Scholarly Assignment on Nursing Ethics
1
Discussion and Ethics Analysis of a CNO Disciplinary Case and Ruling
Scholarly Assignment on Nursing Ethics
By Migmar Tsering
Student#
Professor:
NURS 217
Humber College
Date: November 01, 2014
Introduction and Summary of the Case and Discipline Ruling by the college of Nurse
Scholarly Assignment on Nursing Ethics
2
This paper will analyze and discuss a CNO decision related to professional misconduct
by XYN, an RPN. Along with the study of the CNO findings and rulings on this case, this paper
aims to point out specific ethical values of nursing which the member was alleged and found to
have contravened. As preventative measures, the author will outline two well thought out
strategies to create a nursing environment that leaves no room for client abuse resulting from
professional misconduct.
The member was alleged and found guilty, by way of voluntary and unequivocal
admission, of physical, emotional, and verbal abuse of a client, stemmed from an incident
happened on March 31, 2008 in an undisclosed facility. On March 31, 2008, the member was
alleged to have thrown water over the client in retaliation towards the client’s altercation with the
nurse related to medication administration. The member was also alleged to have made fun of the
client after having poured water over the client’s head. The witnesses in this case included two
PSWs on the floor. The client, as per the record, happened to be a senior, now deceased, who
needed total care, but very alert and no history of cognitive impairment. The nurse was solely
responsible for the alleged professional misconduct that resulted in physical, mental, and verbal
abuse of the client (CNO, 20013).
In this case, I believe the contributing factor was that there was only one nurse assigned
to the unit during the night shift. Two registered nursing staff might have provided better
environment for constructive peer feedback, care support, and assistance in better critical
decision making for a difficult client. Second contributing factor, I believe, was apparent anger
mismanagement on the nurse’s part resulted from possible poor quality assurance measures and
reflective practice. The nurse had no known history of mental illness and substance abuse. Third
contributing factor could be that the member had prior history of client abuse registered with the
Scholarly Assignment on Nursing Ethics
3
college and the College’s inadequate measures taken for earlier client abuse case might have led
to the current abuse claim.
The College’s decision was clear in finding the member indeed guilty by way of
admission of client abuse, contravention of practice standard, and professional misconduct
resulting in client abuse physically, mentally and verbally. I personally believe client abuse is a
serious issue and should be dealt properly to protect the public. The ruling, I think, was firm and
reasonable, but short on the sentencing or penalty part- three months of license suspension seem
bit too light for a client abuse case especially when the member had a similar prior history of
client history where the client got the same three months suspension of license. The member
Identification of Ethical Values Contravened within the Case
Ethical values are keys to establishing a therapeutic relationship between nurse and
client. Therapeutic relationship is a key to health promotion in a client. According to the CNO,
there are several key ethical values that the nurse should strive to uphold and maintain in their
caring relationship with a client. These values include promoting client wellbeing, respecting
client choice, privacy and confidential, respect for life, and maintaining commitment,
truthfulness and fairness (CNO, 2009). Studying this case, I found the member had contravened
the ethical values of promoting client wellbeing and respecting client choice and maintaining
professional commitment to client, self, and the nursing profession.
The main goal of nursing is to promote client wellbeing by doing what is for the best
interest of the client. “Promoting client well-being means facilitating the client’s health and
welfare, and preventing or removing harm” (CNO, 2009, p. 5). But the member failed to uphold
this ethical value in a most blatant way. Instead of promoting client wellbeing and preventing
Scholarly Assignment on Nursing Ethics
4
client harm, the nurse’s action had resulted in the physical, emotional and verbal abuse of the
client, and thus a serious professional misconduct. The very physical act of pouring water over a
vulnerable senior client followed by making fun of it amounted to a most coward form of
physical, emotional, and verbal abuse. It is also typical example of a power abuse too. And this
kind of behavior by the nurse will never be healthy for the promotion of health and trust in the
client. And it is a clear violation of nursing ethical value of promoting client well-being.
Secondly, respecting client choice in the care delivery is very important ethical value.
Client is the sole focus of care, client being a whole person, should not be forced into anything,
especially when the client’s mental status was very intact and sharp as was the case here. Client
alone can decide what is best for them. “Client choice means self-determination and includes the
right to the information necessary to make choices and to consent to or refuse care. Clients know
the context in which they live and their own beliefs and values” (CNO, Ethics Standard, p.6
2009). And here in this case, client was apparently given no choice, and the client’s apparent
refusal and non-cooperation with the nurse’s medical administration should have been met with
more caring and compassionate approach through clear explanation, reassurance, and
encouragement and if indeed the client had refused, that was a client’s right too. But sadly, the
nurse chose to react in upset mood in most uncaring, unethical, and unprofessional sort of way,
resulting in client abuse. Respecting client’s choice in most professional way could have avoided
this incident.
Thirdly, being a member of a nursing profession comes with a special commitment not
only to the client in question, but also to the nursing profession itself and others in the healthcare
team as well. “Being a member of the profession brings with it the respect and trust of the public.
To continue to deserve this respect, nurses have a duty to uphold the standards of the profession,
Scholarly Assignment on Nursing Ethics
5
conduct themselves in a manner that reflects well on the profession, and to participate in and
promote the growth of the profession” (CNO, 2008, p. 6). But the RPN’s action clearly failed to
meet these expected commitments through the contravention of the ethical value of maintaining
commitment to the client, self, peers, and quality assurance program.
