NURS3006 Transition To Professional Practice 3

Scenario: 

An RN graduated in 1997. Her career covered mental health, surgical and disability services in different settings since registering. Working in a general medical unit in a regional hospital several events occurred that led to a series of incident reports being made by the senior nurse manager, an enrolled nurse and the unit manager. The reports led to complaints being made to the Nursing and Midwifery Board of Australia. The allegations included that the nurse had accessed healthcare records for patients not in her care and that when the unit manager was not on shift the RN spent her time on the computer leaving the enrolled nurse to manage the patients. During the course of the investigation and the hearing, the unit manager commented favourably on the RN’s clinical skills and experience. The unit manager also revealed that the RN was under stress resulting from difficulties experienced at her previous place of employment that had not been resolved at the time.

Points to Consider:

a) With reference to the appropriate codes, standards and guidelines for safe practice in Australia identify the possible breaches of these that could potentially lead to a finding of unprofessional conduct or professional misconduct being made against the RN.

b) What would your responsibility be if you were working with the RN and were a witness to the nurse’s conduct?

c) What resources are available to assist you in these types of cases?

d) How does this scenario cause you to think about :

a. Your own and the groups professional conduct

b. Ethics and legislation in nursing practice

c. Mandatory reporting. What are nurses obliged to report?

d. The enablers and barriers to reporting unprofessional behavior and the strategies that would be most effective to handle these.

Answer:

Introduction:

The last few centuries have seen a dramatic shift of registered nurses away from primary care and into the hospital. In this context, providing the best possible care to the patients by ethically involve in professional practice is the duty of care of a registered nurse (Cowin et al., 2019). The case study involves a registered nurse who was working in general medical unit, many complaints were documented against RN regarding an allegation of accessing the medical records of the patients who were not in her care and spending time in the computer while leaving enrolled nurse for managing patient. However, during the investigation, her stress was one of the factors highlighted by her unit manager. Hence, this paper aims to provide possible misconduct of RN, responsibility while working with RN and critical thinking of learning in the following paragraphs.

Clinical misconduct:

The Nursing and Midwifery Board of Australia (NMBA) accepts the professional practice of registered nurses as set by the Health Practitioner Regulation National Law. NMBA does this by designing standards, codes, and guidelines which altogether act as a benchmark for the professional practice of registered nurses. In this current context, many allegations were made against the registered nurse such as breaching confidentiality of patients by accessing the medical records of the patients who was not in her care and medical negligence by not taking accountability for the care and leaving registered nurse to manage the patient. According to principle 3. 5 (Confidentiality and privacy) of code of conduct of NMBA, it is a legal and ethical obligation to protect the privacy of patients by respecting the dignity of the individuals. The registered nurse in this case scenario breached this 3.5 code of conduct by accessing the medical record of the patients who were not in her duty of care (Nursingmidwiferyboard.gov.au, 2019). Besides, the registered nurse also breached code of conduct 1. 2 (lawful behavior) of NMBA by accessing the record of the patients who were not in her duty of care. By spending time on the computer and leaving the enrolled nurse to manage the patient, registered nurse breach 2.1 (Nursing practice) which stated that  registered nurses must be actively engaged in nursing practice rather than leaving handling responsibility to others. The code of conduct 7. 1 (7.1 your and your colleagues’ health) was also breached by a nurse as she was under stress which affected her professional practice. Considering the NMBA standard, the registered nurse breach standard 6 by accessing health records of the patients which further breached confidentiality (Nursingmidwiferyboard.gov.au, 2019). The registered nurse also breached standard 3 (maintains the capability of safe practice) by not actively engage in the nursing and continuing practice under stress.

