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Discuss about the Discuss about the Professional Standards and Professional Misconduct.

Professional Conduct Requirements of Australian Nurses

Registered nurses are expected by the Nursing and Midwifery Board of Australia (NMBA) to conduct their practice within the confines of the standards, codes, and guidelines put up by the board. These standards, codes, and guidelines inform the necessary requirements for the provision of professional and safe nursing care by all nurses and midwives across Australia. Their formulation is aimed at advancing optimal care to patients as well as protecting the public from negligent nursing practices (NMBA 2018abc). As such, they are required to instill due diligence, duty to care and forge professional relationships that enhance the same. The NMBA taps regulatory authority from the Health Practitioner Regulation National Law (the National Law) as enforced in every state and territory across Australia (Queensland Government Legislation, 2009).  

In the event of bleach of conduct or contravention of the standards, codes and guidelines or engagement in any sort of professional nursing misconduct, the NMBA is mandated to advance professional misconduct proceedings against registered nurses in bleach through a responsible tribunal. This is in accordance to s 193(1) (a) (i) of the Health Practitioner Regulation National Law (Queensland). This paper endeavors to critically extrapolate what exactly is meant by nursing professional standards and professional misconduct. In doing so, the paper will draw from the findings and judgment of the Queensland Civil and Administrative Tribunal (the tribunal) that found a registered nurse (Ms. Jodi Laughlan) responsible for professional misconduct with regard to medication administration. This was after the NMBA found Ms. Laughlan responsible for the same during her practice and found several counts of legal and professional misconduct.

Referring to s 193(1) (a) (i) of the Health Practitioner Regulation National Law (Queensland) (National Law) the NMBA presented proceedings against registrant Ms. Laughlan to the Queensland Civil and Administrative Tribunal (the tribunal) for disciplinary action to be determined after the board significantly believed that Ms. Laughlan had engaged herself in behaviors that by and large constituted gross professional nursing misconduct. In its submissions, the board alleged that Ms. Laughlan acted in a manner that would have compromised the health of aged patients in the Salvin Park Aged Care Facility of Blue Care Hospital. The events leading to this gross professional misconduct occurred during the weekend shifts of the healthcare facility on 16 and 17 July 2011. The board found Ms. Laughlan guilty of six separate legal and professional misgivings.

 First, Ms. Laughlan allegedly misappropriated and/or failed to correctly account for about 7 ml of morphine leading to the conclusion that she took the same without lawful authority. Secondly, the board found Ms. Laughlan guilty of self-administering the morphine to her. Thirdly, the board found Ms. Laughlan guilty of maliciously replacing the 7 ml of morphine with water.  Fourthly, Ms. Laughlan was found guilty of trying to influence a fellow practitioner not to report the discrepancy. Fifthly, it was reported that in an attempt to conceal her actions, Ms. Laughlan threw away a ‘post-it-note’ in which the discrepancy had been noted. Lastly, the board accused Ms. Laughlan guilty of failing to correctly compare the actual levels of morphine in the bottle with what was recorded in the Drug Record Sheet and by extension failing to document and report the same.

Defining Professional Misconduct in Nursing Practice

Upon hearing and determination of the case, Ms. Laughlan admitted that she failed to correctly compare the levels of morphine as recorded in the Drug Record Sheet against actual levels in the bottle when she was notified of the discrepancy as well as documenting and reporting the same. Furthermore, Ms. Laughlan accepted the allegation that she threw away a ‘post-it-note’ stuck on the Drug Record Sheet showcasing the discrepancy of 7 ml in the bottle of Ordine. However, Ms. Laughlan vehemently denied misappropriating the morphine, self-administering or replacing the same with water. The tribunal found Ms. Laughlan guilty of professional misconduct reprimanding and suspending her registration for three months besides placing schedule 8 medication education conditions upon return to active practice. The tribunal, however, did not find Ms. Laughlan guilty of self-administering the morphine (Queensland Civil and Administrative Tribunal Act 2009 (Qld), s 102; Nursing and Midwifery Board of Australia v Laughlan [2017] QCAT 388).

The Australian registered nurse standards, codes and guidelines of practice as developed by NMBA give Australian nurses a yardstick and a platform upon which to advance quality and safe nursing practice both at the clinical facility level as well as at the private level and that meet the public’s healthcare requirements (NMBA, 2018abc). These yardsticks work in unison to help mold registered nurses to be ardent professionals in their respective line of practice. They set out the legal requirements, principles of professional behavior as well as conduct expectations of all Australian nurses. Although individual nurses may have their individual beliefs and values, the professional standards, codes, and guidelines take precedence in practice and nurses are expected to strictly adhere to them (Atkins, De Lacey, Britton, & Ripperger, 2017). Moreover, nurses are free to make informed judgments and take appropriate actions for particular patient healthcare requirements. Even as such, nurses are expected to give relevant justification of their conduct, judgment and activities whenever called upon for accountability (Chang, & Daly, 2016). In practice, nursing professional standards require nurses to prioritize the interests of patients and their families by practicing safely and effectively.

