Definition of Unsatisfactory Professional Conduct and its application in a case study

1. The Nursing and Midwifery Council of NSW receives notifications via three different pathways: the impaired health pathway, the performance pathway, or the conduct pathway.  How does the definition of ‘unsatisfactory professional conduct’ apply to the case study and why was the nurse or midwife in the case assessed under the conduct pathway?

2. This question relates to individual professional accountability. What activities did the nurse or midwife need to complete in the immediate situation? Who else in the health care team needed to be involved in the coordination of care? What mitigating factors reduced the individual accountability of the nurse or midwife?

3. What professional standards apply/were breached in this situation?

4. What professional behaviours may have made a difference in this situation?

5. What do you learn from this case study about your own preparedness for professional practice? Choose one aspect of care from the case study that is within the scope of practice for a new graduate nurse or midwife and reflect on what accountable actions apply.

1. As per the Nursing and Midwifery Council of NSW, ‘unsatisfactory professional conduct’ is an amalgamation of several ideas. The primary idea, which is applicable in this scenario, is that a conduct, which has been expected, but it does not meet the practical expectations of the patient by the registered health practitioner (www.medicalboard.gov.au). It also includes the repetition of the misconduct (Gilligan, Outram & Levett-Jones, 2014). The conduct of the nurse or midwife encompasses several of the criteria, which qualifies as ‘unsatisfactory professional conduct’ because she failed to assess the worsening of the condition of patient A. Since she failed to appraise the symptoms and make a prompt move in getting help to the patient. Her other failure involved her into lacking the insight to document her appraisal of the patient.

The conduct pathway involves management of complaints by the council where the complaints can be categorized as ‘unsatisfactory professional conduct’ (www.hpca.nsw.gov.au). Professional misconduct also forms a part of the complaints. The nurse is guilty of ‘unsatisfactory professional conduct’ and she has admitted to all the aspects of the complaint lodged against her. Hence, the decision had to be taken by the Professional Standards Committee in respect to her conduct. Since all the specifics of the complaints held against the nurse, as per the section 90C Health Care Complaints Act, the nurse had to accept the consequences of her action where she has to adhere to the orders meted out to her by the Committee (Chang & Daly, 2016).

Individual Professional Accountability and activities to be completed in a situation

2. In the immediate situation, the actions the nurse needed to complete included drawing a review as soon as the blood pressure and respiratory rate started to fall below the normal levels. The symptoms of the patient showed her to be in the red flag zone, in spite of that, the nurse did not notify the medical officer. Being the registered nurse in charge at that particular moment, she was supposed to notify the Health Service Manager as well as the Clinical Nurse manger. She even needed to document her assessment of the condition of the patient as well as draw a strategy for the treatment. The nurse should have been coordinated with the on-call Medical Health Officer as well as the Health Service Manager.

The mitigating factors that that reduced the individual accountability of the nurse are (www.nursingmidwiferyboard.gov.au, 2007),

Firstly, the nurse had to play the dual role of being in charge of the emergency department as well as the nurse in charge of the hospital.

Secondly, she was injecting Diazepam to a patient in emergency, which requires attention, hence she missed the urgency of patient A’s situation as reported by the enrolled nurse.

Thirdly, lack of prior knowledge about the red flag related situation.

Fourthly, she was perplexed regarding the hospital policies applicable for on-call doctors regarding emergency patients and non-emergency patients.

3. The several professional standards that were applicable/ were breached in this situation are (www.nursingmidwiferyboard.gov.au, 2016):

Standard 2 relates to the involvement of therapeutic as well as professional relationships. A holistic approach is necessary for the treatment of the patient. The professional relationship should be maintained with the patient based on mutual respect as well as trust. This leads to a working atmosphere, which is deemed healthy. A collaborative environment, which needs to be established, which, involves the proper supervision as well as consultation. This standard was breeched as the nurse failed to consult the on-call doctor when the patient’s condition started failing.

Standard 4 it relates to the conductance of assignment in a comprehensive manner. The usage of relevant techniques incorporated in the assessment to gather information on the condition of the patient. This procedure aids the nursing practice when a case requires prior information of the patient. The nurse breached this standard as she failed to document any form of details regarding the patient.

Standard 5 it relates to the development of a plan in respect to the nursing practice. This standard lays stress on the necessity of documentation so that a proper strategic plan can be drawn. The plan is negotiated with the others involved in treating the patient through partnership. It leads achieving a desired result within a short span of time. The nurse breached this standard as she failed to document in this first place and this was followed by lack of drawing the strategic plan to help the patient.