Responsibility:

As a registered nurse, while working with her and witness of such nursing misconducting, my primary responsibility is to exhibit leadership skills and communicate with the registered nurse regarding concerns of the registered nurse to review what happened as she is breaching potential nursing code and standard (Cowin et al., 2019). The actively listening to the nurse and acknowledging the distress as well as identifying possible strategies to support her would be the responsibility of a registered nurse (Cowin et al., 2019). The second responsibility is to rectify the problem and simultaneously report the incident in a timely manner according to code of conducts 2.4 (adverse events and disclosure) and 1.3 (mandatory reporting) which stated that registered nurse must recognize the incident and report in a timely manner for preventing possible harm from the incidents (Cashin et al., 2017).  In this context, I would have encouraged her and supported her to reduce fatigue and stressed and seek possible support from supervisors such unit manager or senior nurse and peers for utilizing nurse and midwife support so that she can actively engage in profession. 

The possible resources to assist in such cases are official documents of code of conduct for nurses and standards for nurses of Nursing and Midwifery Board of Australia (Cowin et al., 2019). The evidence-based journals and other government documents along with case reports are also useful resources to assist nursing professionals to take action if they encounter similar situation.

Documented thoughts of the professional conduct:

After gathering in-depth knowledge of the case scenario, I have understood that in order to actively engage in nursing practice, the registered nurse must act according to the code of conduct. In this context, I have evaluated that I and my peers actively engage in the professional practice according to the nursing code of conduct such as 3.5, 1.2, 2.1 and 7.1.

Ethics and legislation in nursing practice:

After gathering an in-depth understanding of the case scenario, I have understood that nursing ethics and legislations are crucial to providing the best possible practice. Hence, it is legal and ethical obligation of the registered nurse to involve in the nursing practice which reflects ethical principles such as beneficence, non-maleficence, and respect for autonomy that the registered nurse of case scenario failed to exhibit (Snelling, 2016). Moreover, the professionals must act and involve in care practice according to the Safe Patient Care Act 2015 which registered nurses failed to exhibit (Halcomb et al., 2016).

Mandatory reporting:

During mandatory reporting, legal obligation of nurses is to follow requirements and report the incident promptly to protect vulnerable groups such as age, child abuse, and medical negligence (Coleman & Fromer, 2015). The senior nurse, unit manager, and enrolled nurse reported to NMBA which may prevent the possible harms from the incident as the incidents were highlighted.

The barrier to mandatory reporting is inadequate literacy regarding the requirements and policies. The victim also finds it difficult to continue the professional practice. The enabler to mandatory reporting is possible opportunity to rectify the incidents (Satchell et al., 2016). The possible strategy of handling such situation is to identify the situation, communicate with the professional and timely report the incident for minimizing damage.

Conclusion: 

On a concluding note, it can be said that providing the best possible care to the patients according to codes and ethics is part of the duty of care of nursing professionals. The case scenario highlighted that the registered breached various codes and ethics by involving in clinical misconduct. In this context, the responsibility of the registered nurse is to report the incident and effectively communicated with the concerned person for rectifying the situation.

References:

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., … & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.

 Coleman, C. A., & Fromer, A. (2015). A health literacy training intervention for physicians and other health professionals. Fam Med, 47(5), 388-92.

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International nursing review, 66(3), 320-328.

 Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal of Advanced Nursing, 73(8), 1958-1969.

Nursingmidwiferyboard.gov.au 2019. Code of conduct for nurses. [online] Nursingmidwiferyboard.gov.au. Available at: file:///D:/october/1106376/Nusing-and-Midwifery-Board—Code—Advance-copy—Code-of-conduct-for-nurses—Effective-1-March-2018.PDF [Accessed  28 Jul. 2019].

Nursingmidwiferyboard.gov.au 2019. Nursing and Midwifery Board of Australia – Professional standards. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed  28 Jul. 2019].

Satchell, C. S., Walton, M., Kelly, P. J., Chiarella, E. M., Pierce, S. M., Nagy, M. T., … & Carney, T. (2016). Approaches to management of complaints and notifications about health practitioners in Australia. Australian Health Review, 40(3), 311-318.

 Snelling, P. C. (2016). The metaethics of nursing codes of ethics and conduct. Nursing Philosophy, 17(4), 229-249.