Clinical nurses’ legal roles, challenges, and responses to enabling legislation in China: a qualitative study

“I think the legislation can make more people pay attention to the rights and interests of nurses and enhance their social status to a certain extent…… It’s important to make the whole society change its conception of the nursing profession. It’s not just an auxiliary job but also very important for clinical work.” (N15).

“Sometimes patients have different attitudes towards doctors and nurses. They really respect doctors and follow their instructions, but they think nurses only do basic treatments. This attitude can even affect how I feel at work.” (N2).

“The protection of nurses is the most important thing. I think nurses are vulnerable nowadays. It’s not just the pressure from patients; doctors also take it out on nurses. Senior nurses can handle it, but junior nurses can easily be bullied.” (N10).

“The situation of emergency rescue must be defined so that every nurse will know what he can and cannot do when resuscitation is carried out in society.” (N5).

“Voluntarily rendering aid to another person in public is written directly into the physician’s law to provide protection; however, there is no such protection for caregivers.” (N8).

“Personal safety must be guaranteed, but this is not written in the nurses’ regulations. At the same time, there needs to be a clear system of sanctions for certain family members who attack nurses.” (N1 & N6).

“Conflicts between nurses and patients often focus on the nurses’ service attitude, even when they’re not at fault. Hospital administrations typically resolve issues quietly, often requiring nurses to apologize, leaving them feeling wronged and distressed. There’s a lack of proactive protection for nurses’ rights from the nursing department to hospital management.” (N10).

“I barely know anything about the Nurses Regulation, and I haven’t had any specific training on it since I started working.” (N1 & N10).

“We’re always working overtime, so there’s hardly any time for legal and regulatory training. Hospitals focus more on improving service quality and clinical skills than on legal knowledge.” (N7).

“When I’m working in the clinic and see disputes between nurses and patients, or mistakes by non-nursing staff, I usually don’t pay much attention. I can’t worry about those things if I haven’t finished my own tasks.” (N6).

“I think nurses are really vulnerable in the hospital. People should avoid conflicts when they can and always stay out of trouble.” (N10).

“The onboarding training should consist of a 2–4 hour lecture on legal knowledge, some of which will cover clinical cases and explain how to apply the law in the form of case studies.” (N2).

“If you have already had work experience before training, you may have a higher level of absorption and acceptance than when you were unemployed.” (N11).

“Training frequency is once a month or once every three months, it can also be said during the routine shift handover every morning.” (N8).

“①If there are cases, clinical nurses may have a more intuitive understanding of this situation… ②we talk about the laws and regulations that this case may involve, I think the effect may be better.” (N5, N6, N7).

“I think the training content not only includes how to protect patients’ rights, but also how to protect our own rights. I hope to also be exposed to how to pick up legal weapons to defend our rights during the training.” (N1).

“Newly hired nurses may learn the most basic nursing regulations or medical accident related regulations, as they are closely related to their work. Specialist nurses need to learn more about medical related laws, which is actually a way to protect themselves.” (N3).

“As an intern, one should learn more about occupational registration, handling of relevant accidents in hospitals, infection management, and prevention and control of occupational diseases.” (N4).

“The granting of prescription rights to nurses should be subject to certain restrictions, such as requiring certain job titles and years of experience.” (N3).

“Prescription rights should be evaluated by the industry and standardized through processes such as qualification exams and training” (N7).

“There should be a clear distinction between doctors and nurses in terms of prescription rights, such as nurses being able to prescribe dietary care prescriptions and exercise prescriptions, and nurses of different levels should have different prescription rights.” (N15).

“As nursing develops in China, there might be a future where nurses are sent overseas. This raises questions about the future location of nursing careers, and I think the Nurse Act will need to address this issue.” (N3).

“If multidisciplinary practice is expanded, we need to ensure nurses’ personal safety in different settings. It should be mutual, and we definitely need laws and regulations to protect everyone involved.” (N13).

“Multidisciplinary practice is great because some nurses are very qualified and could see patients in other hospitals like doctors do. We also have outpatient clinics run by nurses now. I think the legislation needs to be more standardized.” (N15).

“I think the safety issue is the most crucial. First, there’s patient safety—how do we ensure that online nurses meet the right standards and have the proper qualifications for home visits? This needs to be clearly defined. Second, there’s the safety of the nurses themselves, including safe door-to-door visits, proper use of medications, and protection of personal property.” (N4).

