of cyberattacks, which include ransomware and data breaches, has created a severe hazard to the security and confidentiality of EHR systems. EHR systems must now contain encryption, multi-party authentication, and protected backup methods as part of their processes (Coherent Market Insights, 2024).

Telemedicine Services

Telehealth is becoming an important part of healthcare delivery. It is vital that healthcare providers and clinicians fully explain telemedicine services to patients. Requirements for informed consent for telemedicine services vary by state, and clinicians need to know what legal requirements are applicable in their locale. The expectations, benefits, and possible risks of telemedicine services must be clearly explained to patients. One concern many patients have regarding telemedicine is the security of their healthcare information. Providers must clearly explain the security measures to protect healthcare information when telemedicine is used. A written consent form may need to be signed by the patient; however, oral patient consent recorded in the patient's medical record is sufficient in some areas. Figures from 2021 showed that 37% of people in this country stated that they used telemedicine in the prior 12 months, with a higher user rate among women (42%) than men. However, significant differences are apparent in telemedicine use. Data indicates that it has the lowest usage level among those without health insurance, young adults between 18 and 24, and inhabitants of the Midwest. Tackling obstacles to telemedicine access for vulnerable members of society, including people with disabilities, is critical. These obstacles are often related to technology and regulatory laws (Anawade et al., 2024).

Complaints and Appeals

The patient has the right to an impartial and speedy assessment of any grievance concerning any aspect of their encounter with the healthcare system. A patient complaint can cover a wide range of issues, including:

  • Their healthcare plan
  • Inadequate Facilities
  • Conduct of healthcare professionals
  • Long wait times before being seen by a healthcare professional

Several facilities have a Patient Care Representative on staff who deals with patient complaints and grievances. Many patient complaints can be easily remedied. For example, a patient complains about not getting what they requested on their dinner tray. An apology to the patient and a word with the person who oversees the preparation of the patient's meal tray should resolve this problem. Addressing a concern promptly gives the patient a sense of assurance that they are being well cared for by the facility. For more serious and pervasive problems, the patient may need to take their care to the facility's ethics committee. Patients have the right and expectation that matters concerning their end-of-life care should be handled with respect and understanding. The patient should be able to obtain a copy of their medical bill and an explanation of benefits, irrespective of the payment source.

Greater than 50% of patients who pursue legal action in a healthcare situation do so because of inadequate communication, lack of shared information between healthcare providers, hospital staff, and patients/families, and frustration with what they perceive as an unresponsive system. Grievance management is the responsibility of facility personnel. Prompt and efficient management of grievances from the onset prevents a problem from escalating and decreases the risk of negative legal consequences for the facility and staff. When a complaint requires more detailed intervention, a patient can exercise their right to file a grievance report. Grievance is an official complaint that may be either oral or written. If a patient wishes to file a grievance, the healthcare provider has to meet the following requirements:

  • Explain the facilities' grievance procedure, including the name and contact information of the staff member who handles grievances.
  • Inform the patient and family that they can file a grievance with state agencies, even if the patient has already used the facility's internal grievance procedure.
  • Provide the patient and family with contact information for filing a grievance with the relevant state agency.

The healthcare facility is responsible for conducting an investigation into all grievances within a reasonable time frame and putting in place a plan of action to resolve the issue. A grievance related to patient safety, such as abuse or neglect, must be investigated immediately. The grievance procedure is finalized once the facility provides the patient with a written report of the investigation findings. This report should provide information on the facility's steps to investigate the grievance, their conclusions, and any further action that will be taken (OPM, n.d; U.S. Centers for Medicare & Medicaid Services, 2024b).

Bills and Bill Examination

Patients have the right to ask questions about the healthcare bills they receive. They can request and receive a full description of each item on their bill (U.S. Centers for Medicare & Medicaid Services, 2025).

Patient Responsibilities

In addition to patient rights, patients should be informed of their responsibilities. Patient responsibilities typically include:

  • Providing a clear and complete description of their current health concerns, a history of previous ailments, hospitalizations, prescription and non-prescription medications they are taking, and other issues associated with their health.
  • Reporting unforeseen occurrences in their illness to their healthcare professional.
  • Stating whether they fully understand and follow the plan of action to meet their healthcare needs and their role in the plan.
  • Adhering to the treatment plans proposed by their primary healthcare provider. The plan may require the patient to follow instructions given to them by nursing staff, therapists, or other healthcare workers responsible for implementing the care plan.
  • Keeping appointments and notifying the healthcare professional or facility when they cannot attend.
  • Understanding the consequences if they reject treatment or do not adhere to the healthcare provider’s instructions.
  • Taking action to ensure that the financial responsibilities related to their health care are met as quickly as possible.
  • Being considerate of the rights of other patients and personnel and respectful of the property of others (U.S. Office of Personnel Management [OPM], n.d.).

Additional Pediatric Rights

Patients (and their parents, legal guardians, or other legal agents) have the right to (Society of Pediatric Nurses [SPN], 2020):

  • A hospital, or facility environment that supports the developmental, intellectual, emotional, and social requirements of children and youth–
    • Opportunities for play, educational, and communal pursuits are necessary for all children and youths.
    • Effective and supportive communication on what happens before, during, and after treatments.
    • Involvement of children/families in decision-making related to their medical care.
    • Ensure that parents and healthcare professionals are included as central participants in decision-making and in providing care for their child as feasible.

