Nursing Practice 1
Case 1
Appropriate behavior and conduct towards patients are considered as an ethical and legal necessity while being engaged in nursing practice. A student or a registered nurse is required by law not be involved in any unethical episode of conduct. If a registered nurse (RN) is found to be exhibiting inappropriate behavior towards a patient, he/she is required to be questioned by law agencies as well as be subjected to a trail (Tuyen and Gunawan, 2018). Student nurses are expected to work in collaboration under the supervision of a registered nurse and have the core responsibility to act in the best interest of the patients. This in turn leads to enhancement of the health care facilities being provided.
However, professional misconduct and breach of law have severe implications to a health facility as well a registered nurse. The hospital can get into a crisis or legally sued in case of any professional misconduct towards a patient (Maurits et al., 2016). In this case scenario, I am faced with a situation as a student on placement and have the responsibility to cater to the needs of the patients. I experience a fellow student nurse who is engaged in a heated conversation with a patient. The patient is seen shouting at the student nurse. This ends with the student nurse slapping the patient and walking off from the scene. This gross breach of the Code of Conduct for Nurses in Australia National Law can lead to a tribunal trail for professional misconduct. The trail will get the student nurse being reprimanded and a penalty for not reporting the issue. When I approach the student nurse, he/she tells me not to tell anyone.
This situation leads to a dilemma where on one side I am deeply concerned about the event that took place while on the other side I am also worried about how this might affect the student nurse. The case scenario can be analysed in terms of legal and ethical requirements from the student nurse and the implications it has to the student nurse as well as the health facility. Likewise, to understand and decide on the situation, one needs to consider the legal requirements for the student nurse and the patient, keeping in view the patients’ rights and the consequences of exhibiting professional misconduct towards a patient.
A student practising nursing care is legally and ethically required to be responsible and accountable when providing health care (Dixon, 2017). First, the Code of Conduct for Nurses requires a student nurse to practice legally and adhere to obligations as postulated in the National Law and other relevant laws. According to Code of Conduct principle 1, a student nurse has a legislative responsibility to mandatory report a patient’s condition to the concerned supervisor. Furthermore, as part of caring for the vulnerable, a student nurse also needs to mandatorily report relevant issues being faced by the patients in order to protect groups especially those at a risk. Apart from this, The Code of Conduct for Nurses also requires a registered nurse to practice effectively and collaborate to ensure that all the needs of the patients are catered. The Code of Conduct for Nurses principle 2 section 2.4, elaborates that a registered nurse needs to act immediately in case of any adverse events and have an open disclosure to the concerned authority. The Code also requires timely reporting in case of adverse events and having honest communication with the patient and colleagues. This ensures issues are addressed to the management and can be controlled affectively.
The student nurse who was engaged in a heated conversation with a patient should have communicated the matter to the concerned authority instead of exhibiting professional misconduct. The Code of Conduct for Nurses also requires provision of safe and quality care through application of the available resources and evidence. Registered Nurse (RN) Standard 6 on the other side pertains to the use of adequate comprehensive skills and knowledge to effectively and safely achieve highest nursing practice outcome. The Nurses National Competency 2 Standards element 2.2 requires a registered nurse to identify unsafe practices and take appropriate actions. The registered nurse (RN) should also use risk management strategies and open disclosure policy to follow up unsafe practices.
What I personally reflected from the experience case scenario was how professional misconduct can lead towards legal penalties being imposed as well as putting the health facility in a crisis. The case study involves how a student nurse gets engaged in heated argument with a patient and ultimately exhibits professional misconduct. This undermines safe and effective health care and one should not keep quite when such an event is occurring. In this particular case study, I am the person experiencing the event and hence, I should not keep quiet and should report the incident to the concerned authority, according to Code of conduct and National law (Pich, Kable, and Hazelton, 2017). If I do not report the incident, there can be a chance that I get subjected to a trail along with the student nurse. Before this case study, I thought that a professional can only be implicated for own mistakes or breach of law. I was surprised by how an individual’s action can lead to implication of another person. A certain mistake executed by my colleague can compromise the outcome of the health care facilities being provided and the law requires one to timely report adverse event (Hewitt, Chreim, and Forster, 2017).
