Nurses and Midwives Ethical and legal Accountabilities and Responsibilities Case Study 2022

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Nurses and Midwives Ethical and
legal Accountabilities and
Responsibilities
Case 1: Informed Consent
Consent is an ethical and legal requirement when providing nursing care. A nurse is required by
law to obtain consent before undertaking any nursing procedures or administering medication. A
patient has to give informed consent after being given reasonable information about the
treatment and the risks associated with the treatment (Chrimes & Marshall, 2018). In this case
scenario, a student nurse on placement is faced with a stressing situation where a patient refuses
to consent while the RN/RM mentor has requested the student to come into the theatre. The
patient does not want a student being present while she is under anaesthetic. This situation leads
to a dilemma where on one side the RN/RM wants the student nurse to come along and on the
other side, the patient does not want the student nurse to be present. To understand and decide on
the situation, one needs to consider the legal requirements for the student nurse, and RN/RM and
the implications of failing to honour the patient’s consent by the health facility and the education
provider.
Student nurses are legally required by law to obtain consent prior to a clinical procedure (Young,
2010). The law requires a student nurse, to obtain informed consent from the patient as of the
same level as a qualified practitioner does. The autonomy principle of ethics requires a nurse to
respect a patient’s choices even when they disagree as contained in Value Statement 5 of the
Code of Ethics for Nurses of Australia. According to Consent to Medical Treatment and Palliative
Care Act 1995, Section 2, a patient above 16 years of age informed consent is supreme when
making decisions regarding the patient. The RN/RM cannot go against the patient’s consent that
who does not want to have a student nurse observe her while a procedure is being undertaken.
The Nursing and Midwifery Code of Conduct for Nurses in Australia principle 2 Section 2.3
require nurses in support to informed consent rights to obtain informed consent before
investigating, examining, or providing treatment. The Code of Conduct for Nurses in Australia
Principle 3 section 3.5 also requires RM to respect the privacy and confidentiality of a patient

seeking informed consent and providing a surround that enable confidential and private
consultations and discussion . Therefore both the student midwife and RN/RM need to adhere to
the patient’s consent and the student midwife should not observe or assist the patient’s
procedure.
Failure to honour a patient consent has several implications to health facility and the education
provider. First, not establishing consent has legal consequences. The patient is in a position to
sue the health facility and claim that her rights to informed consent were undermined. The health
facilities will therefore be charged that will lead to penalties. The educator who undermines the
patience consent when teaching a student can be reported to the Nursing and Midwifery Board of
Australia (NMBA) that reports the RN/RM to the Australian Health Practitioners Regulatory
Agency (AHPRA). The AHPRA then investigates and charges the education provider with
professional miscount that requires RN/RM to respect and upload informed consent.
Reflection
In my placement I had a similar case scenario to case study 1 where I had a dilemma of either
following registered nurse instructions or the patient’s decisions. The registered nurse had given
me instruction to administer medication to a patient who refused to allow me undertake the
procedure. The medicine was to be administered at a specific time and I was stressed that I was
to miss the time indicated by my RN educator and it would have an impact to the patient’s health
recovery process. In this case scenario, I have learnt RN/RM instructions and opportunities for
learning does not override patient’s informed consent. As a student nurse on placement, there is a
need to listen and upload the decisions or wish of the patient (Nursing Midwifery Board, 2018).
Before this case study discussion, I thought that the RN educator decisions/instructions are above
patient’s wishes or decision. I also thought that I should only follow the RN educator decisions
and did not know there is law protecting the patient’s decisions. While undertaking this study, I
felt amused by how law protects the patient’s autonomy. The law protects the patient’s
confidentiality and privacy and it requires all health practitioners to uphold patient’s informed
consent prior to any procedures or treatment (Dunn et al., 2019). A health practitioner needs to
uphold ethical principle of autonomy and respect each patient’s choices. Therefore the patient’s
decision is final and RN educator and student nurse should abide to it. In my future practice, I

