A Nurse Board received a complaint concerning allegations that registered nurse, whilst working in the emergency department of hospital, practiced outside the scope by knowingly providing prescription only medication to a patient without the authority of medical officer.
When interviewed, the nurse stated the patient attended the emergency department for treatment and the department was busy at this particular time and the patient knowing this stated that they were not prepared to wait for treatment. The nurse made enquires of the patient’s allergies and responses to medication and then consulted a doctor. The nurse then obtained a packet of antibiotics and provided them to the patient. The nurse also made false entries in the medical record of the patient.
1. Discuss and explain, what is the nature if unprofessional conduct by this nurse in this situation?
The code of professional conduct is the manner in which acting in which a person behaves which acting in a professional capacity. A nurse must practise in a safe and competent manner, also with in scope of nursing. In other words nurse practise and conduct themselves in accordance with laws relevant to the profession and practise of nursing. They provide impartial, honest and accurate information in relation to nursing care and health care products. These are some expected national standards of nursing conduct for Australian nurse.
In the above mentioned scenario, the Registered Nurse provided antibiotics to the patient without the order of the registered medical practitioner, while she was working in the emergency department. As a nurse she is professionally acceptable for the provision of safe and competent care. But she is not allowed to provide a prescription to the patient. Her intention was not to harm the patient, but to deliver quick treatment. But by violating the expected behaviour, she had put the safety of the patient at risk. Apart from that, false documentation was also being made which clearly proves that she is competent and untruthful in profession.
Traditional process used for apprising and displaying nurses who have made honest mistake in the course of the work need to be substantially modified as they are odds with the modes of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains. The nursing profession expect that nurses will conduct themselves personally and professionally in a way that will maintain public trust and confidence in the profession
2. How has the nurse acted outside the professional boundaries?
It is the responsibility of the registered nurse to behave ethically at all times, and to maintain professional boundaries with clients, their immediate family and significant others!
In the given situation, the nurse has acted out of her scope of practice by providing antibiotic without prescription. The unit being busy and patient unwillingness to wait for treatment cannot justify her act and only reveals her known competency and poor knowledge in her carrier. She should have consulted her in-charge or someone responsible for this client before doing so. The provisional boundaries in medication administration restrict a nurse to administer drugs with doctor’s order and providing only the nurse initiated drugs or following telephone orders when an emergency exists or when the doctor cannot write the prescription
Besides, the medication management guidelines for nurses by NBV states that nurse should administer a drug that is not include in the nurse initiated list only if it is prescribed by an authorised professional.
These boundaries are written by the ANMC to be use as a guide in accordance with the code of conduct and code of ethics.
3. Identify the relevant legislation and professional regulation related to this case.
‘The nurses and midwife act 2006’ governs nursing and midwifery practise and registration with in Western Australia and legislation relating to medication use. This incorporates many other acts.
The legislation and professional regulation related to this case, the Medicine s Policy (2000) and the National Strategy for the Quality use of Medicines (2002) points out that medicines should be administered judiciously, appropriately, safely and effectively. Apart from that, Health Regulation 1996 a registered nurse can administer a restricted or controlled drugs to a patient on a Doctor’s or Dentist’s oral or written instruction (RN SECTION 67,175,263).The poison Act (1964) and Poison Regulation (1965) provide clear instruction for nurses and midwifes relating to the administration of drugs should be verbal orders from Medical Practioners and authority for nurses and midwifes at designated remote area.
These are meant to serve and protect public. The ANMC National Competency Standards for registered nurses within a profession and ethical nursing practice demonstrating accountability and responsibility for their own action and decision making in accordance with the legislations and regulations.
4. What type of professional development would you recommend for this nurse to undertake to prevent future such incidents and why?
The nurse must meet the continuing professional development standards. This is a legal requirement. Registered nurses are accountable for making decisions.
This particular nurse has acted outside her scope of practise also made errors in documentation intentionally. The exhibited poor knowledge and non compliance with registration proves that the nurse should review the professional standards and code of ethics and also update with new legislation and regulations relating to medicines administration. While practicing should be very careful about her acts and the consequences, so that she can understand her professional boundaries thereby ensuring safety of patient, herself and co-workers. In addition, continuing nursing education programmes, counselling and a change of work setting may help her to work competently and safely.
The national competency standards demands participation in ongoing professional development of self and others. Also nursing practise in accordance with legislation affecting nursing practise and health care.
5. What is the seriousness of this issue?
The Registered Nurses issues relates to the professional, legal and ethical responsibilities which requires demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting Nursing ,health care and the protection of individual and group rights.
With in the health care system, nurses are responsible for providing safe and competent care. But in this case, the nurse indulged in an unprofessional conduct by administering medication without prescription which may lead to harm to the patient even to the extent of death. Moreover, the false entries in the records may mislead the co-worker and may cause more harm to the patient. Also this misconduct puts disgrace to her career and lead to legal, social and monetary implications resulting in cancellation of Registration.
In addition, the nursing authority has to suffer in terms of need for investigation and the expenditure on making the fault. Repeated incidents of such unprofessional conduct may disrupt public’s faith in health personnel who is considered life savers.