It was an additional opportunity to get to learn the rationale behind exhibiting professional conduct along with mandatory reporting and open disclosure. A registered nurse (RN) therefore needs to take immediate action of intervening and if not report to the relevant authority to avoid being implicated for professional misconduct. In my future career as a registered nurse, I will take responsibility and be accountable of my colleague actions to ensure together we provide safe and effective health care. In case I am not able to intervene, I will timely report to the management.
Case 2
According to a study carried out by Finnell, Tierney and Mitchell (2019), the principles pertaining to Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) have been elaborated. AMERSA is responsible for devising and implementing specific policies that address substance uses in the 21st century. A registered nurse (RN) is expected to abide by laws pertaining to substance use such as alcohol and certain drugs as well as guide nursing practitioners to abstain from such activities (Finnell, Tierney and Mitchell, 2019). In a similar study executed by Tejedor-Cabrera and Cauli (2019), alcohol and cannabis intake by nursing students was elaborated and the resulting outcomes were analysed. An Alcohol Use Disorder Identification Test (AUDIT) was performed on students with the results reporting 31.4% being classified as risky alcohol users. Hence, there are accelerating concerns regarding alcohol misuse by nursing students and specific legislations and obligations should be utilised in order to tackle them.
Health practitioners need to maintain their capability to undertake effective nursing practice. Alcohol and drugs tend to alter a person’s ability to think and take appropriate actions and a health practitioner should not report to work whilst suffering from their effects (Vrbnjak et al., 2016). In this case study, I am faced with a situation involving a newly registered nurse that is my flatmate and has exhibited behavioural changes over the past month following a relationship break up. My flatmate is assigned in the same ward as mine and has been drinking heavily since the breakup and was also charged with drink driving over two days ago. I had to pick up my flatmate from the police station and hence, discussed about reporting the incident to the nurse unit manager (NUM). However, my flatmate refuses to report and the following day still appeared to be affected by alcohol. On insisting to report the incident to the nurse unit manager (NUM), my flatmate again refuses and tells me not to say anything. This case scenario can be analysed by disusing the legal requirements pertaining to me and my flatmate who has been appointed as a registered nurse (RN). The resulting implications our actions have to the health facility and the education can also be analysed effectively.
According to The National Law, a registered nurse (RN), along with his/her actions is also responsible for the actions exhibited by colleagues and should make sure to report any incident of professional misconduct or breach of any law. The National Law Section 140 categorises practice while under alcohol or drugs intoxication as a major professional misconduct (Medicalboard, 2020). Apart from this, the Nurses National Competency 2 Standards element 2.2 requires a registered nurse to identify unsafe practices and take appropriate actions. Furthermore, registered nurse (RN) standard 3 implies that a health professional should be accountable for their own safety and conduct and they should ensure that they exhibit full capability of practice and are not under the influence of substance misuse such as alcohol (Bismark et al.,2016).
From this particular case study, I have learned that how vital it is to report any incident of substance abuse involving a health care professional and in particular a registered nurse (RN). Before analysing this case study, I did not know that one can get terminated due to getting engaged in drug and alcohol usage. Apart from this, I also got a chance to learn how essential it is for a registered nurse (RN) to report any episode of professional misconduct or breach of law pertaining to a fellow colleague. Drugs and alcohol have adverse effects that lead to impairment of an individual’s ability to follow instructions and execute an action appropriately and hence it is the responsibility of fellow colleagues to report to the nurse unit manager (NUM) in order to optimise patient care (Tembo, Burns, and Kalembo, 2017).
Case 3
According to a study carried out by Phillips, Duke and Weerasuriya (2017), skills that clinical facilitators should exhibit while working with nursing students were questioned and analysed. It is mandatory for clinical facilitators to emphasise on the provision of quality patient care as well as to instill critical thinking skills in their students. The results of the study demonstrated that those clinical facilitators who had previously attended related workshops and had studied relevant courses were found to have asked significantly more questions of accelerated cognitive level as compared to those who previously had not been engaged in any workshop or seminar (Phillips, Duke and Weerasuriya, 2017).