Family Responsibilities

The family unit is made up of people who are responsible for the physical and psychological well-being of the child. During a period of illness and hospitalization, parents and guardians are required to (SPN, 2020):

  1. Maintain their parenting role within the constraints of the situation.
  2. Be accessible to staff and available to take part in decision-making concerning the care of the child.

The Affordable Care Act

The initiation of the Affordable Care Act (ACA) in 2010 provided millions of individuals with access to healthcare insurance that they could not previously obtain. Among the many provisions of the ACA was the provision of new protections for people with pre-existing health conditions. Under the ACA, they could no longer be denied healthcare coverage or charged increased healthcare insurance premiums. Mental health and substance abuse care are also included as ‘essential health benefits’. The ACA also banned the implementation of lifetime and annual benefit limits and mandated healthcare insurance plans to limit out-of-pocket expenses for consumers. The ACA also has a provision that permits young adults to continue coverage under their parents’ insurance plan until they reach 26 years of age (Hewitt, 2024; U.S. Department of Health and Human Services, 2023). The ACA serves to:

  • Improving Americans' Health: The ACA has successfully reduced the number of uninsured Americans to record-low levels. By 2023, the number had dropped below 8% (Seitz, 2025). By ensuring that high-risk individuals have insurance, chronic health conditions are better managed, and premature deaths are reduced (Hewitt, 2024). Insured children are less likely to experience avoidable hospital stays than uninsured children, and when hospitalized, insured children are at less risk of dying.
  • Protecting Americans' Savings: High medical costs contributed to some degree to about half of the more than 500,000 personal bankruptcies in the U.S. in 2007.
  • Increasing Workers' Productivity: Providing adequate healthcare for children with health conditions may reduce the number of missed work days for parents. Parents will also be freed from "job lock," which occurs when people are afraid to take a better job because they might lose coverage for themselves or their families.

It has also provided important consumer protection for more than 100 million individuals and has improved healthcare overall. Despite uncertainty about the future of the Affordable Care Act, it now covers 24 million people. However, the tax credit that allowed health care coverage to be less expensive for those enrolled in the ACA is set to conclude at the end of 2025 unless Congress enacts new legislation (Seitz, 2025). Following the enactment of the Affordable Care Act came the adoption of the Patient’s Bill of Rights, which included patients’ rights relevant to healthcare insurance.

Please click the links for more information about the Patient's Bill of Rights:

Since the Patient's Bill of Rights was enacted, the Affordable Care Act has provided additional rights and protections.

Surprise Medical Bills Protection

Towards the end of 2020, the United States Congress passed a bill, the No Surprises Act, which was signed into law by the President. This new law affords federal protection to people from surprise medical bills. The bill's provisions protect patients from liability for the cost of unforeseen, out-of-network medical expenses. Surprise medical bills are often incurred in medical emergencies, when there is no option but to receive care. They may also occur in non-emergency care when a patient at the in-network facility is provided care from a healthcare professional, such as anesthesia personnel, who is not part of the network and was not selected by the patient. The law mandates private health insurance companies to pay for surprise medical bills for emergencies, including air ambulances, and to provide coverage for care given by out-of-network providers at in-network facilities. The law also stipulates that non-network providers cannot bill patients for additional charges incurred.

Other stipulations of the bill include:

  • Health plans are required to supply a prior explanation of benefits. Starting in 2022, people can ask for advance information regarding how treatments will be covered before they receive them.
  • Health plans must maintain coverage between the continuation of healthcare coverage and the time a provider departs the network. Under the law, health insurance companies must inform patients when a provider or facility leaves the plan's network.
  • Health plans are required to keep correct provider network directories. Health insurance companies must reply within one business day to questions from enrollees about the status of a provider or facility, whether they are in-network or not. The information provided to the consumer becomes binding on the insurance company.
  • Health plans are mandated to release data on broker commissions. Persons enrolled in a healthcare plan have a right to be informed about the sum of direct and indirect reimbursement given to brokers for that enrollment (Kaiser Family Foundation, 2021).

Case Study

Ms. R., a 78-year-old woman, is having a left knee replacement. When the nurse checks on her, she notices Ms. R. appears distressed. The nurse sits beside her chair and asks, “Is there something else?” “I don’t want to do this,” Ms. R whispers. “I called my sister,” she continues, and she said I signed the consent, and I have to go through with it.” Understandingly, the nurse asks, “Do you want to tell me why you’ve changed your mind?” the nurse asks. To this question, Ms. R. replies, “The young doctor came in a little while ago and tried to explain it to me, but I didn’t understand most of what he said. He was so nice, I was too embarrassed to ask questions.” The nurse smiles, “I understand. You can withdraw consent and not have surgery. That is always your right. If you want to tell me your questions, I will see if I can answer them. Ms. R. begins, “After surgery, he said I’m going to a facility, is that a real hospital, will I still get my medications?” The nurse replies, “It’s a skilled nursing facility, not a hospital like this. But you will still get your medications there.” Next, the patient asks, “What about pain medication?” “They will be able to give you the pain medication the doctor has ordered for you.” Ms. R. thought momentarily, “They are going to help me learn to walk with the new knee, what if I need more help when I have to leave there?” “A physical and occupational therapist can visit your home a few times weekly and continue working with you there. Will you have anyone with you when you go home?” the nurse asks. “My niece will stay with me at night, and I hope I’ll be able to manage during the day,” states Ms. R. The nurse tells her, “I will put a note in your chart for the social worker at the skilled nursing facility to talk with you about getting extra help at home.” Ms. R. looks relieved, “Thank you,” she says. ‘I feel better now that I understand what is happening, and I want to get my new knee.”

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

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