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The ICN Code of Ethics for Nurses

The primary responsibility of the nurse is to take care of people. While giving the care, the nurse should enhance the environment where the patient's rights, values, spiritual beliefs and customs are respected (International Council of Nurses, 2012). The nurse also needs to provide correct and appropriate information in a timely manner so that it will benefit the treatment and care of the patient. In addition to that, nurses should also advocate for social justice and equality in the allocation of the resources. With that, the nurse should also show professional values such as integrity, responsiveness and compassion towards the patient (International Council of Nurses, 2012). In the case study provided, it can be seen that the registered nurses have not properly performed their role and that have to lead to adverse events in the facility. For that, they are now facing legal allegations. Therefore, it is important to understand the problems which are associated with the working of the nurses so that these kinds of practices do not happen again.

In the case study where the patient was admitted to the acute ward of the mental health facility of Western Sydney Local Health District, it can be seen that the registered nurses were not following the guidelines and policies which have been set for their practices. Registered nurse Pandya and registered nurse Prasad were the main accountable nurses for the death of the patient in the facility. They were charged with multiple allegations because the care that they deliver was not appropriate. It can be said that if RN Pandya and RN Prasad have performed their roles and duties responsibly then the patient could have been saved from suicide. The main problem that was conducted by registered nurse Pandya was that he failed to give early advice to the team leader of an early departure because of his second shift at another facility. His team leader was Ms Khan who in the proceedings stated that RN Pandya has not properly communicated that he wants to leave early. RN Pandya stated that he talked with Ms Khan in the morning and told her that he might go early upon which she said that it would be alright if he arrived early at 3:00 pm. Whereas, Ms Khan stated that she said it would be alright if he left at 3:00 pm. As a result of miscommunication, RN Pandya left the facility half an hour early before his shift ended and he also did not inform anyone upon leaving especially to the team leader. He thought he already has communicated in the morning and that would be enough. These mistakes would have been corrected if the nurses have followed the guidelines set by Nursing and Midwifery Board AHPRA which mentions about the roles and responsibilities of the registered nurses. They state that nurses have to think critically before taking any decision and have to analyze the situation completely (Nursing and Midwifery Board Ahpra, 2020). Also, nurses should be alerted while doing shift work because their performance could have a direct impact on patient care and safety (Ganesan et al., 2019).

 Another mistake which is done by RN Pandya was that he actually left the facility approximately at 2:35 pm on the day his patient committed suicide that was on 28 February 2014. This kind of mistake would be rectified if nurses worked with their experiences and feelings so as to know how these will affect their practice (Nursing and Midwifery Board Ahpra, 2020). Good nursing requires practising with ethics and efficacy and it also depends on taking accountability of the patient (Aliyu et al., 2015). They should also work according to the legislations and guidelines and policies so that they will take the relevant decision which will benefit the patient. Nurses should also make use of ethical frameworks while making any decisions (Nursing and Midwifery Board Ahpra, 2020).

RN Pandya also failed to provide handover. He admitted that he had not spoken to any other nurse and discussed the patient collectively and also not informed RN Tint about the mental behaviour or state of the concerned patient. RN Pandya also did not check whether RN Tint has taken the responsibility of his patient or not. He also did not make the required behavioural observation that was due at 2:00 pm and 2:20 pm. Moreover, he also did not keep any clinical notes or any proper documentation for his patient care. He also did not make any physical observation of the patient. This could be avoided if the registered keep accurate and timely documentation for the purpose of assessments, decision-making, evaluations, planning and actions. It is also stated in the guidelines that nurses should foster safety culture so that they can engage with other healthcare professionals so that knowledge and information can be shared which will ultimately support person-centred care (Nursing and Midwifery Board Ahpra, 2020). The incident could also be avoided if proper handover was done as they are used by the nurses to avoid and prevent mistakes and practice which is unsafe (Drach‐Zahavy & Hadid, 2015)

Another nurse who was Prasad also committed various mistakes. Firstly, she signed all the observations inappropriately and then left the floor knowing that not enough nurses were there on that day. This error can be prevented if nurses work according to the legislations and guidelines and policies so that they will take the relevant decision which will benefit the patient. Nurses in addition should also make use of ethical frameworks while making any decisions (Nursing and Midwifery Board Ahpra, 2020). Nurses should also have knowledge about legal and ethical aspects so that medical errors could be reduced in their working (Aly et al., 2020).

In addition to this, when searched began for the patient, RN Prasad did not search for the patient in the bathroom but only looked into the room and then later in the hallway and other places. She also demonstrated an inadequate understanding of the case of the concerned patient. Therefore, these are the mistakes that were committed by the registered nurses on 28 February 2014. This mistake can be corrected if nurses consider and respond in a manner which will enhance the wellbeing of self and the other person as well. With that, they should accept the accountability of their actions, responsibilities, decisions and behaviours. They should also promote the role of their nursing practice that would help in getting better outcomes for the patients who are receiving care. Nurses should also recognize and report about the potential risk to patient safety or about the standards where the practice is below the expectations level. They should also work under the standards that are set. Moreover, nurses should make sure that the practise which has been performed is accurate for the patient or not. They should work under their scope of practice (Nursing and Midwifery Board Ahpra, 2020).