This particular case study has me as a registered nurse (RN) responsible for facilitating students on clinical placement in a rural facility for several education providers. I have been working with a student on admitting a female patient. I go off to get an envelope to put her valuables including her watch and necklace. However, once I return, the necklace is missing and the student exhibits to having it and hands it back to me. The student is unable to follow instructions. This case scenario can be analysed by disusing the legal requirement of the facilitator and the student nurse and the implications their actions have to the health facility and the education provider. A facilitator is required by law to supervise a student nurse to ensure adequate training and learning in their placement. In this case scenario, the facilitator noted an action exhibited by the student nurse that pertains to the act of theft. The National Law Section 143 states that an education provider or clinical facilitator should communicate with the concerned authority in case the provider believes that student nurse is involved in professional misconduct and is not abiding by the rules during clinical training. Consent is an ethical and legal necessity when providing nursing care. A nurse is required by law to obtain consent before handling any personal belongings of a patient (Royal College of Nursing, 2017). The Code of Conduct for Nurses in Australia Principle 3 section 3.5 also requires a registered nurse (RN) or clinical facilitator to respect the privacy and confidentiality of a patient and to make sure that student nursed are also adhering to these principles (Cowin et al., 2019).
From this case scenario, I learned that informed consent is an important part of the nursing practice. As supervising a student nurse on placement, I should ensure that I and my student nurse adhere to laws and acquire consent from the patient before touching any belongings and doing any treatment. Although, the student nurse owns up taking the necklace, he/she can be sued in case the patient makes a complaint. While undertaking the case study, I felt amused by how law protects the patient’s autonomy. The law protects the patient’s confidentiality and privacy and it requires all health practitioners to uphold patient’s informed consent prior to any procedures or treatment (Dunn et al., 2019).
References
Bismark, M.M., Mathews, B., Morris, J.M., Thomas, L.A. and Studdert, D.M., 2016. Views on mandatory reporting of impaired health practitioners by their treating practitioners: a qualitative study from Australia. BMJ open, 6(12).
Cowin, L.S., Riley, T.K., Heiler, J. and Gregory, L.R., 2019. The relevance of nurses and midwives code of conduct in Australia. International nursing review, 66(3), pp.320-328.
Dixon, K., 2017. Reporting of professional misconduct is influenced by nurses' level of education and managerial experience. Evidence-based nursing, pp. 20-26.
Dunn, M., Fulford, K.W.M., Herring, J. and Handa, A., 2019. Between the reasonable and the particular: deflating autonomy in the legal regulation of informed consent to medical treatment. Health Care Analysis, 27(2), pp.110-127.
Finnell, D.S., Tierney, M. and Mitchell, A.M., 2019. Nursing: Addressing substance use in the 21st century. Substance Abuse, 40(4), pp.412-420.
Hewitt, T., Chreim, S. and Forster, A., 2017. Sociocultural factors influencing incident reporting among physicians and nurses: understanding frames underlying self-and peer-reporting practices. Journal of patient safety, 13(3), pp.129-137.
Maurits, E.E., de Veer, A.J., Groenewegen, P.P. and Francke, A.L., 2016. Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff. BMC nursing, 15(1), p.59.
Medicalboard, 2020. Medical Board Of Australia - Guidelines For Mandatory Notifications. [online] Medicalboard.gov.au. Available at: <https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Guidelines-for-mandatory-notifications.aspx> [Accessed 17 August 2020].
Phillips, N.M., Duke, M.M. and Weerasuriya, R., 2017. Questioning skills of clinical facilitators supporting undergraduate nursing students. Journal of Clinical Nursing, 26(23-24), pp.4344-4352.
Pich, J.V., Kable, A. and Hazelton, M., 2017. Antecedents and precipitants of patient-related violence in the emergency department: Results from the Australian VENT Study (Violence in Emergency Nursing and Triage). Australasian emergency nursing journal, 20(3), pp.107-113.
Royal College of Nursing, 2017. Principles of consent: guidance for nursing staff. British Journal of Healthcare Assistants, 11(10), pp.498-502.
Tejedor-Cabrera, C. and Cauli, O., 2019. Alcohol and cannabis intake in nursing students. Medicina, 55(10), p.628.
Tembo, C., Burns, S. and Kalembo, F., 2017. The association between levels of alcohol consumption and mental health problems and academic performance among young university students. PloS one, 12(6), p.142.
Tuyen, L.T.T. and Gunawan, J., 2018, October. Behavior management in the field of nursing: A concept analysis. In Nursing Forum (Vol. 53, No. 4, pp. 481-488).
Vrbnjak, D., Denieffe, S., O’Gorman, C. and Pajnkihar, M., 2016. Barriers to reporting medication errors and near misses among nurses: A systematic review. International journal of nursing studies, 63, pp.162-178.
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