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Case Study of Nursing Professional Misconduct
Xin Zhao (Nanette)
823-579-008
NURS217
Professor Sylwia Wojtalik
Friday, November 7, 2014
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Case Study of Nursing Professional Misconduct
Client-center care is the core of nursing care. At the same time, nurses should also remember to
provide ethical care which can help advocate client’s optimum benefits.
The Case
The Nurse was a Register Practical Nurse in Ontario who worked in a long-term care facility
[Facility A]. On February 22, 2009, at round 12:45 after lunch in the dining room, the Nurse
approached the Client and wanted to help the Client leave the dining room. The Client was an
elderly resident with dementia and might frequently resist care. The Client did not want to leave.
Therefore, the Client was annoyed and threw a glass of milk to the Nurse as a response. The
Nurse picked up a glass of milk and poured the milk directly on the Client’s head. And the Nurse
said, “How do you like that?” Witness A, a personal care provider (PCP), told the Nurse that she
could not do it like that. And the Nurse told Witness A that she was just joking to the Client.
However, the Nurse told a different story to the Discipline Committee of College of Nurses of
Ontario (CNO). She stated that some liquid was spilled on the floor which led to a glass of milk
to land on the Client, according to the letter she wrote to CNO. Furthermore, she falsified her
references when she applied for a job at Facility B. Witness B, a Director of Care at Facility B,
called the Nurse’s previous Director of Nursing at Facility A. She found out that the Nurse did
not have permission to use the Director of Nursing at Facility A as a reference and the Nurse was
terminated from her position at Facility A.
The Nurses contravened Professional Misconduct as follows: First, she violated “Abusive
conduct” as she physically, verbally and mentally insulted the Client; second, the Nurse failed to
meet the standard of practice of the profession. She did not provide a guide to the attitudes that
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are needed to practise safely; finally, her action of falsifying references was dishonourable and
distrustful. The Nurse should not use references without people’s permission.
The Discipline Committee decided that the Nurse committed professional misconduct as she
abused a client physically and emotionally by throwing milk in her face and the Nurse was
disgraceful as she falsified her references (Discipline Committee of CNO, 2013).
I agree with the Discipline Committee’s decision because the Nurse acted unprofessionally.
She did not provide client-center care, as a consequence, she harmed the Client’s benefit. In
addition, the Nurse did not follow the Nursing’s Scope of Practice Statement. The Client did not
receive “supportive, preventive, therapeutic, palliative and rehabilitative” care (Service Ontario,
1991, para.4) Furthermore, the Nurse is dishonest about her personal reputation by making up
her references.
Ethical Values
The Nurse’s professional misconduct contravened Ethical Values in three aspects: client wellbeing, maintaining commitments to clients and maintaining commitments to team members.
Client well-being
According to Ethics (CNO, 2009a), client well-being means advocating the client’s health,
welfare and preventing client from harm. In this case, the Nurse poured milk on the Client’s
head. Also, the Nurse talked to the Client: How do you like that?” and laughed. The Nurse not
only abused the Client bodily but also verbally and emotionally. In other words, the Nurse did
not optimize the Client’s benefits. To make it worse, the Nurse posed threat to the Client. In
addition, the Nurse failed to maintain client-center care as the Nurse did not notice that her
misbehaviour harmed the Client’s well-being. Likely, she neglected to reduce threats and to
optimize client’s benefits (CNO, 2009a). According to CNO (2006), nurses should not show
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disrespect to clients and engage in physical, verbal and non-verbal abusive behaviours. Nurses
are clients “protectors” and they should have zero tolerance of abusive behaviour. In other
words, nurses should protect clients from harm and help clients achieve the highest level of
health.
Maintaining commitments to clients
Nurses should keep their promises to provide harmless, protective environment as well as
ethical care for clients (CNO, 2009a). The Nurse should try her best to maintain client well-being
and facilitate quality client care. In contrast, she threw milk to the Client as a response and
mistreated the Client verbally and psychologically.
Nurses are faced with different ethical issues. Lacking of staff, increasing workload and
client’s turnover influence the quality of health care provided (Duffield et al., 2009). On one
hand, nurses need to provide clients optimal health and make sure client well-being. On the other
hand, they need to deal with their stresses like handling aggressive clients. Take this case for
example, the Client acted violently towards the Nurse. Therefore, the client-nurse conflict
occurred. The Nurse should “protect themselves and other clients in abusive situations by
withdrawing services, if necessary” (CNO, 2009b, p5). When nurses are faced with situations
like this case, they should step back, withdraw if they think they think they cannot handle it.
Besides, they can seek assistances from another health team colleagues instead of acted
abusively.
Maintaining commitments to team members/colleagues
“Nurses need to respect all health care professionals and their roles, and are expected to
collaborate and coordinate care with team members” (CNO, 2009a, p9). When Witness A saw
the Nurse’s behaviour, she talked to the Nurse that she could not act like that. And the Nurse just
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told Witness A that she was just kidding to the Client. The Nurse denied what she did to the
Client and did not take her colleague’s advice seriously. According to Ethics of CNO (2009a),
nurses should behave themselves in a way that facilitates respect to health care team members.
Besides, nurses should think and reflect co-workers’ unusual comments and demeanour in order
to find out the reason why the co-work acts abnormal to them. Moreover, nurses should work
with health care team members in order to ensure that clients can obtain the highest level of
welfare and health (Canadian Nurses Association, 2008). In this case, the Nurse should accept
and reflect Witness A’s comments. Also, she can discuss with Witness A or any other nursing
professional.
