92444 Professional Accountability - Health

Introduction

Accountability means facing the consequence of one’s actions or performances. It is an essential part of any institution and society as whole, since without accountability, people will not own their actions in order to avoid the consequences. Accountability, in healthcare, has become a major issue. Accountability plays a major role in identification of who made the error (Denis, 2014). This human error can be viewed in two ways, with the help of Person approach, and through System approach. Each approach identifies the reason behind the error made in different manner and using different philosophies. Recognizing the difference in each approach is essential to recognize the factors and people responsible/accountable behind the error incurred (Reason, 2000). To understand Professional Accountability in healthcare, the paper would discuss a recent case, Health Care Complaints Commission v Tane. Ms Tane was prosecuted by Health Care Complaints Commission (HCCC), before NSW Civil and Administrative Tribunal. The Tribunal found Ms Tane guilty of professional misconduct. The respondent was found guilty in Stage 1, and Stage 2 proceedings determined the protective orders by the Tribunal.

Errors On The Part Of Ms Tane 

Brief of the Case

Health Care Complaints Commission v Tane.

Ms Tane, from here on, will be addressed as respondent in the essay. The respondent was found to be guilty of professional misconduct on the grounds of two complaints; first one includes discussion of personal and financial problems with Patient A and borrowing a sum of $7500 from Patient A on 11 September, 2017. She returned only $1500 to Patient A, and did not pay the rest of the amount back. The second complaint includes of her providing a drug which was not prescribed to Patient B in January, 2017, in exchange of money. This drug was illegally procured from hospital supplies, and continued the supply of the drug to Patient B, even after she was discharged in July, 2017. She was also found guilty of borrowing the amount of $6000 from Patient B (Civil and Administrative Tribunal New South Wales, 2020).

Actions Which Should Have Been Avoided

The RN should have avoided keeping any kind of communication with the patients, outside and other than what was required professionally. There was no need for her to discuss her personal and financial problems with the patients at the drug and rehabilitation facility. Additional to this, she should also have avoided borrowing the sum from Patient A and Patient B. The above-mentioned actions of the respondent are considered unsatisfactory professional conduct. In extreme case, she should have returned the amount back to the patients, which the respondent did not.

 In the second complaint filed against her, the respondent was providing the Patient B with Schedule 4 D drug, which was not prescribed to the Patient, as she was at the facility for rehabilitation, in exchange of money. She misused the hospital’s supplies by illegally procuring the drug, and used it for her own benefit. She should not have provided the patient B with the schedule 4 medication, when it was not prescribed. She should also not have used the hospital resources for her own personal gain. All the above actions performed by the respondent led to the Tribunal finding her guilty of professional misconduct, which made suspension and cancellation of her registration, justified on Tribunal’s part (Civil and Administrative Tribunal New South Wales, 2020).

Omissions by Ms Tane, actions which she did not do

Ms Tane omitted some actions which led to the adverse events. She omitted to follow and respect the professional boundaries set up by Nursing and Midwifery Council of New South Wales. These professional boundaries are in places to protect the vulnerability of the patients from being violated by the power that a practitioner has over patients. She omitted to follow the professional boundaries by discussing her private life, along with her personal and financial problems with the patients. She also violated these boundaries by borrowing money from the patients. Her omission to take care of the patients, in place of using their vulnerability led to the adverse events.

In addition, she omitted to adhere to the legal rules and regulations by procuring schedule 4 medications from the hospital. By omitting to follow the code of conduct, and by providing drug which was not prescribed to the patient B. Missing and not following the code of conduct, and providing patient B with drugs, even after she left the facility in July, 2017, respondent violated the code of conduct (Civil and Administrative Tribunal New South Wales, 2020).

System Based Errors and Factors

The above-mentioned errors were made by a single person, and person approach was used to determine the responsibility/accountability of the actions. But some errors are also made by the system due to which the adverse events could not be avoided. The head nurse of the facility should have better supervised the staff, and monitored their actions more closely to ensure that no one is violating and crossing the professional boundaries set up. The lack of monitoring led to system-based error. The facility should have been aware of the problems going on in the life of their healthcare staff. This would have ensured that the respondent did not approach the patients with her personal and financial problems. When the institution takes better care of their staff, such situations and errors would not take place in the organization.

