NUR222 Health Law and Ethics | Nursing Ethics and Conduct
1. The legal requirements for student nurses and/or student midwives, registered nurses and/or registered midwives as appropriate for the case study.
2. The implications for the health facility and/or education provider as required for each of the cases.
3. Your reflection on your personal life experiences (you do not have to have experienced any of these specific incidents). Think about situations you have encountered in the past, your ethical stance and how this will inform your actions in each case study and your discussion on how easy or difficult it will be to meet the requirements for each of the cases.
Answer:
Introduction
Over time, nursing work has gained popularity and has subsequently been incorporated as a field of professional competency by developing codes and standards to regulate practitioners. International Council of Nurses (ICN) was the first to develop the standards in 1953. Codes and standards were introduced in Australia in 1985 as reflected in the general occupational standards. their applicability into the nursing field became precise after the transition of nursing education into the tertiary sector. Nursing standards play a significant role in the conveyance of professional standing as well as aiding in the definition of behavior and practice for regulatory purposes for the government, regulatory authorities, employers, education providers and healthcare consumers at large (Cashin et al. 2017). The Nursing and Midwifery Board of Australia (NMBA) is tasked with the duty of developing and approving nursing standards. It operates under umbrella legislation as well as national registration for health practitioners which encompasses all nurses. The Health Practitioner Regulation National Law Act 2009 (National Law) is a combination of sixty-five independent pieces of legislation and the state and territorial health regulatory boards for professionals. The Australian Health Practitioner Regulation Agency (AHPRA) is also actively involved in monitoring and setting standards for nurses (Staunton & Chiarella 2012). The chief aim of the standards and codes of ethics is to ensure that nurses conduct themselves in the most acceptable ways in the execution of their duties. They also ensure that health consumers are protected from certain actions of nurses that could endanger their health. Nurses are therefore held liable for any harm that occurs to a patient and arose out of the negligence of non-compliance to any standard, law, and/or code of ethics (Berman et al. 2014).
Case 1:
The issue here arose when a fellow nurse engaged in a deep hot argument with a patient. Consequently, the patient was overcome by anger and uttered an expletive to the nurse. Subsequently, the nurse was also driven by high tempers and slapped the patient. On following the nurse, I found her in seclusion crying and overwhelmed by the ordeal she had just been through. She, however, requests me not to say anything to the registered nurse in charge. In my opinion, this was an absurd act as patients should be treated with at-most respect. By human nature, nurses during their course of duty are bound to encounter healthcare consumers with all kinds of behaviors and expectations from the hospital personnel. Whenever their expectations are not met, some individuals may be triggered to utter abusive words. As a professional nurse whoever, it is ethically wrong to physically abuse a client no matter the level of intimidation (Atkins et al. 2017).
According to the International Council of Nurses (ICN) code of ethics for nurses, nurses have four fundamental responsibilities assigned to them. They are; to promote health, to restore health, to prevent illness and to alleviate suffering (Nursing-and-Midwifery-Board-of-Australia, 2018). In doing so, nurses should be adherent to human rights more so the right to choice and life as well as treating patients with respect. By the nurse slapping the patient, she deviated from the codes and disciplinary measures ought to be inflicted on her. The first element under the ICN’s code of conduct requires a nurse to maintain professional conduct with people requiring nursing care. It is therefore upon an individual nurse to demonstrate values such as compassion, trustworthiness, respectfulness, integrity, and responsiveness (Harris et al., 2014). Engaging in a heated argument with a patient in the presence of other patient and staff was an act of contradiction to the aforementioned values. The nurse also compromised the third element which requires a nurse to uphold positive relations between her and the nursing profession. She ought to have been creating a positive working environment in addition to maintaining equitable and safe economic and social operating conditions.
The argument between the nurse and the patient could have resulted from the patient feeling that she was not receiving the right care she expects to get from a nurse. This contradicts the sixth standard of Enrolled Nurse Standard for Practice as tabled by the Nursing and Midwife Board of Australia (NMBA). The standard requires that nurses provide timely and skilled care to healthcare seekers while simultaneously promoting consumers’ involvement and independence in making decisions related to care provision (Smith 2018). The patient is legally entitled to file a lawsuit against the nurse and demand for damages. the nurse could find herself on a narrow path and even at risk of her career termination (Staunton & Chiarella 2016). With her continued requests on me not to report to the RN, it is clear that she is aware of her misconduct. As a colleague and friend, I would approach the RN and report the issue. I would, however, recommend the RN to dig deeper into the issue and establish the cause of the confrontation before taking any action as the involved nurse seemed overwhelmed by grief from the incident. I would also advise the nurse to open up to the RN and explain the whole ordeal truthfully.