With that, registered nurses should also practice within National Safety and Quality Health Services standards. The governance body should establish an organizational and clinical leadership framework in the workplace. With that, organizations should also review and check the procedures, policies and protocols so that nurse’s actions could be improved and that they work within the regulations, legislation and jurisdiction. The organization should also help with quality betterment. They should recognize the quality measures and should check the outcomes and performances. They should also know where improvements can occur so that the safety level is increased of the patients. Moreover, the organization should know and document the probable risks in the organization and should also support data collection so that they can actually reduce the risks. They should also inform about the risks to the consumers and workforce and should plan effectively to deal with external or internal emergencies. They should also know how to manage incidents. They should have knowledge about supporting the patients, families and carers and how to communicate the concerns. Hence, these standards can help in better functioning of the organization and can improve patient safety (National Safety and Quality Health Services standards, 2017). 

The mistakes could also have been rectified if the registered nurse would have listened to her team leader effectively. It was known that RN Pandya has joined recently. Being a new nurse could create problems for him. So, for that, he could take help from his preceptor nurse. Preceptor nurses help in building the confidence of new nurses and also increase the information and knowledge of the new nurses. They help in transitioning new nurses to their new roles and also help them to work safely with the patient. They also create an environment where new nurses could learn about documentation and could handle their time while giving quality care to the patient (Powers, Herron &Pagel, 2019; Cheng et al., 2020). Moreover, the readiness of the nurses before they engage with the patient can also be checked. This will help in gaining results which would indicate whether they are ready or not. This will lead to an increment of patient safety (Mirza et al., 2019; Wiersma, Pintz&Wyche, 2020; Charette et al., 2019).

In the conclusion, it can be said that in the case study RN Pandya and RN Prasad showed various misconduct on their part. If they did not commit those mistakes like leaving early before the shift ended, not giving any handover, not keeping any record, signing the entries without conducting the observation, leaving the floor and so on, then the adverse event with the patient could have been prevented. Also, for future practice, it should be advised that a nurse should work in accordance with the legislation and jurisdiction. They should also document everything about the patient and should provide quality care. With that, they should work accordingly with their preceptor nurse and their readiness level should also be checked before they engage with the client.

References for Ethico-Legal Responsibilities of Registered Nurses

Charette, M., McKenna, L. G., Deschênes, M. F., Ha, L., Merisier, S., & Lavoie, P. (2019). New graduate nurses’ clinical competence: A mixed methods systematic review. Journal of Advanced Nursing.https://doi.org/10.1111/jan.14487

Cheng, Y. C., Huang, L. C., Yang, C. H., & Chang, H. C. (2020). Experiential learning program to strengthen self-reflection and critical thinking in freshmen nursing students during COVID-19: A quasi-experimental study. International Journal of Environmental Research and Public Health17(15), 5442. https://doi.org/10.3390/ijerph17155442

International Council of Nurses.(2012). The ICN code of ethics for nurses. Available at https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf

Mirza, N., Manankil-Rankin, L., Prentice, D., Hagerman, L. A., &Draenos, C. (2019). Practice readiness of new nursing graduates: A concept analysis. Nurse Education in Practice37, 68-74. https://doi.org/10.1016/j.nepr.2019.04.009

National Safety and Quality Health Services standards.(2017). Australian commission on safety and quality in healthcare. Available at https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

Nursing and Midwifery Board Ahpra.(2020). Registered nurse standards for practices. Available at https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Powers, K., Herron, E. K., &Pagel, J. (2019).Nurse preceptor role in new graduate nurses' transition to practice. Dimensions of Critical Care Nursing38(3), 131-136. 10.1097/DCC.0000000000000354

Wiersma, G., Pintz, C., &Wyche, K. F. (2020). Transition to practice experiences of new graduate nurses from an accelerated bachelor of science in nursing program: Implications for academic and clinical partners. The Journal of Continuing Education in Nursing51(9), 433-440. https://doi.org/10.3928/00220124-20200812-09

Ganesan, S., Magee, M., Stone, J.E…Sletten, T, L. (2019). The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers. Scientific Reports 9, 4635 (2019). https://doi.org/10.1038/s41598-019-40914-x

Aliyu, D., Adeleke, I. T., Omoniyi, S. O., Samaila, B. A., Adamu, A., & Abubakar, A. Y. (2015). Knowledge, attitude and practice of nursing ethics and law among nurses at Federal Medical Centre, Bida. American Journal of Health Research3(1-1), 32-37.

Drach‐Zahavy, A., & Hadid, N. (2015). Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. Journal of advanced nursing71(5), 1135-1145. https://doi.org/10.1111/jan.12615

Aly, N. A. E. F. M., El-Shanawany, S. M., & Ghazala, A. M. A. (2020). Ethico-legal aspects and ethical climate: Managing safe patient care and medical errors in nursing work. Clinical Ethics, 1477750920920559. https://doi.org/10.1177/1477750920920559

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