The paper will be a comprehensive review into the conduct of two (RNs) Registered nurses following the death of a six-month-old baby. The alleged complain against the two nurses was that they failed to appropriately manage as well as communicate with the pediatrician the changes and responses of the patient’s condition. They also failed to maintain appropriate clinical records of observation. To effectively analyze the case study, it is important first to examine some of the key terms to be examined in the paper. Professional conduct in nursing, also known as the nurse’s code of ethics is a compilation of existing ethical rules which are designed to guide nurses in making informed and correct decisions in difficult patient care situations. Technically, the two RNs in the case study failed in their delegation towards the nurse’s code of professional conduct. On the other hand, the professional responsibilities of nurses refer to the ethical as well as moral obligations related to the nursing profession. The standards are in regards to the patient care, integrity, morals, and responsibility to effectuate social changes. In summary, professionalism in nursing is essential in achieving a healthy work environment and is technically enabled by the context of practice.
Technically, the paper will in an in-depth analysis examine the professional misconduct as well as the ethical breaches violated by the two RNs. Specific regards will be laid on the legal as well as the professional issues raised by the complainants. Other areas of the concern in the paper will be the concept of good practices by the medical providers and how exactly the NMBA codes of ethics and general ethics apply in this context. Professional bodies and the body of NSW Ministry of health policy statements will also be examined (Cho & Kim 2014, p. 550). Codes normally outline the roles of the nursing profession in terms of commitment to respect patients, promote, protect as well as uphold the fundamentals rights of recipients of health care. Relatively, the purpose of the set code of ethics for the nurses in Australia includes: provide nurses with somewhere they can refer to in terms of how to conduct themselves, indicate to people the human rights standards and ethical values expected from nurses and finally, guide the ethical decision-making process for registered nurses (Daly, Speedy & Jackson 2017, p. 170). One of the value statements that was breached by the two nurses that are quickly identifiable is the value statement number seven for nurses that points out that nurses should value ethical management of information.
The importance of Registered nurse standards
RNs, with their position as regulated health professionals, are responsible and accountable to NMBA, the Nursing and Midwifery Board of Australia. With a combination of NMBA codes, standards and guidelines, theses Registered nurse standards should be evident in their practice (Perry et al 2016, p.60). In addition, the RN practice, as a professional line of work, should be characterized by continuous thinking in the context of the thoughtful development of constructive relationships. Responsibilities of RNs include determining, coordinate and provide safe as well as quality nursing. The practice of providing quality nursing include providing comprehensive assessment, development of effective planning as well as implementation and evaluation of outcomes (Parahoo 2014, p.170). In relation, as part of their practice, it is paramount for RNs to ensure that they are responsible and accountable for supervision and delegation of nursing activities. Practice should not be viewed as restricted to the provision of direct clinical care. Subsequently, this is where the two nurses failed; they should have taken every responsibility assigned to them seriously and hence used their nursing skills and knowledge. The extended provision of care for patients, in this case, including working in a direct non- clinical relationship with the parents of the infant as well as the pediatrician. Other areas include: working in the management, research, advisory and other roles that impact the effective delivery of services (Lane et al 2017, p. 130). Technically, it is the responsibility of RNs to autonomously practice within the dynamics systems as well as in the relationships with the other healthcare professionals. The registered nurse standards can be classified into seven standards. In summary, the main responsibility of professional standards is to shape and maintain safety as well as clinical competency in the field of nursing practice.
How the registered nursing standards for practice are used.
