Contemporary Nursing Tribunal Decision

Questions: 1. Describe how the episodes of misconduct (deliberate actions that constitute a lack of accountability) in this case, might have been prevented or addressed in the context of collegial accountability. 2. Describe the implications for organizational tolerance of shifts in practice across safety boundaries (organizational accountability) and appropriate organizational responses in the event of professional misconduct in the context of the case provided. Answers: The essay focuses upon the individual accountability in the clinical practice and the relationship within the professional codes and standards of practices for advanced practice nursing and nurse practitioners. The essay would focus upon the professional misconduct of Mr. Ashford who is a registered nurse in NSW at the St. George Hospital Emergency Department. The Health Care Complaints Commission (HCCC) investigated against Mr. Ashford for the professional misconduct and unsatisfactory professional conduct in the organization Butts and Rich 2012). Finally, the case lead to the cancellation of Mr. Ashfords registration as a registered nurse. In this context, the individual, collegial and organizational accountability for this case would be discussed. In the particular case of Mr. Ashford, the HCCC team has found four components against Mr. Ashford including unsatisfactory professional conduct, professional misconduct, having an impairment and he is not suitable for holding the registration as a registration nurse in the NSW healthcare framework (Caselaw.nsw.gov.au 2016). From the individual accountability, it has been revealed the complaints alleged that through several months Mr. Ashford had misappropriated addiction related drugs for his own use from his working hospitals. The drugs included Oxycontin and Fentanyl. Mr. Ashford wanted health Care complaints commission to consider his impaired physical status, drug dependence as a mitigating factor in this case (Grove et al. 2012). However, tribunal did not consider his approach. HCCC reported that on 12th February 2013 Mr. Ashford misappropriated nine oxycontin tablets from St. George Hospital for his own usage and provided false information during investigation. On 23rd July 2013, he misappropriated fentanyl from Westmead hospital for his own use (Caselaw.nsw.gov.au 2016). Therefore, from the above data, it can be interpreted that Mr. Ashford has not met the professional nursing codes and nursing competency standards as well. According to the poisons and Therapeutic Goods Act 1961, division 1 part 4, his professional misconduct and unsatisfactory professional conducts has been judged which are justified. In addition, he provided false and misleading information about why he did not tell other staff about his misconduct (Austlii.edu.au 2016). The oxycontin tablets were potential properties of patients in the hospital and he theft the medications of those patient who might not get appropriate pain relief. Therefore, he failed to provide appropriate care to th e patients and thus failed to fulfill duty of care and failed to respond to unsafe or unprofessional practice, thereby relating his professional misconduct to the nursing competency standards and ethical codes (Huffman Rittenmeyer, 2012). He showed repeated dishonesties over last 6 months. The third complaint against Mr. Ashford was his impairment, post traumatic stress disorder or substance abuse, which he wanted to be considered as a mitigating factor. However, he provided his false medical report of impairment. It has been analyzed that the letter related to his impairment was not received before December 2013; however, Mr. Ashford acknowledged that he was experiencing drug dependence since 2009. In contrast, Dr. Samuels reported that Mr. Ashford experienced particular impairment in September 2010. The last complaint against Mr. Ashford was that he was not suitable for holding the position of a registered nurse in the New South Wales health care framework. The complaints were judged according to the Health care Complaints Act 1993 as they received a section 40 letter. The letter referred that Mr. Ashford was prescribed Oxycontin by Dr. Anell, thus he was not taking any non prescribed drug illegally. However, he has already stated that he misappropriated fentanyl for his own use. In this context, it has been noted that the code of professional conduct for Nurses in Australia states that Nurses practice on a safe and competent manner that is not compromised by personal health limitations, including the use of alcohol or other substances that may alter a nurses capacity to practice safely at all times (Fawcett and Desanto-Madeya 2012). Nurses whose health threatens their capacity to practise safely and competently have a responsibility to seek assistance to redress their health ne eds. This may include making a confidential report to an appropriate authority. Therefore, while accepting the barristers submission about Mr. Ashfords breach of conduct and physical impairment, it could be interpreted that he is not able to play his professional role or capacity in his current condition (Caselaw.nsw.gov.au 2016). Thus, he did not met the nursing competency standards as he did not integrated organizational policies and guidelines with professional standards and did not communicated effectively with other nursing staff to facilitate provision of care while administrating medication. With the help of collegial accountability the preventive measures can be addressed in Mr. Ashfords case. From the report of HCCC, it has been reported that the documentary evidence provided a different shed of light upon Mr. Ashfords misconduct and unsatisfactory professional conducts. In this context, it has been revealed that number issues were addressed by the hospital authorities regarding Mr. Ashford but due to the lack of tight regulation, he did not caught previously. If he was placed in day shift, there was less chance to misappropriate drugs from the hospital premises. Mr. Ashford requested to the key holder for Fentanyl infusion for a severe burned patient. The key holder did not investigate the disappearing of drug properly. It might be helpful for preventing the situation. After medical intervention taken for Mr. Ashford in emergency department, he attended a 1st stage disciplinary meeting on November 2009, however, without taking tough regulation against him, he was allo wed to work again (Russell 2012). It allowed his to continue his misconducts. He acted dishonestly by the provision of misleading and false information to hospital staffs, to the council and PSU. The history of substance abuse supported the third complaint. In addition, he failed to address his colleagues about his substance abuse issue which led to his continued work as a registered nurse in spite of having a substance abuse problem which is against the nursing code of conduct and ethical codes. If it had been decided that under 149C(4) of National Law Mr. Ashford is disqualified from his registered nurse post for a specific period, it would be appropriate order under 163A of National law and Mr. Ashford could be subjected to review body for reinstatement order after expiry of disqualification period, It could have a positive impact upon the professional career of Mr. Ashford as it would allow him to re-register to National Board (Austlii.edu.au 2016). In order to discuss about the implications for organizational tolerance of safety boundaries and policies which has been breached by Mr. Ashford, it has been revealed that the protective barriers should be more tightly regulated in the health care context. The internal investigation Board should be stricter to identify the false information provided by employees. During night shift he did not met the health district policy of the organization. In addition, he did not meet the professional conducts required to be maintained by a registered nurse (Dekker 2012). In addition, the organization should be improve the regulations for identifying the unfit staffs having some kinds of issues including drug abuse because it would affect the overall quality of care provided by organization and can have negative impact upon patients health outcomes. In conclusion, it can be said that this essay highlighted the importance of professional conducts, laws and regulations in nursing practices and the implications of non compliance to the professional conducts and nursing standards. The individual, collegial and organizational accountability for the case of Mr. Ashford has been described and analyzed in this essay. Reference List Austlii.edu.au, 2016. POISONS AND THERAPEUTIC GOODS ACT 1966. [online] Austlii.edu.au. Butts, J.B. and Rich, K.L., 2012.Nursing ethics. Jones Bartlett Publishers. New South wales Caselaw.nsw.gov.au, 2016. Health Care Complaints Commission v Ashford - NSW Caselaw. Dekker, S., 2012.Just culture: Balancing safety and accountability. Ashgate Publishing, Ltd.. Fawcett, J. and Desanto-Madeya, S., 2012.Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. FA Davis. Grove, S.K., Burns, N. and Gray, J., 2012.The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences. Huffman, D. M., Rittenmeyer, L. (2012). How professional nurses working in hospital environments experience moral distress: a systematic review.Critical care nursing clinics of North America,24(1), 91-100. Russell, K.A., 2012. Nurse practice acts guide and govern nursing practice.Journal of Nursing Regulation,3(3), pp.36-42.