This case scenario is a classic case of professional misconduct carried out by Nurse X. The nurse did not have enough medical or chemical knowledge and therefore she made this mistake. It is common sense for any health care professional to realize that nasogastric or endoscopic route is very different to an IV route. All nurses and health care providers must be extra careful when administering to the patient's body through the IV route. It is noteworthy here that something as minor as an air bubble can result in the death of the patient. Through the nasogastric and endoscopic route, the medicines are introduced in the gastrointestinal tract from where they are absorbed in the blood. Therefore it should be noted that there is a huge difference between drug solution made for gastric route and drug solutions made for the IV route. Drugs that are administered through the IV line are made such that they do not need to be absorbed to act according to their mechanism of action.
Subsequent to discussing the case scenario at hand, it only deems necessary to shed some light on the entire aspect of professional misconduct. The nursing and Midwifery board of Australia has stated the professional code and the ethical code for the nurses runs side by side. A breach in this code can result in either professional misconduct or unprofessional conduct. Proffesional misconduct basically refers to wrong or erroneous conduct of the nurse outside their practice domain. One of the code enlisted by the board is that a nurse is required to be competent enough to practice in her domain and not put the safety of the patient at risk. (Nursing and Midwifery Board of Australia, 2008)
It is very obvious that the knowledge and skill of the nurse gets better as they move on from beginner to professional level (Benner, 1984) It is clear that Nurse X was not medically competent. Due to this reason, she assumed that the nasogastric and IV route were quite similar. Dr. Selma Alliex (2002) talks about the conditions and instances in which a nurse can be accused of professional misconduct. Misconduct means that the nurse was unethical in terms of incompetence, impropriety and carelessness. We see here that being careless or incompetent in providing care for the patient is a reason for the Nursing Board to take action against the nurse.
In this case scenario, the nurse made a clear violation of many ethical principles of nursing. Beneficence is one of the principles that this nurse violated. Beauchamp & Childress (2009) stated that beneficence means that the health care provider should act and work in such a way that it results in the good of the patient in all situations. Considering more details of this principle, it means that the nurse should work to improve the patient's health. Therefore, the main target is to improve the health and that also means refraining from actions that would cause harm to the patient.
This incident brings up one of the major areas where the nurse didn't pay much attention and took this case easily. It is stated that every situation should be dealt with in a different manner. No two patients are the same and therefore their management is also different. This is relevant because what is good for one patient might not be good for the other patient. Nurse X stated that they delivered the same form of crushed oral medications via the NG route to some other patient. She should have realized that this patient and the other patient are different and hence their management would be different as well.
It has been stated that the doctor's orders should be closely followed by the nurse. A major ethical violation is not listening to or following the orders that have been written down by the doctor. A small mistake like altering the route of administration of a drug can lead to the death of the patient. Only if the nurse had listened to the orders written down, the patient would not have died. This is exemplified by the nurse because she ignored the 'Nil by mouth' command that was listed. She assumed that the same thing that could be given by mouth could be given IV as well. She may have read the previous notes wrong but the crime that the nurse committed only required common sense.
The history of Nurse X shows that she has the knowledge of nursing and therefore she passed the medical assessment. After this incident however, it is quite clear that the nurse lacked practical skills and practical knowledge. Starting off in a new situation, Nurse X probably panicked and could not think straight. A study carried out by Chang (2003) states that new nursing graduates give poor performance due to role ambiguity and stress. It is not clear if the nurse is sure about her profession and whether she has enough knowledge to carry it out in a proper way. All these reasons therefore conclude that Nurse X did show professional misconduct and therefore got suspended.
It should be noted that this patient was already in a lot of distress. Any little aggravating factor could have made her condition worse and that is exactly what happened. It was the nurse's duty to care for the patient and improve her health. This leads us to discuss the duty of care that the patient owed the nurse.
Duty of Care
Nurses and midwives both have a professional and a legal duty to care. This means that they are required by law to work to provide care to their patients. In doing so, the nurses should make sure to avoid errors or acts that would injure the neighbor. The law states that the neighbor is a person who would be directly affected by the nurse's action. It is crucial to outline what the duty of care for the nurse is. This is because many nurses are going to take roles and carry out actions that would be allocated to physicians and surgeons. (Young 2009) In doing so, they then make a mistake and are therefore held accountable.
According to the Nursing and Midwifery Board of Australia (2010), there is a professional boundary between the power the nurse has and the patient's vulnerability. The nurse needs to well aware of these boundaries and act within them. The nurse should think before she crosses the boundary and should think before she carries out any duty for the patient. It is clear from our scenario that Nurse X did not think about the consequences of her actions. The Joint commission on Accreditation of Health Care organization defines negligence as improper conduct or lack of skill or knowledge by a holder of professional or official position. Malpractice results in irreversible damage to the patient most of the times. . There are many cases of nursing negligence as concluded by a study conducted in 1997. The most common reasons were failing to communicate relevant information to the doctor, nursing intervention, and medication errors. (Campazzi, 1980)
Scope of practice and the Standard of care
The board of Nursing has the right to take action against any nurse who is violating nursing laws or is a danger to the public. (Brous, 2012) The American Association of Critical Care nurses have stated the scope and standard of care that is expected of nurses. The major aim of all practicing nurses is to ensure patient safety and improve their care. A very important standard to be met that is relevant in this case scenario is education and knowledge. This means that the nurse should have knowledge that will guide his or her actions. We see that in this scenario Nurse X had very poor knowledge of drug administration. Even though she was not sure, she did not go on to ask for a second opinion before administering the drug. As mentioned earlier, the scope of care is patient safety. Nurse X failed to meet the standards and was the least concerned about delivering adequate care. Therefore, failing to meet standard of care and not working within the scope of practice led to Nurse X being charged of professional misconduct.
Evans (2009) concluded that medication errors are the most common reason for medical negligence in acute hospital settings in Australia. Croke (2003) has stated that there are many ways to reduce instances like these. It is very important for all nurses to improve their skills and therefore work to reduce chances of errors. Some ways to reduce mistakes like the ones Nurse X did are for nurses to brush up on their skills by attending classes and seminars. A nurse should not take assignments and carry out tasks that they are not trained to do so. Collyer (2013) carried out a review regarding the regulatory practices that are being carried out in the country. Surely nurses are doing their job but it is also very important…