Registered nurses are required by professional standards to practice their nursing roles under the guidance of existing national, state and territorial laws. Moreover, they are expected to maintain high professional integrity by upholding virtues such as honesty, compassion, and respect (Baillie, & Black, 2015). This is all geared at promoting the health and wellbeing of healthcare stakeholders including patients, families, fellow colleagues and the community (Maurits, de Veer, Groenewegen & Francke, 2016). For instance, with regard to this case, Ms. Laughlan was obligated to observe sections 193 and 196 of the National Law to orient herself with what could be the impacts and implications of being involved in professional misconduct. Section 193 gives the NMBA the requisite authority to report to a responsible tribunal professional misconduct of all registered nurses while section 196 gives the tribunal the powers to make a judgment concerning the professional misconduct.

Case Study: Ms. Jodi Laughlan

Ms. Laughlan failed to live, act and practice her nursing roles as per the demands of the nursing profession’s standards, codes of conduct and guidelines leading to her being deemed to have been involved in professional misconduct. Professional misconduct refers to situations in which healthcare professionals such as registered nurses are involved in profession malpractices that contravene the provisions of set professional standards of practice; codes of practice; and national, state and federal laws as well as other set guidelines and regulations (Cashin, et al., 2017). On the contrary professional conduct relates to the way an individual behaves while in professional capacity. The Code of Professional Conduct for Nurses in Australia and the Code of Ethics for Nurses in Australia advances the minimum standards of behaviors a registered nurse is supposed to uphold while in practice.

These codes together with Registered Nurse Standards for Practice and others provide a framework for legal and professional accountability and responsibility in the nursing profession. Parandeh, Khaghanizade, Mohammadi and Nouri (2015) assert that the nursing profession is of the expectation that all registered nurses carry themselves individually and professionally in ways that espouses the trust and confidence the public posit the profession. Nurses also posit a social contract with patients, families, society and to each other and therefore they are expected to be accountable and responsible for any of their nursing practice actions (Dixon, 2017). In this case, Ms. Laughlan critically bleached the trust and faith accorded to her by the patient’s she served, the facility’s administration and fellow healthcare practitioners potentially portraying herself as a person full of ill will.

By failing to correctly compare the amount of morphine in the bottle against what was recorded in the Drug Record Sheet when notified of such a discrepancy and further failing to document and/or report the same was outright unprofessional conduct. According to conduct statement three of the Code of Professional Conduct for Nurses in Australia, nurses are obligated to report mistakes and errors to healthcare facility’s authorities for appropriate actions to be taken in a bid to protect the interest of patients and the public. Conduct statement six of the same assert that nurses are obligated to refrain from giving statements that are misrepresentations and misstatements of the true facts. To this end, by further removing and throwing away the note indicating the discrepancy between the bottle containing morphine and the Drug Record Sheet, Ms. Laughlan intended to create a false representation of the true volume of morphine in the bottle.

Legal and Professional Accountability in Nursing Practice

The allegation that she injected water to the bottle to fill up the discrepancy and misappropriated the drug by self-examination would have severely compounded the judgment against her. Indeed, even though the tribunal found Ms. Laughlan not guilty of these allegations, it admitted that this would have accorded Ms. Laughlan grave implication on her nursing career. This withstanding, trying to influence a fellow healthcare practitioner not to report the discrepancy further contravenes conduct statement three that further states that nurses are obligated to report any sort of professional misconduct of colleagues and other co-workers whenever they happen to witness them (NMBA, 2018a). By and large, Ms. Laughlan breached the Code of Professional Conduct for Nurses in Australia in its entirety since it is vivid that she was oblivious of the requirement to advance safe, quality and competent care to the patients under morphine administration. Failing to clearly account for the morphine discrepancy meant adverse healthcare outcomes to these patients.

Registered nurses’ standard number one of the NMBA requires nurses to always comply with set legislation, policies, regulations, and guidelines pertinent to the context of practice when making decisions. This is especially the case when maintaining accurate, comprehensive and timely activity, assessments, and events' records, as well as patients’ documents, is considered (Starr, 2016). Ms. Laughlan ought to have heeded to the call of this regulation to prevent her indictment of the unprofessional conduct. Furthermore, the standard asserts that nurses ought to conduct their practice under the confines of ethical frameworks especially before arriving at critical decisions (NMBA, 2018c). Nurses are supposed to value quality nursing care; respect, compassion, and honesty; a culture of safety and ethical management of information (Milligan, et al., 2017).

Nurses should endeavor to conduct themselves with utmost integrity whenever they are in their courses of duty to eliminate the possibility of being referred to disciplinary tribunals by the NMBA. Professional misconduct emanates when nurses are not willing to abide by the set rules and regulations and actually go right ahead to break them. Nurses that follow established standards, codes of conduct and ethics, national, state and territorial laws and other guidelines are deemed to possess professional integrity. Kangasniemi, Pakkanen and Korhonen (2015) assert that professional integrity can be termed as conduct adopted by a nurse who endeavors to perform his/her nursing roles and responsibilities according with commonly accepted standards and principles as well as specific codes and guidelines as established by a regulatory body. Nurses must always endeavor to do that which is morally right to themselves and to others (Manfrin-Ledet, Porche, & Eymard, 2015). They should also stand firmly with the professional ideologies and principles informing the nursing profession and by extension try to nurture the capacity of reflecting on what pertains right conduct.

