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Ethics: Professional Misconduct
Student: Marina Pidluzhnyy
Student No: 822 867 131
Date Submitted: November 4, 2014
NURS217 (366): Legal, Professional and Ethical Issues in Nursing Practice
Professor: Rosemary Watkins
Humber College ITAL
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I selected case No. HI06356 that came on for hearing before the Disciplinary Committee
of College of Nurses of Ontario in 2012. In this case, the nurse who committed a professional
misconduct (the “Member”) was taking care of an elderly client who was suffering from arthritis,
cardiovascular disease, had a history of stroke and dementia, all of which contributed to a high
risk for falls. The Client was agitated and wandered around the home unite in the Facility despite
the Member’s multiple attempts to bring him back to his room. The Member restrained the Client
and listened to his banging and yelling behind the closed door. A few minutes after the Client
quieted down, the Member discovered him lying on the floor in a pool of urine with a fractured
hip and bleeding from the head; the Client sustained intracranial hemorrhage which led to his
death a day later. The Member acted against standards of nursing practice, contravened ethical
values and compromised professional integrity as well as abused the Client both physically and
emotionally. The following elements point to the alleged misconduct: the EMS’s notification of
client death to the Facility, security video from the Facility which depicted the Member’s actions
during the incident and the Personal Support Worker’s (PSW) incident report. In this case The
Member was the only individual responsible for the misconduct. From the case protocol it is
evident that there were no contributing factors that led to the wrongdoing. The Member was not
known for a substance abuse, violence nor had mental illness. Based on the overview of this
case, at the time of the accident, there were no environmental factors or conditions which could
have distracted the alleged Member and led to her unprofessional and unethical activity. The
Disciplinary Committee decided that the Member shall be reprimanded, the Member’s nursing
license shall be suspended for two months and the Member shall attend disciplinary sessions and
complete educational modules. I believe that the penalty for the Member is insufficient for the
misconduct that has led to the death of vulnerable, frail and dependent elderly man. I believe a
stricter penalty such as longer license suspension would have been more suitable.
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Being a nurse means providing care to your clients. Such care is not limited to bathing
and feeding the clients, but rather means promoting safe, competent and ethical care while
developing and maintaining therapeutic nurse-client relationships. A nurse needs to show respect
and trust for those that she/ he takes care of. It is essential for each nurse to show professional
integrity where she/he follows moral and ethical values. In my opinion, the nurse is required to
recognize that every client is unique and vulnerable human being, and deserves a professional
and ethical commitment. In this case the Member has “failed to respond in timely manner to the
need of the Client” (CNO, No. HI06356). To be more precise, the actions of the Member led to
severe injury and tragic death of the Client. In the Practice Standard: Ethics states that “client
well-being…is primary value” (CNO, 2008). In my understanding, it is the primary
responsibility of each nurse to ensure safety of the client and the most importantly do not harm.
In some cases an obligation of not causing harm overrides the responsibility of helping or
treating a client. For example, a palliative client who suffers from end stage cancer with a
prognosis of a couple of days to live and needs a painful scheduled debridement of his/her large
sacral ulcer stage IV a principal of nonmaleficence supersedes the need to cause extra pain for
this client. In a given example our ethical obligation is to remove harm, such as painful
repositioning of a client, and instead administer pain relieving medication to provide comfort to
the client. Going back to my case, I want to emphasize that the Member contravened one of the
most important ethical values: client’s well-being. As stated in College of Nurses of Ontario
(CNO) Practice Standard: Ethics: “promoting client well-being means facilitating the client’s
health and welfare, and preventing or removing harm” (CNO, 2008). In the book written by
Beauchamp and Childress (2009) indicated: “the principle of nonmaleficence imposes an
obligation not to inflict harm on others…. Above all [or first] do not harm”. The Member, caring
for the elderly Client who suffered from dementia failed to demonstrate understanding of the
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Client unique needs, failed to use her knowledge, skills and experience to promote the best
interests of the client. Due to her lack of moral ethic, compassion, empathy, critical judgment
and ability to recognize harmful situation the Member breached one of the essential ethical
values: promotion of the client well-being. In my opinion, in order to prevent similar situation
from happening we need to enforce an extra course on gerontology and psychiatric mental health
for nurses who are planning or applying for a position in long term facility or unit and will
primarily be dealing with senior residents. This course should emphasize physical and
psychological age related changes and therapeutic strategies to achieve best possible care for a
client.