“It’s essential to set clear qualifications for on-demand nurses, specifying the certifications they need and identifying the responsible organizations and personnel involved in this process.” (N8).

“Since I’m not a law student, I think it’s important to explain the basics: who can be a nurse, what their duties are, and the roles of different positions, like assistant nurses. Understanding these fundamentals, including the rights and responsibilities of nurses, is crucial.” (N8).

“I think the rights and obligations mentioned earlier are necessary for interns. It is necessary to clarify and regulate what interns can and cannot do, who is responsible for what they do, their salary, and working hours” (N14).

“It is necessary to establish a sound nurse training system, because now everyone is talking about standardized training. If different hospitals need to re regulate training, it may not be very necessary.” (N4).

“The law should advocate for the establishment of a unified training system, preferably in a structured environment of leading hospitals, including monthly assessments and final comprehensive exams. After one year of training, if the assessment is successful, you can directly start working in other hospitals because you have already learned and developed your knowledge and skills.” (N10).

“I personally think that centralized training may not be a good way for nurses. Because each department has its own characteristics, and each hospital is also different, and the standardized training in the past two years actually involves the issue of practice location.” (N3).

“Tailored training based on individual circumstances and the specific needs of each hospital is more important. The training experience of different hospitals may vary, and the training plan should be flexible to meet the unique requirements of various medical environments” (N9).

“When nurse-patient conflicts arise, nursing staff often become the target of blame, making it difficult to protect their rights.” (N10).

“Nurses’ rest time should be respected, and if hospitals encroach on this time, there should be a legal compensation mechanism.” (N13).

“Hospitals do not place enough emphasis on the protection of interns’ rights; both schools and hospitals should clearly define the interns’ entitlements to work injury insurance, medical insurance, and social insurance during their working period.” (N14).

“Intern nurses inevitably face different issues in clinical work compared to senior staff, especially when tasks are assigned. Their personal interests must be protected first in order to effectively fulfill their duties. This may include receiving educational training and legal protection, such as reasonable working hours, rights to rest and vacation, and the right to receive appropriate compensation.” (N16).

“It’s not fair to base pay solely on nursing workload. The value of experienced nurses isn’t captured just by how much work they do. Other factors should be included in the payroll to more accurately reflect their contributions.” (N10).

“This inconsistency not only creates a sense of unfairness among nurses but also impacts the stability and quality of nursing care.” (N16).

“Especially in specialized departments like the emergency room, where about a third of the nurses are male, appropriate facilities have been provided to accommodate their needs.” (N2).

“Due to insufficient staffing within the hospital, some nurses are employed through external organizations or society. While equal pay for equal work and fairness in title progression have been addressed, women’s rights related to maternity benefits have been compromised.” (N3).

“For nurses with rich clinical experience and outstanding clinical work abilities, their promotion qualifications should not be evaluated solely based on scientific research.” (N7).

“legal standards must be flexible and adaptable to future policy changes, emphasizing the need for a promotion system that remains responsive to evolving requirements.”(N8).

Additionally, the integrity and fairness of the promotion system require close scrutiny. “There are variability in promotion protocols across different hospitals and a unified legal standard needs to be established to ensure transparency and equity in the promotion process for all nursing personnel.” (N10).

“The reward mechanisms established in the Physicians Law for involvement in significant medical events should be preserved and adapted for the Nurse Act. This integration is especially relevant in the context of the ongoing pandemic, ensuring that nurses receive recognition and rewards commensurate with their vital roles and contributions.” (N1).

“Many nurses in the department suggest establishing incentive systems and financial subsidies specifically for individuals exposed to radiation and chemotherapy.” (N6).

“While hospitals should encourage research, they must also ensure that nurses’ fundamental work rights are protected, including stable income. Efforts should be proportional to the rewards, with corresponding incentives provided based on achievements to foster greater research participation.” (N8).

“Due to financial constraints, nursing staff often resort to low-cost projects like health education, which hampers their ability to undertake more substantive research. This situation restricts the growth and development of nursing research.” (N10).

“Research funding should be distributed according to a defined budget and strictly used for designated research activities. Implementing such regulations can ensure that funds are utilized effectively, minimizing waste and misuse.” (N15).