Conclusion

In this case study, Mrs. Laughlan contravenes all the facets informing professional conduct and professional integrity. According to New South Wales Repealed Acts; Nurses and Midwives Act (1991) - Sect 4, “professional misconduct” relates to instances when nurses and midwives engage in “unsatisfactory professional conduct” severe enough to warrant the removal of the nurse from the register. Unsatisfactory professional conduct according to the act refers to any conduct that is of negligence nature; contravenes nursing standards, codes of conduct and ethics, national laws and other regulations; and not complying with orders, directions or determinations made concerning nursing conduct by a regulatory agency (Griffith & Tengnah, 2017).

From these provisions, Mrs. Laughlin was strictly liable of professional misconduct. Being the registered nurse responsible to keep the keys to the dangerous drug cabinet, she ought to have been more careful with the keys in the morning of 17 July 2011. Alleging that at one point in time, she left the keys to the dangerous cabinet with a junior employee was an act of negligence on her part. If she were more careful, the misappropriation of the 7 ml morphine in the bottle containing Ordine could not have occurred. Moreover, she further contravenes nursing standard number six that provides that nurses ought to advance “safe, appropriate and responsive quality nursing practice” by plucking and throwing away the “post-it-note” meant to showcase the discrepancy in the amount of morphine in the bottle and what was recorded in the Drug Record Sheet”. This action meant Mrs. Laughlan was not mindful of the healthcare repercussions she would have imposed patient on morphine medication. This was by and large unethical.

The Code of Ethics for Nurses in Australia; Value Statement one provides that “Nurses value quality nursing care for all people in Australia”. If indeed Mrs. Laughlan was cognizant of this value statement, she shouldn’t have acted the way she acted. The value statement is of the viewpoint that by valuing quality nursing care, nurses are bound to provide safe and competent nursing care within the boundaries of their professional practice (Lyneham, & Levett-Jones, 2016). Ethical value statement number seven of the same asserts that nurses ought to value medical information under their custody (NMBA, 2018b). By failing to document, record and report the discrepancy in the amount of morphine in the bottle and by extension throwing away such a critical record, Mrs. Laughlan was in clear breach of her professional conduct.

Conclusion

Conclusively, professional standards are critical at driving discipline in the nursing profession. Registered nurses ought to acquaint themselves with all the nursing professional standards, codes of conduct, codes of ethics, guidelines, directions as well as other national and state laws pertaining the profession to shield them from committing professional misconduct. These professional standards are for the good of nurses themselves, the smooth running of the nursing profession as well as for protecting the public from negligence nursing practice. The Nursing and Midwifery Board of Australia (NMBA) is the mandated regulatory board of all Australian nurses. The board is statutory mandated to institute any disciplinary proceeding against any registered nurse through a responsible tribunal. To this end, following Mrs. Laughlan professional misconduct, the board had to institute such proceedings. Mrs. Laughlan was clearly found guilty of professional misconduct from her malicious actions of 16 and 17 July 2011

References

Atkins, K., De Lacey, S., Britton, B., & Ripperger, R. (2017). Ethics and law for Australian nurses. Cambridge University Press. Bulman, C., & Schutz, S. (Eds.). (2013). Reflective practice in nursing. John Wiley & Sons.

Baillie, L., & Black, S. (2015). Professional values in nursing. CRC Press.

Chang, E., & Daly, J. (2016). Transitions in Nursing: Preparing for Professional Practice.

Clarke, D. (2016). Law, regulation and strategizing for health. Strategizing national health in the 21st century: a handbook. Geneva: World Health Organization.

Dixon, K. (2017). Reporting of professional misconduct is influenced by nurses' level of education and managerial experience. Evidence-based nursing, 20(3), 89-90.

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.

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Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.

Lyneham, J., & Levett-Jones, T. (2016). Insights into Registered Nurses' professional values through the eyes of graduating students. Nurse education in practice, 17, 86-90.

Maurits, E. E., de Veer, A. J., Groenewegen, P. P., & Francke, A. L. (2016). Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff. BMC nursing, 15(1), 59.

Manfrin-Ledet, L., Porche, D. J., & Eymard, A. S. (2015). Professional boundary violations: A literature review. Home healthcare now, 33(6), 326-332.

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New South Wales Repealed Acts NURSES AND MIDWIVES ACT 1991 - SECT 4 Available from https://classic.austlii.edu.au/au/legis/nsw/repealed_act/nama1991223/s4.html

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development of professional values among nursing students and instructors: a systematic review. Global journal of health science, 7(2), 284.

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Queensland Civil and Administrative Tribunal Act 2009 (Qld), s 102 Nursing and Midwifery

Board of Australia v Laughlan [2017] QCAT 388 Available from https://archive.sclqld.org.au/qjudgment/2017/QCAT17-388.pdf 

Starr, L. (2016). Inappropriate access to medical records-a case of professional misconduct.

Australian Nursing and Midwifery Journal, 24(3), 27.

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