The standards technically consist of the following:
- Think critically and analyses the nursing practice
- Comprehensively conducts assessments
- Engages in therapeutic and professional relationships
- Develops a plan for nursing
- Evaluates the outcomes to inform nursing practice
- Provides safe, appropriate and responsive quality nursing practice
It is important to point out that the standards are interconnected and that each of the standards should be accorded the relevancy it deserves. Some standards relate to each other and others relate to each dimension of practice. In relation, it is important for all hospitals to ensure that their RNs put into place the use of each standard (Mcdonald et al 2016, p. 130). Take, for example; each standard has a criterion that stipulates how the standard should be conducted. For example, all nurses work in partnerships hence delegate responsibilities. The registered nurse standards for practice rare hence for all RNs across all the defined areas of practice. It is important that they are read with a combination of applicable NMBA companion documents like codes, standards, and guidelines. Relevant codes in this case include the codes for ethics of nurses, code of professional conduct for nurses, national frame for the development of decision making for midwifery and nursing practice, guidelines for mandatory notifications and supervision guidelines for nursing and midwifery (Watkins 2015, p. 6).
The set standards, in this case, ensure that there is accountability. Like in the case study, the two RNs can be accused of lack of professional ethics in the grounds of accountability. In nursing, accountability means that the nurses are answerable to the patients that they provide care for, their employers and the nursing regulatory authority. They should also be accountable for their decisions, actions, and behaviors as well as the responsibility that is automatic in their nursing roles like documentation. Accountability is a vital component and hence cannot be delegated.
Ethical management of information- How the value statement was breached
The generation and management of healthcare records and other relevant documents should be performed with integrity as well as professionalism (Cherry & Jacob 2016, p.155). Technically, this is where the concept of professionalism comes joins the conversation. Subsequently, the requirement here is that the information that is processed is accurate, non-judgmental and relevant to the health, care as well as the treatment of a patient. In relation, the two nurses did not adhere to this value statement since they mismanaged the information that they issued due to either due to arrogance or unprofessionalism (Catalano 2015, p. 97). The health record is a document that cannot be altered with apart from specified situations like when there is a need for additional information. A notation in a document used in healthcare communication is very powerful since it can bear both positive and negative results in terms of the quality of healthcare that the patient receives. In terms of ethical management of information, there should be respect for the patient’s privacy as well as confidentiality without compromising the safety or health of the patient. Subsequently, this applies to all the relevant data, an inclusive of research and clinical data regardless of the medium in which the information is stored.
Nurses should also be entitled to technically the same professional, moral and legal safeguards as any other patient. In relation, they also have a right to protection of their personal information just as in the case of their patients
The person, in this case, is the health consumer. Nurses should be made aware of as well as comply with the conditions under which the information about patients an inclusive of children and people who are incapacitated who may not be able to speak or read that may or may not be shared with others. It is also important for nurses to comply with the mandated reporting requirements as well as conform to privacy regulations and legislation (Black 2016, p. 60). On the other hand, ethical information management may also require RNs to generate, maintain as well as the records needed to ensure the provision of quality nursing care. In this case study, the nurses seem to have divulged the needed information on the toddler to a person not necessarily authorized to handle the data which should not have been the case.
The regulation effect under colleague’s section was not appropriately handled. Take for example one of the accused nurse's roles in the case. Technically, the case would have been different if at all one of them could have taken the initiative to report aspects of the other’s professional practice which gave reasons for concern. One of the primary responsibility of nurses under this code of ethics is to ensure that colleagues are given sufficient and reliable information on the risk posed to the patients to which they are providing the healthcare for. However, this is subject to approved policies as well as relevant privacy and other regulations.
The community plays a central role in the process of complying with systems of information management. The information management system should meet the expected standards and expectations of the community (Katsikitis et al 2013, p. 40). This is inclusive of measures that comply with and support the confidentiality right and privacy rights of its patients. Also, nurses should be sensitive to, as well as respect the required requirements that apply to the communication or also sharing of information that has cultural significance.
According to the nursing and midwifery board of Australia, nurses have a number of code of ethics to abide by:
- Nurses should value the diversity of people
- Nurses value a socially, ecologically and economically sustainable environment that in return promotes health and wellbeing of others.
