1
Running Head: ETHICS SCHOLARLY ASSIGNMENT
Ethics Scholarly Assignment
Student Name: Tanya Bowman
Student Number: 821-427-853
NURS 217(366)
Professor: Kelly Ross
Submitted: March 31, 2015
821-427-853
2
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
The term ethics is a way of understanding and societal view that includes moral issues,
social norms and practices (Kelly & Crawford, 2013). A code of ethics exists within the nursing
profession. This particular code is not written as part of our legal system nor, is it a statutory
law. The code mainly requires adherence by all professionals as part of their responsibilities
(Kelly & Crawford, 2013). When a nurse breaches the code of ethics it is the responsibility of the
College of Nurses (CNO) to investigate and discipline. The purpose of this paper is to analyze a
CNO disciplinary hearing decision. Within the paper we will identify the professional
misconduct, discuss the ethical values contravened and strategies identified to reduce the risk of
future incident.
The discipline hearing decision I chose to review was one where a Registered
Practical Nurse (RPN) developed an intimate relationship with the spouse of a client while caring
for the client. The RPN was employed at a senior’s retirement facility. She was caring for a
patient diagnosed with Alzheimer’s disease. Over time the clients spouse began to confide in the
RPN. The spouse started telling her personal things about his life. The client’s spouse told the
RPN that he was lonely living in an empty house. The RPN over time developed a
friendship with the client’s spouse. The friendship then developed into a personal intimate
relationship. The client’s sons discovered the relationship between the nurse and their father. The
spouse stated that he was contemplating moving his wife back home and the RPN would move in
to take care of her.
This RPN was being heard for an alleged professional misconduct. The professional
misconduct was she abused a client emotionally. As well, she engaged in disgraceful,
dishonourable conduct and failed to meet the standards of her profession. The discipline
committee found her guilty of abusing a client emotionally and acting unprofessionally and
3
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
dishonourably. They decided to suspend her registration, ordered her to be reprimanded within
three months of the order and conditions set if she ever becomes an active registrant of the CNO.
According to the CNO practice standard Ethics, the nurse contravened the ethical values;
client well-being and maintaining commitments. In nursing care the client’s well-being must
be considered in every aspect of care. As indicated a nurse promotes a client’s well-being by
ensuring client safety and preventing or removing harm. Promoting client well-being means
facilitating the client’s health and welfare and preventing or removing harm. (CNO, 2009) This
particular RPN contravened this value by emotionally abusing her client. The CNO document
Therapeutic Nurse-Client Relationship directs that a nurse protect her client from abuse by not
engaging in relationships such as friendship, romantic relations or sexual relations with the
client or their spouse for a period of one year following the termination of the therapeutic
relationship. (CNO, 2013). The RPN discussed in this case established an intimate personal
relationship with the client’s spouse of sixty years. This type of act is detrimental to
the client’s well-being as it caused emotional harm to a client and her family. Such actions could
also have a profound effect on the client’s health.
The other value that was contravened ethically was maintaining commitments. There are
three subsections outlined in the ethics document standard. These subsections are maintaining
commitments to client, maintaining commitment to one’s self and maintaining commitments to
the nursing profession. It is a nurse’s responsibility to maintain all client commitments they have
made. The nurse is supposed to put her client’s needs and wishes first. They need to
ensure that they are acting in the best interest of the client at all times. The care is to be centred
around the client and also may include working with family members. It is important that professional
boundaries are maintained when working with a client as well. The CNO ethics document reveals that
nurses have an obligation to not abuse, abandon or neglect their client. They are to provide care with
4
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
empathy and utilize their knowledge. (CNO, 2009) The nurse must adhere to ensuring all clients
relationships are professional. The CNO refers to professional relationships being based on the values of
trust and respect. When a nurse follows this practice standard the result is improved client care.
(CNO, 2009).This particular RPN failed to maintain professional boundaries in her client care. She did
not protect the client from abuse. As well, her actions were not in the best interest of the client. The
RPN never considered the client when she made her decision to pursue a relationship with the clients
spouse.
The second subsection is maintaining commitment to one self. The RPN should have recognized
that it was inappropriate for her to continue providing care to the client. When she developed a
friendship with the client’s spouse she should have discontinued care and discussed the issue with her
supervisor. The RPN did not stay committed to herself, her values and her profession in this scenario.
She continued to provide unethical care after the relationship was established. The CNO regulates that
if a nurse is no longer able to provide care to a client they must arrange for another nurse to take over
the care. (CNO, 2009) The RPN failed to meet this practice standard and continued to provide care to
the client and even considered moving into the clients home to care for her.