will respect and uphold patients’ informed consent in order to respect their decisions, privacy
and confidentiality.
Case Study 2: Open Disclosure
RN/RM work in collaboration and have a responsibility to act in best interest of the patients and
enhance delivery of quality health care. In this case scenario, a registered nurse midwife in a
local hospital notices one of the colleague not washing hands between patients that undermines
infection control procedures. This situation lead to cross contamination and patients develop
urinary infections and would infections in the hospital. In this case, there are two ethical and
legal issues. The RN/RM fails to report an adverse misconduct by a colleague. Secondly, the
colleague nurse failed to provide safe and quality health care to patients of the hospital. The case
scenario can be analysed in terms of legal and ethical requirements from the RN/RM and the
implications it has to RN/RM and the health facility.
RN/RM is legally and ethically required to be responsible and accountable when providing
health care (Dixon, 2017). First, the nurses are required to abide with the ethical principle of
non-maleficence that they have a duty not to harm and protect patients from harm. The Code of
Ethics for Nurses in Australia Value Statement 1 requires nurses to value quality care to all
patients. This involves being accountable of the standard of practice and helping raise the
standards. Secondly, Code of Conduct for Nurses requires RN/RM to practice legally and adhere
to obligations as stipulated in the National Law and other relevant laws. According to Code of
Conduct principle 1 section 1.3, RN/RM has a legislative responsibility to mandatory reporting.
As part of caring for the vulnerable, RN/RM need to mandatory report relevant issues to protect
groups especially those at a risk. The Code of Conduct for Nurses also requires RN/RM to
practice safely effectively and collaborate to ensure woman entered practice. The Code of
Conduct for Nurses principle 2 section 2.4, require RN/RM to act immediately in adverse events
and have open disclosure (Nursing Midwifery Board, 2017). The Code requires timely reporting
in case of adverse events and having honest communication with the patient and colleagues. This
ensures issues are addressed to the management and can be controlled. The RN/RM who saw a
colleague expose patients to risk should have reported to the relevant authority. Secondly, the
Registered Nurses Standards 1 and 6 of Practice requires RN/RM to provide quality and safe
practice. Midwifery Standard 1 of Practice requires promotion of health and wellbeing through

evidence based practice (Nursing Midwifery Board, 2018). The Standard requires provision of
safe and quality care through application of the available resources and evidence. RN Standard 6
on the other side entails the use of comprehensive skills and knowledge to effectively and safely
achieve highest midwifery practice outcome. Standard of practice section 6.4 emphasises that
RN/RM has to p-provide timely and effective direction to enhance the outcome of the midwifery
practice provided. Thirdly, the Nurses National Competency 2 Standards element 2.2 requires a
RN/RM to identify unsafe practices and take appropriate actions. The RN/RM is required to
identify any practice that might compromise effective and safe care and take appropriate action.
The RN/RM should also use risk management and open disclosure policy to follow up unsafe
practices. Lastly, Code of Ethics for midwives value statement 1 and 4 require RN/RM to value
quality care and access of quality midwifery care respectively. The value statement 1 outlines
that RN/RM has a primary responsibility to provide midwifery care. Value statement 4 entails a
RN/RM promoting non-harmful and non discriminatory care.
Professional misconduct and breach of law have severe implications to a health facility and a
RN/RM. The hospital is in crises as a result of several patients developing urinary tract infections
and would care infections from a RN/RM poor infections control procedures in the hospital. This
situation will raise alarm to the authority and lead to investigations. The health facility will risk
closure or penalty for providing unsafe health care. On the other side of the RN/RM and the
colleague, they are both guilty of professional misconduct. The RN/RM failed to report a
colleague that was engaged in unsafe practices that exposed patients to risk of getting
compromised health care. This gross breach of the Code of Conduct for Nurses in Australia
National Law will lead to a tribunal trail for professional misconduct. The trail will get the
RN/RM being reprimanded and a penalty for not reporting the issue. The RN/RM involved in
poor infection control procedures in the hospital will be implicated for breaching Standards of
Practice and Midwifery National Competence Standard. This RN/RM failed to provide safe and
effective health care. The RN/RM registration will be suspended and further education required
enhancing competence in the practice.
Refection
In one of my previous placement session, I saw a fellow student nurse who forgot to change
gloves from one patient to another. I had known the student for some time and we had become