Case 2:
The issue here is about a fellow registered nurse who has changed her behavior after breaking up with a fiancée in a relationship. The RN has immersed herself into excessive alcohol consumption. Recently she had even been arrested and charged with drunk driving and I had to pick her from the police station early in the morning. She is however against the point of reporting the issue to the Nursing Unit Manager with the simple argument that she hurt no one and therefore did nothing wrong. While in the lift in the morning to work, I am hit by a strong smell of alcohol, a significant evidence that she is still intoxicated. Her physical appearance also tells more of her drunk state. It is clearly evident that she spent much time the preceding night drinking.
As an RN, it is my responsibility to report her to the NUM regardless of her view towards her drinking habit. Attending to patients in her current state where the alcohol smell is prevalent will definitely damage the reputation of the nursing profession to the public. Additionally, it is a breach of the professional conduct of all nurses which calls upon all nurses to promote and preserve trust, privilege integral and faith when relating with the individuals receiving nursing care (Shih-Ning & McDonald 2014). With her prevailing disturbed mental condition arising out of a failed relationship, she better seeks professional guidance help to aid her in coping with her personal issues rather than indulging in alcohol consumption. It is also general knowledge that nurses amongst other health professionals cannot establish and maintain positive relations with patients if they are physically as well as mentally unfit. Documented in section 193 of the Queensland’s Health Practitioner Regulation National Law, a registered nurse has a duty to disclose such kind of information that relates to another staff’s misconduct to relevant heads in charge (Moseley-III 2013). The health Ombudsman (HO) should also be notified of any serious concern emanating from an employee and amounts to gross professional misconduct.
AHPRA 2014 assigns an RN a mandatory duty to report any occurrence of another nurse being intoxicated either by alcohol or any other intoxicant that could impair their capacity to reasonably exercise care to patients or deploy their skills in their line of duty (Buka 2014). Under the Queensland Health Practitioner Regulation National Law Act, section 141 assigns a duty to health professionals to report to the national agency any notifiable conduct of another health practitioner. An HO can also issue an interim prohibition with sole intention to protect the health and safety of the public if they encounter or are notified of a practitioner operating incompetently and unsafely under the influence of drugs and/or alcohol (Healy 2016). An HO can do the aforementioned while exercising the powers vested to him/her under section 68 of the Queensland Health Ombudsman Act.
It is my legal, ethical and professional duty as an RN to help in establishing and maintaining a good reputation for the health facility where I am stationed (Griffith & Tengah 2017). It is also my duty to help healthcare consumers evade any kind of risk that may prevail. My colleague’s intoxicated state is one such kind of risk as some of the decisions that he may make may be out of alcohol influence and could endanger patients’ safety. It is, therefore, my duty to report the case to the NUM regardless of the nurse’s opinion regarding her own state. As a close friend, I would advise the nurse to take some days off to ease her depression relating to her broken relationship (Burton 2010). I would also advise her to seek emotional as well as psychological support from her friends and/or family members (Sorrentino & Remmert 2016). I would however strongly reject her idea of working while intoxicated and see to it that she does not proceed to the wards in that condition.
Case 3:
This case involves a student on placement trying to steal a patient’s valuable. I was on early shift and in the company of a student in placement. We were jointly preparing a woman who needed to go to the theatre for a surgical operation. I had to take off the patient’s necklace and watch and placed them in the top drawer and ascertains to the woman that her property would be safely enclosed in a well labelled envelope. I then proceed to get the envelope but on returning the necklace is missing. Upon asking the student of the necklace’s whereabouts, she admits to having taken it and hands it back.
To begin with, the student acted in violation of the most basic standards stipulated under the Nursing and Midwifery Board of Australia. The first standard under the enrolled nurse standards for practice brought forth by the NMBA requires nurses to function in accordance with all the policies, laws and procedures that affect EN practice. The student violated this standard by not refraining herself to engage in activities that do not display high standards of ethics and morals (Butts & Rich 2015). Unlawfully taking a patient’s property is a criminal offense punishable by law. Her action is therefore in contradiction of section 15 of the Crime and Corruption Act 2001. The student also acts against the codes laid down under the International Council of Nurses (ICN) codes of ethics for nurses. The first element of the code requires that dignity and respect are maintained between nurses and people. Taking possession of a patients’ valuables is an act of disrespect that should be avoided on the highest priority (Wheeler 2013).