Standard 6 it relates to the providing quality nursing practice to the patients based on the safety and appropriateness of the treatment.  Effective quality care will involve the nurses to follow professional nursing abiding by the rules and regulations as stated by the standard. The nurse failed to provide quality nursing to the patient because her lack of professional attitude proved to be fatal for the patient by failing to appraise her worsening condition properly. 

Mitigating factors and their influence on accountability

4. The professional behaviors that might have made a difference in the situation are (www.nursingmidwiferyboard.gov.au/, 2010):

Firstly, the critical assessment behavior would have made a difference in the situation. If the nurse had the expertise to decisively judge the situation, it would not have proved to be fatal for the patient.

Secondly, the supportive care, which the nurses are supposed to provide with, by being completely devoted to the well-being and health of the patient, was lacking. This professional behavior would have made a significant improvement in the condition of the patient.

Thirdly, professional behavior on part of the nurse also involves having competence in dealing with a crisis. To have sufficient knowledge about the human anatomy, physiology and related fields helps in providing with effective nursing.

Fourthly, professionally, a nurse is supposed to appraise a situation and provide with the itinerary of the plan of action. If the plan of action would have been decided in prior, the patient could have been helped.

Fifthly, professionally, a nurse is supposed to take the consult with fellow nurses or doctors regarding difficult situations, which the nurse is unable to assess on her own. When the condition of the patient started deteriorating, at once the doctor should have been notified and given a detailed briefing of the condition of the patient. None of these steps was followed.

Sixthly, as part of the professional behavior, the nurse needs to experience enough clinical cases to assess a situation as well as should have sufficient background on the condition of the patient. As a part of a personal effort, the nurse should work on it. 

5. From this case study, it can be assessed that documentation and the promptness in chalking out a strategy to deal with a crisis is highly essential. Hence, ‘competence’ can be chosen as an aspect of care from the case study, which is within the scope of practice for a new graduate nurse. It is quite common for nurses to face situations where the patient is in critical condition and needs assistance right away (Chen & Crozier, 2016). However, if the nurse fails to appraise the condition of the patient carefully, like the given case, it can prove to be life threatening (Dempsey et al., 2009). A good background on human anatomy and physiology will assist the nurse in differentiating an optimal body condition from the diseased body condition (Pairman et al., 2015). Competence lies in the fact of how efficiently the nurse is able to judge the situation and act accordingly. Competence not only deals with being knowledgeable but, to have the ability to communicate with the patient properly. Competence will also involve proper documentation of the details of the patient (Savage, 2015). Lack of documentation can prove to be fateful for a patient. In a situation where one’s blood group has been recorded or the allergen specific for the patient has not been recorded, can lead to life threatening situations (Staunton & Chiarella, 2012). To avoid such a situation, it is advisable to document each physiological and vital details of the patient intricately.

References:

Chang, E., & Daly, J. (Eds.). (2016). Transitions in nursing: Preparing for professional practice (4th ed.). Chatswood, Australia: Elsevier.

Chen, T., & Crozier, J. A. (2016). Carotid endarterectomy: What difference does a clinical protocol make?. Journal of Vascular Nursing, 34(3), 100-105.

Dempsey, J., Hillege, S., French, J., & Wilson, V. (2009). Fundamentals of nursing and midwifery: a person-centred approach to care| NOVA. The University of Newcastle’s Digital Repository.

Gilligan, C., Outram, S., & Levett-Jones, T. (2014). Recommendations from recent graduates in medicine, nursing and pharmacy on improving interprofessional education in university programs: a qualitative study. BMC medical education, 14(1), 1.

Nursing and Midwifery Board of Australia (2010) ‘A nurse’s guide to professional boundaries’. Retrieved 15 September 2016, www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursing and Midwifery Board of Australia. (2007) ‘National framework for the development of decision-making tools for nursing and midwifery practice’. Retrieved 15 September 2016, www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx

Nursing and Midwifery Board of Australia. (2015) ‘Supervision guidelines for nursing and midwifery. Retrieved 15 September 2016’, www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement/reentry-to-practice.aspx

Pairman, S., Pincombe, J., Thorogood, C., & Tracy, S. K. (2015). Midwifery: Preparation for practice (3rd ed.). Chatswood, Australia: Churchill Livingstone.

Savage, P. (2015). Legal issues for nursing students: Applied principles (3rd ed.). Frenchs Forest, Australia: Pearson Australia.

Staunton, P. J., & Chiarella, M. (2012). Law for nurses and midwives. Elsevier Australia.