The third subsection is maintaining commitments to the nursing profession. Nurses are
obligated to adhere to legislation and nursing practice standards. Nurses are required to adhere to the
standards of the nursing profession, represent the profession in a positive manner and ensure
participation in the enhancement of the profession. (CNO, 2009) A nurse is a health professional and as
such should provide care in a professional manner. As indicated in the CNO document Professional
Standards nurses must provide ethical nursing care, ensuring to act with professionalism in all clients
actions and to ensure client well-being. (CNO, 2009) The RPN in this case did not represent the
profession positively. She contravened professional standards set out by the CNO. She did not uphold
her nursing responsibilities. She was not professional in her actions by crossing the professional
boundaries with the clients spouse. Most of all she did not ensure the wellbeing of her client. This RPN
5
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
sends out a negative message to the public regarding the nursing profession. She did
not maintain a therapeutic relationship with her client. As written in the CNO document Therapeutic
Nurse Client Relationship nurses are responsible to ensure limits and boundaries have been set with
their client. There can be incidents where family involve the nurse in their personal life and the nurse
needs to recognize when she is crossing boundaries. In this case the RPN did not report or acknowledge
that she was crossing professional boundaries. (CNO, 2013)
Facilities that are dealing with such a vulnerable population should have strategies in place to
assist their nursing staff to handle situations of boundary crossing. It is in my experience in a home care
environment that policies are created to protect the nurse from breaching their professional standards.
Strategies that could be put in place to prevent future incidences could be to create a professional
boundaries policy, create and follow a strict plan of care, provide professional boundary education,
connect with nursing peers to avoid professional isolation with the client and involve more members of
the health care team in the clients care. (Nursing Council of New Zealand, 2012)
When policy is created is makes the nurse accountable to the organization for their actions.
Policies help to reinforce public safety as the nurse is providing care to a vulnerable population. Policies
provide a clear outline of the care being provided, guidelines for the nurse to follow and outline the
organizations risk management strategies ensuring client safety and care effectiveness (Mentor
Consulting Group). It is also important that the organization provide education to their staff around their
policies and procedures. Another strategy is to ensure strict adherence to a specific care plan. The nurse
and other members of the health care team must ensure consistency with care. Adherence and
consistency will reduce the risk of boundary crossing. It will not leave room for personal discussions or
unrelated care plan tasks being completed.
Professional boundary education I feel is another important strategy in ensuring therapeutic
nurse client relationships. Educating your staff will help to answer questions and ensure a clear
understanding of the expectations of the organization and the nursing profession.
6
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
It was identified that organizations who educate their staff related to professional boundaries will help
your staff to proactively identify and resolve issues before they escalate. (College of Registered Nurses
of British Columbia, 2015). Lastly, to ensure professional relationships are maintained other members of
the health care team should be involved in the clients care. This will significantly reduce the risk of the
nurse developing an untherapeutic relationship. Having many members involved in the clients care will
reduce the risk of personal attachment. It will also provide support to the nurse should she be presented
with an unethical situation. It ensures that the nurse is more accountable to her colleagues, increasing
the probability of policy adherence.
To summarize the content of the discussion the RPN involved did commit a professional
misconduct. The professional misconduct was contravened when the RPN became personally involved
with the clients spouse while she was caring for the client. . The boundary crossing started when the
clients spouse started to share personal information with the nurse. The clients spouse stated that he
was lonely and that he lived alone. The nurse allowed herself to develop a friendship with the clients
spouse that later turned into an intimate personal relationship. The clients son’s discovered the
relationship was happening between the RPN and their father. The clients spouse was even considering
moving the client back home and having the RPN move in with them to take care of her.
As confirmed throughout this paper the RPN contravened two ethical values that are defined in
the CNO document Ethics. The ethical values contravened were client well-being and maintaining
commitments. Included in the discussion as well the three subsections; maintaining commitments to
clients, maintaining commitment to oneself and maintaining commitment to the nursing profession.
These values contravened were defined within the paper and the violations rationalized according to
the allegations of the RPN. When nurses contravene organizational policy and CNO regulations it
creates a forum for further learning opportunities. The opportunity for re-education is presented as
well, the opportunity for the organization to re-evaluate their policies and education. Some of the
proposed strategies outlined within the paper were to ensure policy in place, adherence to a specific
7
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
care plan, provide professional boundary education and involve other members of the health care team
in the clients care. Organizations do have strategies in place with respect to ethical client care. It is the
specific strategies in place that reduce the risk of incidence. Implementing strategies regarding
professional boundaries is important in reducing risk of boundary crossing. They provide guidance,
support and accountability to help ensure public safety.
8
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853
References
College of Nurses (2009). Ethics. Retrieved from:
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College for Nurses (2009). Professional Standards. Retrieved from:
http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf
College of Nurses (2013). Therapeutic Nurse Client Relationships. Retrieved from:
http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
College of Registered Nurses British Columbia (2015). Boundaries in the Nurse Client
Relationship. Retrieved from:
https://www.crnbc.ca/Standards/PracticeStandards/Pages/boundaries.aspx
Mentor Consulting Group. The function of policies and procedures. Retrieved from:
http://www.ofe.org/mentoring/startprogram.pdf
Nursing Council of New Zealand(2012) Guidelines: Professional Boundaries
http://www.adhb.govt.nz/newborn/NsgTools/ProfBoundaries.pdf
Kelly, P., Crawford, H., (2013) Chapter 20: Ethics and the Profession in Nursing. In
Nursing Leadership and Management 2nd Edition (p.177). Nelson Education Ltd.
Toronto, Ont.
9
Running Head: ETHICS SCHOLARLY ASSIGNMENT
821-427-853