In brief, according to Clayboum (2011), employees who have high level of commitments to
their organization may be more concerned about clients’ welfare and respect other staff. Nurses
should adhere to their commitments to clients, health care team members and facilities.
Strategies
Increase interpersonal opportunities
According to Claybourn (2011), facility’s climate and employee’s job satisfaction are
closely relate to work harassment. Moreover, if staff feel they are mistreated by their colleagues
or organization, they are more likely to increase the levels of harassment. Therefore, it is an
organization’s responsibility to create a harmony, non-abuse environment for employees. Having
positive interpersonal opportunities is one of the strategies that help reducing harassment
surrounding and promote health care team members working together to provide clients optimum
care. For example, nurses can have a post-conference after every shift and get feedback from
each other. Additionally, supervisors can meet with nurses privately in order to give nurses
feedback and help. Feedback can be positive or negative. If employees get positive feedback,
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they feel they are valued and respected by their colleagues. As a result, they will be more
satisfied with their jobs and work with colleagues to maintain client-center care. However, if it is
negative, they will also have a good interaction with other colleagues and ask for advice from
colleagues. Besides, facilities can hold events which can give opportunities for nurses to know
staff from other units or other areas. Nursing is a team work job. Better interpersonal interaction
with other health care professionals help them work together better to provide clients the highest
level of welfare and health.
Provide ongoing training or education
Learning is life-long. This saying applies to nurses perfectly. Nurses should keep up with upto-date knowledge to equip themselves. Nursing knowledge includes not only nursing skills but
also the understanding of ethic care. Nurses’ knowledge and their usage of ethical codes are
insufficient (Aghdam et al., 2013). Providing ongoing training and education is another strategy
that helps nurses work ethically. Trainings about how to reduce elder abuse show improvement
of nursing performance and reduces reports of staff’s abusive behaviour (Daly, 2011). For
example, short period trainings which range from 1 to 8 hours can be provided. Forms of training
can be classroom teaching, one-on-one instruction, or online learning modules etc. These
trainings can be teaching nurses how to prevent abuse or how to provide ethical care etc. After
each session, quizzes and comments about the training will be given to the staff. Besides,
facilities can provide funding for employees who want to study further in universities to keep
themselves more competent and capable for their jobs. In the meantime, facilities should make
sure their positions will be kept. These ensure nurses use their knowledge, skills and equipment
properly.
Conclusion
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It is very important for nurses to follow government legislations and CNO documentations
such as Professional Misconduct during their practices. Furthermore, nurses should also practise
ethically. In order to provide ethical care, nurses should adhere to use Ethics of CNO as a guide
when practising. Nursing should ensure client well-being, maintain commitments to clients as
well as to health care team members. The power between nurses and clients is imbalance,
however, nurses cannot misuse their powers. If nurses abuse their power, trust and respect from
clients are easily lost. Once trust and respect are breached, it is tough to regain.
Nurses are faced with different kind of ethical issue when taking care of clients. Also, nursing
is a stressful job. However, that is not an excuse for nurses to abuse their power. When conflict
between client and nurse happens, nurses can withdraw if they think they cannot handle it. After
leaving this situation, they can make a care plan or seek assistance from other nursing
professionals.
Strategy like having a positive interpersonal opportunity with team members help health care
providers work together better and promote clients’ highest level of benefits effectively. Besides,
nurses should maintain themselves to be competent and capable. Ongoing trainings or funding
for further education can keep nurses up-to-date and be more confident and competent of their
jobs.
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References
Aghdam, A. et.al. (2013). Knowledge and performance about nursing ethic codes from nurses'
and patients' perspective in Tabriz teaching hospitals, Iran. Journal of Caring Sciences,
2(3), 219-227. doi:10.5681/jcs.2013.027
Canadian Nurses Association (2008). Code of Ethics. Retrieved from
http://www.cna-aiic.ca/~/media/cna/files/en/codeofethics.pdf
Claybourn, M. (2011). Relationships between moral disengagement, work characteristics and
workplace harassment. Journal of Business Ethics, 100(2), 283-301.
doi:http://dx.doi.org/10.1007/s10551-010-0680-1
College of Nursing of Ontario (2006). Therapeutic Nurse-Client Relationship, Revised 2006
Retrieved from: http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
College of Nursing of Ontario (2009a). Ethics. Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nursing of Ontario (2009b). Conflict Prevention and Management. Retrieved from
http://www.cno.org/Global/docs/prac/47004_conflict_prev.pdf
College of Nursing of Ontario (2012). Professional Misconduct. Retrieved from
http://www.cno.org/Global/docs/ih/42007_misconduct.pdf
Daly, J. (2011). Evidence-based practice guideline: elder abuse prevention. Journal of
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Gerontological Nursing, 37(11), 11-17. doi:http://dx.doi.org/10.3928/00989134-20111004-01
Discipline of Committee of CNO. v. S.D. (2013). Retrieved from
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Duffield, C. et al. (2009). Nursing staffing, nursing workload, the work environment and
patient outcomes. Applied Nursing Research 24, 244–255.
DOI: 10.1016/j.apnr.2009.12.004
Service Ontario (1991). Nursing Act. Retrieved from
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_91n32_e.htm