The professional practice of registered nurse (RN) is evidence-based and patient-centred with emphasis on supportive, formative, preventive, restorative, palliative and curative aspects (NMBA, 2018). It is the registered nurse’s responsibility to take relevant steps to maintain the standards of personal conduct which safeguards the patient and also work towards a better image and public confidence of the profession (The ICN Code of Ethics, 2012). The leaders and workers of the healthcare organisation are responsible for the continuous care of the community while also improving the quality and safety of the services they provide (ACHS, 2017). The Australian Council for Health Care standards advocate continuum of care to be adhered to and brought about by clinical safety. It also promotes that the healthcare providers have to abide by their institution’s guidance for patient handover and recommend the use of handover notes as a medium to exchange vital information and prevent mistakes during the handover time (ACHS, 2017). The aim of this discussion is to identify the professional practice issues with the help of a case study from Health Care Complaints Commission v Pandya and Prasad (2017).
On the afternoon of 28th February 2014, a visitor arrived at Bungarribee house to meet her husband who was admitted in the mental health facility’s acute ward of the Local Health District of Western Sydney. RN Sumintra Prasad having finished her handover duty was returning and acknowledged the visitor’s request. RN Prasad went back to get the patient but was not able to locate him in his bed and other places. She asked for help from a colleague, RN Pandya and asked him to check for the patient in the toilet. RN Harivadan Pandya found the patient lying on the floor and seemed to have taken his own life. They alerted the other doctors and staff, but the attempt went futile as they could not save the patient. The care for the patient had been assigned to RN Pandya during his shift, however, he left the ward about thirty minutes early from when his shift was supposed to get over to reach the other ward in order to begin his other shift. RN Prasad carried out the assessment of the conduct of the patient due at 2:40 pm on account of RN Pandya’s early departure before she proceeded with the handover at 2:45 pm. The manner and reason behind the death of the patient was a cause of apprehension and concern for the coroner.
Following the incident, the Professional Standard’s Committee looked into the matter and enquired RN Prasad and RN Pandya about their shifts and duties practised on 28th February by them towards the patient who lost his life. It was understood that RN Pandya’s practise was critically below the standard expected of a nursing practitioner with equivalent qualification and experience and the professional conduct on his part was not found to be satisfactory. Due to this, RN Pandya was reprimanded, restricted with respect to his practice, was understood to be allowed to practice under supervision and advised to pursue further education. The care practised by RN Prasad during the handover time was recognised to be considerably below the expected standards for a nurse with the qualifications and experience as hers. While there were loopholes in some aspects of the conduct and care by RN Prasad, her professional conduct was found to be satisfactory and hence, she was given a warning.
From the case study, it has been identified that both the registered nurses did not abide by the Registered Nurses Standards for Practice given by the Nursing and Midwifery Board of Australia (2018) according to which nurses as registered healthcare professionals coordinate and provide safe and quality nursing. Also, the registered nurses in the case study failed to serve their duty as per the NMBA’s Registered Nurses Standards for Practice (2018) standard 2.7 which is “the nurse actively fosters a culture of safety and learning that includes engaging with health professionals”, standard 2.8 “participates in and/or leads collaborative practice” and standard 3.1 “considers and responds in a timely manner to the health and wellbeing of self and others in relation to the capability for practice”. It is critical to develop and apply the standards of nursing in order to protect the people seeking healthcare and also to achieve an improved quality of the practice of nursing (Cashin et al., 2017).
Registered nurse Pandya did not serve his duties adequately and his negligence proved to be a great barrier in the provision of appropriate and timely care of the patient. As per the ICN code of conduct for the nurses (2012), “The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, trustworthiness and integrity”. The lack of responsiveness and integrity on RN Pandya’s part led to his negligence and carelessness. Unfortunately, this incident of negligence caused the patient his life, had he been looked after at the right time and had suicide-risk factors been noted at the right time, maybe the patient’s life could have been saved.
Handovers in the nursing practice are the most effective and preventive method to omit miscommunication and errors due to missing out of relevant and critical information being passed on. They can help communicate the essential information with accuracy about the condition, the needs anticipated and the treatment plan for the patient (Wainwright & Wright, 2016). When not practised right they can prove to be hazardous if information is missed out, inaccurate or incomplete. Therefore, the Australian Commission on Safety and Quality in Health Care (2017) has reinforced the significance of clinical handovers by declaring it as a National Standard. However, RN Prasad failed at performing her duty of clinical handover which contributed towards the negligence caused on the part of nursing staff in the case study. Had she adhered to the protocol of clinical handover and accurately passed on the information during the handover it could have helped serve her duty as per the standard expected from her.
Nurses are involved intricately in the lives of the individuals they provide care to and hence this poses them at a position of great risk (Terry et al., 2017). Apart from the financial aspect, the victims of improper care and negligence may face a physiological and psychological danger which then makes the registered nurses and their employers legally liable. There are several purposes that the codes serve such as maintaining and promoting the ethical professional standards as well as providing a regulatory and decision-making framework.
Even though the nurses and allied healthcare providers are known to be self-regulatory majorly, their practice guided by the code of ethics as well as code of conduct helps serve quality healthcare and uphold the safety and wellbeing of the patients (Freshwater et al., 2015). Numerous rules and principles espoused by the codes of conduct help in governing the practice and the behaviour of the healthcare practitioners as individuals and as groups through the medium of both punishments and rewards. Therefore, it can be understood from this case study how negligence and improper clinical handover can result in grave errors in the nursing practice and how the code of conduct as well as code of ethics helps uphold patient safety and quality healthcare.
To develop a practice where negligence is eliminated and the duties as well as timings of the shift are acknowledged and addressed in an appropriate manner can help build a practice that helps the registered nurses provide safe and better services. Clinical handovers carried out ineffectively can lead to huge errors and difficulties with respect to inappropriate and inadequate healthcare delivery (Manias et al., 2015). A protocol should be maintained for proper clinical handover protocol and rushing through the duties towards the end of the shift should be avoided. The aim of caring for the patients in the best way possible and taking precautions to prevent any harm to them or the society should be kept in mind by the nurses as they perform their duties. These steps can help build a practice to omit the mistakes made by the registered nurses in the given case study.
From the discussion of the case study, it can be thus concluded that it is highly critical for the registered nurses to abide by the code of conduct and code of ethics as per the NSQHS (2017), NMBA (2018) and ICN Code of Ethics (2012). Failing to abide by the code of conduct, engaging in negligence and inadequate practice of duties can result in unforeseeable circumstances. If RN Pandya would have been careful and had he not neglected his duty and shift timings, he would have been able to perform his duty appropriately and adequately. Clinical handovers hold great significance and are a great way to effectively communicate the essential details, needs and treatment plans for the patients. However, improper, incomplete and inaccurate clinical handover can lead to an unwanted outcome. If RN Prasad had adequately performed her duties of clinical handover it could have prevented the shortcomings in her duty as per the code of conduct.
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