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 in Australia is a set of expected national standards of nursing
Conduct for Australian Nurses. The code is not intended to give detailed professional advice on specific issues and areas of practice. A breach of the code may constitute professional misconduct or unprofessional conduct. A nurse must provide a safe and competent Nursing care by which she can uphold and maintain the standard of the profession.
In the aforementioned scenario, the Registered Nurse provided antibiotics to the patient without the order of the registered medical practiotioner, 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. This may leads to offensive quality of care and unprofessional code of conduct. 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?
The national competency standard for the Registered nurse are the core competency standards by which your performance is assesses to obtain and retain your licence to practice as a Registered Nurse in Australia. Professional practice relate to the professionals, legal and ethical responsibilities.
In the above situation, the nurse being unauthorised to prescribe a medicine gave antibiotics to the patient clearly acted out of her scope of practice. Furthermore the explanation nurse being busy and the patient’s unwillingness to wait for cannot justify her act and only reveals her non-competency and poor knowledge in her carrer.The professional 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 and Midwives 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.
3. Identify the relevant legislation and professional regulations related to this case.
Professional regulatory bodies have been delegated the authority under provincial legislation to govern the practice of their members in the public interest. Their mandate at all times is to serve and protect the public.
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,saftly 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.
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. A Professional nurse is to comply with these professional legislation and regulation.
4. What type of professional development would you recommend for this nurse to undertake to prevent future such incidents and why?
The national competency standards for the Registered Nurse are the core competency standards by which our performance is assessed to obtain and retain your license to practice as Registered Nurse in Australia. The Registered Nurse should be demonstrates competence in the provision Nursing care as specified by the registering authority licence to practice, educational preparation, relevant legislation and context of care.
In this scenario had difficulty in practising within her scope of practice and acted in an unsafe and incompetent manner by making errors in documentation intentionally. The ANMC code of ethics states that ,nurse value ethical management of information which requires nurse to record information accurately and non-judgemental.Eventhough,the exhibited poor knowledge and did not work in comply with legislation by giving non prescribed medicine.
Hence this 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.
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,fuctioning in accordance with legislation affecting Nursing ,health care and the protection of individual and group rights.
In 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 recodes 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.
Furthermore, 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.