Another ethical value, client choice, was contravened by the Member. As stated in
Practice Standard: Ethics “when a client is incompetent, nurses need to ensure that a therapeutic
relationship is maintained with a limited possibilities of the client and with substitute decisionmaker” (CNO, 2008). In this case the interventions were set out in the Client care plane, where it
was clearly mentioned that the client is allowed to wander within his home unit. By restraining
the client in the closed room the nurse disregarded the care plan and the choice made on behalf
of the client. Regardless of the client’s condition, it is the responsibility of the nurse to attempt to
build mutually respectful and trustworthy therapeutic relationship.
This leads us to another value from Practice Standard: Ethics that the Member failed to
provide: maintaining commitments to the clients (CNO, 2008). The Member did not act in the
best interests of the Client or followed standards of practice. The Member simply restrained the
client in his room without any safety measurements or concerns for Client’s well-being which
violated behavioural directives provided in Practice Standard: Ethics “making all reasonable
efforts to ensure that client safety and well-being is maintained during any job action” (CNO,
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2008). As I can conclude from the case, the actions of the Member did not show any compassion
which is fundamental in nursing care and demonstrated as sympathy, kindness and empathy to
someone’s discomfort. However, due to lack of compassion the Member failed to meet the
essential needs of the client: safety, freedom from restrain and harm.
Lastly, in my chosen case there was another ethical value - respect for life, that the
Member contravened. The nurse has to ensure that her/his client is safe, free from harm and
his/her life is preserved. According to CNO Practice Standard: Ethics (2008) “respect for life
means that human life is precious and needs to be respected, protected and treated with
consideration”. After restraining her client in his room, the Member was standing behind the
closed door and listening to her Client’s yelling, kicking and banging on his door. Only when it
became quite she entered the room and found the Client lying on the floor bleeding from his
head and in the pool of his urine. In my opinion, the Member failed to fulfill basic human need:
to value the Client life and assure that the Client’s life is safe and taken care of. Elderly
population is usually the most vulnerable, dependent, sick, fragile and undergoing a lot of
physiological changes. Providing ethical care and recognizing ethical values will ensure that
every client is safe and receives the care that reflect client’s unique needs and wishes in order to
promote, provide, treat or prevent the disease. That is why I believe that a strong emphasize
should be placed on respecting ethical values. One way to achieve this mission is to implement
ethical value statute into each medical institution protocol and ensure strict adherence to the
statute with disciplinary punishment for those who contravene it. When severe ethical offence
becomes a comparable to the crime of killing, every nurse will pay more respect to the human
life, his/her clients’ safety and dignity.
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In the case No. HI06356 the Member was an employee of the Facility for a number of
years. The termination of her employment came as a result of her misconduct towards an elderly
client who suffered bodily harm while under Member’s care at the Facility. The Client’s injury
was so severe, that it led to his death. The Member contravened the Practice Standard:
Professional Standards of practice: “providing, facilitating, advocating and promoting the best
possible care for clients” (CNO, 2002). She did not evaluate the Client mental and physical state
of health on the night of the accident and placed the Client under environmental restriction which
led to severe bodily harm. The Member failed to predict the outcomes of her interventions and
failed to recognize her professional limitation such as inadequate knowledge on how to deal with
an agitated client and failed to recognize the need to seek professional advice from intraprofessional health team at the Facility. Her uncompassionate behaviour during the accident
demonstrates the Member’s incompetence and failure to comply with ethical values that are
essential in promoting and attaining client’s safety, preventing harm, promoting client’s wellbeing, protecting life and dignity, and satisfying client’s right of choice. In my opinion, every
nurse wishing to work with elderly people who are the most vulnerable, fragile and ill population
needs to pass the detailed course on geriatric physiological changes and psychological challenges
in order to be allowed to practice with seniors. This course should prepare nurses to work with
geriatric clients, to help them appreciate their age, wisdom and life experience. Lastly, in order to
achieve respectful nursing practice toward vulnerable clients I recommend passing a provincial
law mandating that every medical institution implements and enforces an ethical statute for every
nurse and other medical personnel to abide by and noncompliance should be punishable by law.
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Reference
Beauchamp, T. L., & Childress. J. F. (2009). Principles of Biomedical Ethics (6th ed.).
New York, NY: Oxford University Press, Inc.
College of Nurses of Ontario. (CNO). (2012). Discipline Committee of College of Nurses
of Ontario: Case No. HI06356. Retrieves from www.cno.org
College of Nurses of Ontario. (CNO). (2008). Practice Standard: Ethics. Retrieved from
www.cno.org
College of Nurses of Ontario. (CNO). (2002). Practice Standard: Professional
Standards. Retrieved from www.cno.org