“ Nurses have an obligation to maintain commitments that they assume as regulated
health professionals, such as keeping promises, being honest, and meeting implicit or explicit
obligations towards their clients, themselves, one another, the nursing profession, other members
of the team” (Kozier et. al, 2005, p. 77). The member in the case had failed to maintain
commitment to the profession through professional misconduct; the member failed to maintain
commitment to the client by abusing the client; and the member failed to maintain commitment
to fellow peers in the professional by not consulting and communicating with them about the
issue and ways to prevent them in the unit.
Preventative strategies to avoid Client Abuse in Future based on the Case
Client abuse in any forms is a serious matter and appropriate and strategies must be in
place to prevent any client abuses. CNO (2011) states client abuse usually comes through the
misuse of power or the breach of trust, respect or intimacy in the therapeutic relationship. Based
on this case, I would offer two effective strategy to prevent future case of client abuse that might
stem from similar circumstances.
Firstly, I would address the nurse’s anger issue here. The member was clearly displaying
typical symptoms of anger mismanagement and clear lack of self reflections in the professional
practice. This kind of client abuse could have been prevented nurse if the nurse had approached
the situation with calm mind, and had controlled her anger even when the client did not agree
with the nurse’s view of medication administration. So, to prevent such incident, the concerned
Scholarly Assignment on Nursing Ethics
6
member should attend an in or out service workshop on anger management and stress
management as a learning plan so that the member becomes more aware of one’s emotions when
dealing with a client.
CNO (2013) through its quality assurance program expects nurse to reflect on values and
attitude that affects the nurse in their caring practice settings, and clarify and change their
attitude or values in accordance to changing client situations and provocations to promote
therapeutic nurse-client relationship. Quality assurance helps nurse in finding their learning
needs, skill inadequacies through self-assessment, practice assessment and peer assessment.
Their learning goals, learning plans, and expected outcome should be revised and checked
frequently if they indeed had met the standard set by the CNO in their quality assurance
program. This should definitely help in finding nurse’s attitude and value flaws and learning
needs which will help in also anger management thus preventing client abuse in the long run.
Second strategy I would suggest would be to focus on nurse’s continued education as a
preventative strategy. Member should know they have the duty to protect the client by
preventing abuse. “Nurses protect the client from harm by ensuring that abuse is prevented, or
stopped and reported” CNO (2006, p. 9). The member should be reassessed by a concerned
appropriate nurse educator for any inadequacies in knowledge, skill and judgement related to
care giving. It is also important to take a round of facility where only one nurse is assigned to a
unit as is the case here. One option would be to periodically send the member at risk for client
abuse to an expert for re-education on practice standard, nursing ethics, professional standards,
and specifically on how to prevent client abuse. All attendances must be documented, and
reassessment should be done to see if the goal has been met. The member or all members must
Scholarly Assignment on Nursing Ethics
7
be, as part of learning plan, mandatorily made to read the CNO’s literature on client abuse
prevention and also watch one is one too many video on how to prevent client abuse.
Conclusion
I personally believe client abuse is a serious issue and one is one too many is indeed true.
In this case, the member was alleged and found guilty through admission of having contravened
three ethical standards and professional conducts expected of the profession all stemmed from
professional misconduct. Member’s first allegation was the failure to meet the standard of
practice regarding treatment of the client. Second allegation was the physical, verbal and
emotional abuse of a client, thus, committing professional misconduct. Third allegation was that
the member had committed a professional misconduct which other members in the profession
would deem it to be disgraceful, dishonorable, and unprofessional (CNO, Decision, 2013). Based
on the facts of this case, CNO ruling was though firm, I find the penalty too light in light of the
serious of the allegation and professional misconduct. The client was physically, emotionally,
and mentally abuse. Act of pouring water over the client followed by making fun of it is serious
violation of nursing ethics. So, I would have preferred a harsher penalty and suspension of
license for a year and re-education if CNO is truly to protect the public.
Based on this case, preventative strategy like improving resources for assisting healthcare
provider in anger management, and workshops would go a long way in preventing client abuse.
This can be done through periodically assessing the member’s learning inadequacies through
quality assurance program. This first strategy must be coupled with nurse education and reeducation and improving the resources for nurse education on client abuse prevention strategy.
Doing so will help in the long run to create a client abuse free environment.
Scholarly Assignment on Nursing Ethics
8
References
College of Nurses of Ontario. (CNO). (2006). Therapeutic nurse client relationship.
Retrieved from www.cno.org
College of Nurses of Ontario. (CNO). (2009). Practice standard: ethics. Retrieved from
www.cno.org
Canadian Nurses Association. (2004). Code of ethics for registered nurse (2nd edition).
Ottawa:Author.
College of Nurses of Ontario. (CNO). (2013). How we protect the public. Retrieved from
www.cno.org
College of Nurses of Ontario. (CNO). (2011). Preventing client abuse. Retrieved from
www.cno.org
College of Nurses of Ontario. (CNO). (2013). Quality Assurance. Retrieved from
www.cno.org
Kozier, B., Erb, G., Snyder, S. J., Bouchal, D. R., Hirst, S., Yiu, L., & Stamler, L.
L.(2010). Fundamentals of canadian nursing (2nd ed., pp. 117-209). Toronto: Pearson
Ministry of Ontario. (2011). E-laws: Regulated health professions act, 1991. Retrieved from
www.elaws.gov.on.ca