The drug and rehabilitation facility where Ms Tane worked, should have monitored the staff, along with keeping an eye on the inventory of its drug supplies. For an institution responsible for ensuring that the patients in the facility recover from their addiction, they should have been more cautious about the drug usage by both, the nurses and the patients. The inventory and the supplies should have been monitored better to ensure that the drugs are not being misused by the staff. Also, during the rehabilitation process, the doctor practitioner should have recognized that the patient is still using drug which he/she was not prescribed. The symptoms of drug usage should have been detected early on. Lack of these actions’ performance by the system/rehabilitation facility led to the adverse effects on patients.

Actions that should have been taken by RN to avoid the Misconduct And Its Adverse Effects On The Patients

The Registered Nurse could have, firstly, respected the professional boundaries set by the Nursing & Midwifery Council in New South Wales. She should not have formed any personal relation with the patients, which falls outside the bounds of a professional relationship between the patients and the RN. She should also not have discussed her personal and financial problems with the patients. If she had stayed within the professional boundaries, she could have avoided the adverse effects of her actions (Nursing & Midwifery Council NSW, 2017).

 The RN should not have borrowed money from the patients. This action of hers also falls under misconduct by noncompliance of the code of conduct established (Nursing & Midwifery Council NSW, 2021).  Instead of borrowing the money from patients, she should have either approached a financial institution for loan, or should have approach her place of employment to help her with her financial problems. Even when she borrowed money from the patients as last resort, she should have repaid the money back to the patients. As non-payment of the amount borrowed led to loss of the patients and abuse of the vulnerability of the patients, Ms Tane should have reimbursed the patients as soon as she could.

Ms Tane could have followed the legal rules and regulation mentioned in Health Practitioner Regulation National Law (NSW), and not stolen from the facility’s supplies (Jade, 2020). She should have avoided getting engaged with the Patient B, and provide her with the drugs which were not prescribed to her during her rehabilitation process (Nursing & Midwifery Council NSW, 2021). This not only violated the legal rules, but abused the vulnerable position of the patient B, who was at the centre due to opioid use disorder. The respondent should have taken care of the patient B, and not provided her with the medication in exchange of money. This would have avoided further degradation of the health of the patient, and would not have put the respondent in the position of performing an illegal act of stealing from the hospital.

Conclusion

In conclusion, it can be said that the respondent was accountable for the professional misconduct and its adverse effects on the patients. Ms Tane could have avoided certain actions, which would have avoided the situation of vulnerability on patients’ part. It would have also ensured that she did not face any disciplinary actions, and her practitioner registration would not have been cancelled. She omitted to perform certain actions, like putting the health of the patient first, instead of putting her personal gain first. The facility could have also avoided the situation from happening, but due to error and lack of monitoring on their part, the patients were affected by the actions of the respondent. It is essential that the RNs follow professional boundaries, along with code of conduct and the policies of the council to ensure that they do not misuse their power and abuse the vulnerability of the patients.

References

Civil and Administrative Tribunal New South Wales. (2020). Health Care Complaints Commission v Tane (No 2) [2020] NSWCATOD 159. https://www.caselaw.nsw.gov.au/decision/1768310c0ddcaa05c7df7552

Denis, J. L. (2014). Accountability in healthcare organizations and systems. Healthcare Policy, 10(SP), 8.

Jade. (2020). Health Practitioner Regulation National Law (NSW). https://jade.io/article/276006/section/1684

Nursing & Midwifery Council NSW. (2017). Managing Professional Boundaries: Professional v's Personal Relationships.  https://www.nursingandmidwiferycouncil.nsw.gov.au/managing-professional-boundaries-professional-vs-personal-relationships

Nursing & Midwifery Council NSW. (2021). Professional standards. https://www.nursingandmidwiferycouncil.nsw.gov.au/professional-standards

Reason, J. (2000). Human error: models and management. Bmj, 320(7237), 768-770.

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