Nursing Case Study Evaluation Of Professional Conduct Of A Nurse
Question
Task: Choose a nursing case study related to NMBA Code of Professional Conduct for Nurses and prepare a report evaluating the professional issues in the selected case.
Answer
Introduction
Nurses while rendering their professional duties need to behave as per their professional capacity, which is also known as professional conduct. Nurses need to conduct their duties and uphold exemplary standards of conduct while abiding by their responsibilities. The NMBA Code of Professional Conduct for Nurses outlines the relevant national standards and regulatory guidelines that nurses need to comply with (NMBA,2020). In the current case study analysis, it can be seen that in a mental health care setting, a patient committed suicide, while nurses were in the handover phase. This led to commissioning health care complaints against nurses in both the shifts, which are RN HardavanPandya and RN Sumintra Prasad. The current scope of case analysis in mental health nursing involves evaluating professional issues in the case study from a nursing perspective. By identification of relevant professional errors that led to the incident, informing a sound future clinical practice can be attained. With this case example, it will be possible to arrive at appropriate learning for future nursing practice.
Analysis
The case study discusses professional errors that had been committed by both the RNs as indicated above. Both the nurses failed to identify their professional roles and responsibility even in acute cases of mental health faced by the patient, which led to potential risks and finally disastrous patient outcomes (Mather et al, 2017). While analyzing the case study, complaints (professional errors) identified against RN Pandya that amounted to unsatisfactory professional conducted were in five parts. Firstly, RN Pandya failed to provide early advice to his team leader or other members of the team regarding his early departure, hence there was no proper handover that took place. RN Pandya had acted in an inappropriate manner leaving his assigned unit at 14.35 hours before taking to his head Mr. Khan (Birks et al, 2016). No handover took place as RN Pandya left in a hurry hence failing to abide by his professional responsibilities and provide continued care as well as support to his patient. As seen evident in the National Safety and Quality Health Service Standards (NSQHS) nurses need to recognize and respond to acute deterioration and provide comprehensive care to patients (NSQHS, 2020). Most importantly he failed to identify any particular behavioral observations which were of concern for the patient. Moreover, he failedto maintain any kind of clinical notes, especially in regards to this particular patient (Patient A) he did not document any entry or clinical notes with physical observation (Ross et al, 2013). Lack of maintaining clinical notes especially can lead to concern during handovers taking place. Therefore, there is a lack of communication and observation which primarily led to his unprofessional conduct. As per NSQHS, he failed to communicate for safety, by way of effective communication to multidisciplinary teams and clinicians to prevent and minimize risks of harm to patient A (NSQHS, 2020). He did not follow appropriate professional standards while conducting his duties and responsibilities. The nurse hence failed to apply appropriate clinical governance, safety, and quality systems that are needed for enhancing and maintaining safety, reliability, and quality of health care standards for patients (Bryce et al, 2017). As per NSW Health Policy documents, there was the mental health care policy and procedure manual that was neither followed. The Bungarrabee House policy clearly stated to undertake continuous supervision of acute clients between 0700 hours and 2300 hours yet it had not been adhered to. Further, the nurse was found to be not abiding by the National Law for protecting the public.
In regards to RN Prasad included inappropriately signing of observations (Southgate, 2014). It is crucial for RNs to personally undertake behavioral observation before signing them, such that through interaction potential risks evident from patients can easily be identified. It can be identified that the nurse did not follow procedures as per NSQHS Standards which required abiding by clinical governance such that quality and safety systems for the patient can be maintained (NSQHS, 2020). His unprofessional behavior deteriorated the reliability, quality, and safety which in turn emerged a risk factor for the acute patient. Also, it is important to note that she had not been notified to undertake observation of Patient A or that the patient’s condition is alarming (Sinclair et al, 2013). The RN inappropriately left the floor even though he should have handed over and provided sufficient information before departing. As per nursing policy at NSW, it is the responsibility of nurses to provide continuous supervision to acute patients. Also, as per NSQHS Standards he failed in recognizing as well as responding to acute deterioration of the patient in an effective manner so that the patient could be responded to (Mellor, & Greenhill, 2014).Especially as in this case patient A was facing cognitive condition deterioration, there was needed continuous monitoring and risk assessment to provide appropriate care. However, he did not ensure proper provisioning of supervision before another RN taking responsibility. Mainly lack of short-stay staff or any staff supervision led to the accident taking place, this revealed inappropriate following of standard supervision (ACT, n.d). The RN exercised poor judgment while locating the patient in the ward, only he went to look for Patient A after receiving the patient's wife's attention. He failed to look for the patient in the bathroom, though he went to check for the patient in the room, he started getting diverted and looked for the patient in the ward (Ralph, 2015). This depicts poor competence in exercising professional conduct. It can be straight be ascertained from the complaint against the RN that he did not possess an adequate understanding of the patient's mental health condition. Inadequacy and lack of understanding of the patient's mental health as a professional nurse with possible risk factors associated. Even after such a risk situation arising for the patient, the nurse failed to communicate for safety to multidisciplinary teams to search for the patient. Though in her hearing she claims that she understands mental illness appropriately (Cowin et al, 2019).She did not abide by her obligation to perform her professional responsibility competently. Thus, these discussed relevant professional errors led to the incident taking place.