The student nurse should also observe the second element of the code which requires her to maintain positive relations between her and the nursing practice. In doing so, she should uphold personal conduct standards that will reflect on the profession and enhance the public view as well as public confidence (Burkhardt & Nathaniel 2013). She, however, observed the third standard of the Enrolled Nurse Standards for practice documented by NMBA by accepting accountability and responsibility for her own actions. Had she denied having taken the client’s necklace, she would have violated this standard and subsequently brought some internal crisis as the patient would have to be compensated.
As the RN in charge of placement, the first action I would take would be to communicate with the student’s respective school authorities. That was an act of greed and appropriate disciplinary measures ought to be taken (Cherry & Jacob 2013). The student should also serve as an example to warn other students against indulging in similar activities while in placement or in future as registered nurses. It is also my responsibility as laid down in section 220 of the Health Practitioner Regulation National Law 2014 to report her to the relevant facility authorities. In this case, I would report her to the NUM.
Conclusion
It is the duty and responsibility of nurses in all ranks to ensure that the work environment is protected from all errors with the chief aim of offering the highest quality healthcare. Consumers of healthcare should also be protected from nurses whose actions could endanger their health, safety, and overall wellbeing. It is also our duty as nurses to spot nurses who are a threat to the nursing profession, to the healthcare facility, to other healthcare personnel, and to patients. Such nurses should be reported to the relevant authorities so that appropriate action can be taken to curb their wrong-doings and subsequently evade any imminent dangers.
References
Atkins, K, De-Lacey, S, Ripperger, R & Britton, B, 2017, Ethics and Law for Australian Nurses 3 edn, Cambridge University Press.
Berman, A, Snyder, S, Kozier, B, Erb, G, Levett-Jones, T, Dwyer, T, Hales, M, Harvey, N, Moxham, L, Park, T, Parker, B, Reid-Searl, K, 2014, Kozier & Erb's Fundamentals of Nursing Australian Edition, Pearson Higher Education AU.
Buka, P, 2014, Patients' Rights, Law and Ethics for Nurses, Second Edition, revised 2nd edn, CRC Press.
Burkhardt, M, A, & Nathaniel, A, 2013, Ethics and Issues in Contemporary Nursing, 4 edn, Cengage Learning.
Burton, V, 2010, Depression - a Nurse's Experience: Shadows of Life, Radcliffe Publishing.
Butts, E. & Rich, K, L, 2015, Nursing Ethics. illustrated edn, Jones & Bartlett Publishers.
Cashin, A, Heartfield M, Bryce, J, Devey, Lisa, Buckley, T, Cox, D., Kerdo, E, Kelly, J, Thoms, D, Fisher, M, 2017, Standards for practice for registered nurses in Australia, Collegian, June,Vol 24, Issue 3,Viewed 22August 2018, https://www.sciencedirect.com/science/article/pii/S1322769616300038
Cherry, B, & Jacob, S, R, 2013, Contemporary Nursing Issues, Trends, & Management,6: Contemporary Nursing, illustrated edn, Elsevier Health Sciences.
Griffith, R, & Tengnah, C, 2017, Law and Professional Issues in Nursing, Learning Matters.
Harris, P, Nagy, S, & Vardaxis, N, 2014, Mosby's Dictionary of Medicine, Nursing and Health Professions - Australian & New Zealand Edition - eBook, 3 edn, Elsevier Health Sciences.
Healy, J, 2016, Improving Health Care Safety and Quality: Reluctant Regulators, Routledge.
Moseley-III, G, B, 2013, Managing Legal Compliance in the Health Care Industry, Jones & Bartlett Publishers.
Nursing-and-Midwifery-Board-of-Australia, 2018. New codes of ethics in effect for nurses and midwives, Nursing and Midwifery Board of Australia, 01 March, https://www.nursingmidwiferyboard.gov.au/news/2018-03-01-new-codes-of-ethics-in-effect.aspx
Shih-Ning, N, & McDonald, F, 2014, Ethics, Law and Health Care: A guide for nurses and midwives. Macmillan Education UK.
Smith, J. W, 2018, Hospital Liability. revised edn, Law Journal Press.
Sorrentino, S, A, & Remmert, L, 2016, Mosby's Textbook for Nursing Assistants - E-Book, 9 edn, Elsevier Health Sciences.
Staunton, P, J, & Chiarella, M, 2012, Law for Nurses and Midwives, Elsevier Australia.
Staunton, P, J, & Chiarella, M, 2016, Law for Nurses and Midwives, Elsevier Health Sciences.
Wheeler, H, 2013, Law, Ethics and Professional Issues for Nursing: A Reflective and Portfolio-Building Approach, Routledge.
Legislations
Crime and Corruption Act 2001 (Queensland)
Health Ombudsman Act 2013 (Queensland)
Health Practitioner Regulation National Law Act 2009 (Queensland)
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