- Nurses value quality nursing care for all people irrespective of the age or social status
- Nurses value well-informed decision making
- Nurses value ethical management of information
- Nurses value a culture anchored on safety in healthcare
In terms of the code of professional conducts for nurses in Australia, the two-nurse breached Conduct statement three which states that nurses practice by the set standards of the profession as well as the broader health system. It is important to point out that a breach of conduct may be manifested in two ways: professional misconduct or unprofessional conduct. Professional misconduct refers to the erroneous conduct of a nurse outside the domain of his or her practice examples include disorderly conduct, theft, assault or drunkards. On the other hand, unprofessional conduct can be defined as the conduct that is contrary to the accepted practice standard of the profession (Karimi et al 2014, p.190). Technically, the type of misconduct in this case study can be considered as unprofessional conduct. Nursing profession requires nurses to conduct themselves professionally in a way that upholds public trust as well as confidentiality in the profession. In this case, the two nurses had a mandated responsibility towards the child, a responsibility that they together with the pediatrician did not effectively see through. Two conduct statement will be analyzed to examine what the two nurses did right and wrong.
Conduct statement six
Nurses have the mandate to provide impartial, honest and accurate information in regards to nursing care and healthcare products
Nurses should refrain from participating in exploitation, misrepresentation, and misinformation with regards to healthcare products and nursing care. If the nurses present a negative nature of their services, mistakes are bound to happen in the process of healthcare provision just as in the case study. Also, nurses should fulfill roles that can be considered outside the professional role. This includes taking care of family members, friends and the community in general. In summary, it is also important for nurses to take all the needed steps to ensure that the safety as well as the security of the possessions of the patient receiving the medical care.
Conduct statement three
Nurses practice and conduct themselves by the relevant laws to the profession as well as the practice of nursing. All the registered nurses are familiar with the set laws and standards of the profession. It is important to ensure that they do not engage in practices prohibited by the set laws and standards or delegate responsibilities assigned to them (Huston 2013, p. 55). Just as mentioned in the sections above, it is also paramount to ensure that nurses understand that it the responsibility of each of them to report any form of misconduct that they may witness to ant relevant authority. In relation, this ensures that the necessary body takes the relevant precaution and addresses the problem to safeguard the interest of the patient. If a nurse makes a report of an unlawful or an unacceptable conduct to their supervisors or employers and the employers fail to produce the needed response, the nurse is mandated to make the matter known to an external authority.
Generally, in terms of making informed decisions, in the situations where the patient cannot independently make informed decisions, an appropriate advocate should represent the patient. In the case study, the parents of the infant should have been accorded the primary mandate to make the needed decisions (Arnold & Boggs 2015, p. 37). On the other hand, relevant head bodies should ensure that Australian RNs provide honest, impartial and accurate information in relation to healthcare products and nursing care. The nurses, in this case, should have fully explained the advantages as well as the disadvantages of alternative care products to help the pediatrician and the parents of the infant make an informed decision.
Ethics regards the set standards of moral judgment as well as professional conduct. In relation, Nurses are accountable to patients, employers, the public as well as the profession itself. In relation, it is imperative that RNs have an in-depth analysis of the various ethical, legal as well as professional issues that is normally faced in the profession. The Australian Health Care System and factors that affect the healthcare delivery process is an important process. From the findings, it was determined that there was an unsatisfactory professional conduct against the two RNs in response to the circumstances that led to the death of the infant. The pediatrician, on the other hand, did not voluntary indulge in the unsatisfactory professional conduct. Although the blame cannot be entirely charged on the two nurses, the pediatrician played a second-row role in the case study (Griffith &Tengnah 2017, p. 203). The logic behind this is that the medical attendance did not conduct them by the expected knowledge, judgment, and care in the nursing profession. Technically, this was below the expected standards despite the fact that the practitioners are trained and have the needed experience in the profession. In addition, the case study raised serious questions about the level of clinical reasoning ability that Australian Registered Nurses have. Nursing should be regarded as a caring profession, caring, in this case, encompasses empathy and connection with patients. In relation, core nursing values are essential in the clinical practice. The two nurses, in this case, should be tried on the basis that they did not conduct themselves legally and professionally.
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