During my future cope with practice, I will need to implement professional codes and standards of practice judiciously. This case has revealed several areas of professional errors that can easily arise and lead to significant outcomes and risk instances. For appropriate future practice as a clinical nurse, I will need to implement the NSQHS Standards framework available and also follow the NSW Health Policy which will include my organization's specific guidelinesand protocols. It is most essential that published policy documents are created and then monitored as well as reviewed for undertaking the informed practice. The NMBA professional standards and codes of practice can also inform regarding specific odes, duties, and responsibilities that nurses have towards their patients. Following and abiding by these codes of conduct will enable nurses to implement diligence and professional standards in their care practice. While transitioning to practical experience, it might emerge difficult to implement these codes and remember them. Maintaining a journal of these codes and professional standards of duties and responsibilities will assists in the avoidance of professional misconduct and apply suitable approaches especially in mental health nursing and in reducing risks posed to patients. The most important aspect in undertaken an informed practice is self-reflection, which includes reflecting upon the practice and comparing them to knowledge learned, such that gaps in practice can be filled and professional practice can take place.
Conclusion
In conclusion, the case presented reveals several professional errors and breaches that took place. As discussed in the case there were two nurses, who did not undertake handover and communication, leading to significant issues arising in patient A. Finally, as the patient committed suicide, a commission was held such that proper proceedings can be decided against the nurses. There have been identified several professional errors and misconduct by the nurses and evaluated against NSQHS Standards as well as the NSW Health Policy to understand the issues that they pose. In the end learnings from this case study have been ascertained such that informed future practice can be undertaken guided by standards, codes, and regulations.
References
ACT, N. (n.d.). NEW CODES OF CONDUCT FOR NURSES AND MIDWIVES.
Birks, M., Davis, J., Smithson, J., & Cant, R. (2016). Registered nurse scope of practice in Australia: an integrative review of the literature. Contemporary Nurse, 52(5), 522-543. https://doi.org/10.1080/10376178.2016.1238773
Bryce, J., Foley, E., & Reeves, J. (2017). Conduct most becoming. Australian Nursing and Midwifery Journal, 25(6), 25.
Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019).The relevance of nurses and midwives code of conduct in Australia. International nursing review, 66(3), 320-328.https://doi.org/10.1111/inr.12534
Mather, C. A., Gale, F., & Cummings, E. A. (2017).Governing mobile technology use for continuing professional development in the Australian nursing profession. BMC nursing, 16(1), 1-11.https://doi.org/10.1186/s12912-017-0212-8
Mellor, P., & Greenhill, J. (2014). A patient safety focused registered nurse transition to practice program. Contemporary nurse, 47(1-2), 51-60.https://doi.org/10.1080/10376178.2014.11081906
NMBA.(2020). Code of Professional Conduct for Nurses in Australia.Nursing and Midwifery Board of Australia. Retrieved from [www.nursingmidwiferyboard.gov.au]
NSQHS.(2020). National Safety and Quality Health Service Standards.Australian Commission on Safety and Quality in Health Care. Retrieved from [https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf] Ralph, N. (2015). Communication in context: developing a professional identity.
Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: what does this mean for Australian nurses. BMC nursing, 12(1), 1-7.https://doi.org/10.1186/1472-6955-12-9
Sinclair, P. M., Bowen, L., &Donkin, B. (2013). Professional nephrology nursing portfolios: maintaining competence to practise. Renal Society of Australasia Journal, 9(1), 35-40.