friends. When I noticed this had happened, it was hard to report her to the RN educator. At first,
I asked her if she had noted that she didn’t change the gloves and she said the gloves did not look
dirt and she confused to have changed to new ones. Finally we asked the RN educator how was
the risk and she said it was minimal in that case. From this case scenario, I realised how failure
to take an action of a colleague can lead to adverse implication to one’s practice. Not reporting a
colleague in such a scenario, undermines safe and effective health care and one should not keep
quite when such thing is happening as it mandated to reporting according to Code of conduct and
National law (Pich, Kable, & Hazelton, 2017). Before this case study, I thought that a
professional can only be implicated for own mistakes or breach of law. I was surprised by how
one person’s action can lead to implication of another person. The mistake of a colleague
compromise the outcome of the health care provided and the law requires one to timely report
adverse event (Hewitt, Chreim, & Forster, 2017). It was good learning the rationale behind
reporting and open disclosure. Nurses need to observe the ethical principle of non-malifecence
and do things that do not harm others. Failure to adhere to mandatory reporting and open
disclosure compromises the delivery of safe and effective health care and threatens the patients’
lives. A nurse therefore needs to take immediate action of intervening and/or reporting to the
relevant authority to when nursing care is compromised to avoid being implicated for
professional misconduct. In my future career as a nursing professional I will take responsibility
and be accountable of my colleagues’ actions to ensure together we provide safe and effective
health care. In case am not able to intervene, I will timely report to the management or other
relevant authority in the interest of safe and effective health care provision.
Case 3: Mandatory Reporting
Health practitioners need to maintain their capability to undertake their practice. Alcohol and
drugs impairs a person’s ability to think and take appropriate actions and a health practitioner
should not report to work still feeling their effects (Vrbnjak et. al 2016). The following case
study has a facilitator having a student nurse/midwife who reports into work with unusual
behaviour as a result of drug use. The student admits to using drugs because of loss of a family
member. The student is unable to take and follow instructions. This case scenario can be
analysed by disusing the legal requirement of the facilitator and the student nurse/midwife and
the implications their actions have to the health facility and the education provider.

A facilitator is required by law to supervise a student nurse to enable their training and learning
in their placement. First, the ethical principle of beneficence requires nurses act on benefits of
patient. The nurse has to act in best interest of patient by deciding and take action that minimize
patient’s risk of unsafe care Secondly, the National Law Section 143 states that an education
provider should make mandatory notification if the provider believes the student nurse is
impaired in the course of getting clinical training or an arranged training and the impairment
places the public to risk of harm. The National Law Section 140 (a) categorizes practice while
under alcohol or drugs intoxication as a notifiable conduct (Medical Board of Australia, 2017).
On the other side, the student nurse/midwife, the Registered Nurse Standard 3 requires
maintenance of the capability for practice. The RN Standard 3 states that health professionals
should be accountable and responsible for their safety and ensure they have the capability to
practice. This entails self management and timely response to one’s health and wellbeing in
regards to capability for practice (Bismark et al., 2016). Therefore, the facilitator is required to
mandatory notification by the National law while the student nurse is required by the standards
of practice to maintain capability for practice.
This case scenario has implications to the facilitator in case of failing to make the notification.
The facilitator will face consequences on failure to notify AHPRA as section 142 requires. Once
the AHPRA knows that the facilitator failed to make a notification, it writes a report to the
Minister in charge. The Minister then reports the employer’s failure to make a notification to a
health complaints entity, licensing authority and other appropriate entities within the jurisdiction.
This implication can lead to the closure of the health facility.
Reflection
Once in my placement, I attended a party where I took alcohol and I had to attend my nursing
training next morning. While on the training, I felt tired and I tried hard to maintain my normal
behaviour. Though my RN educator did not fully come to a conclusion that I had an abnormal
behaviour, she commented once that it seemed I was trying hard to cooperate. From the legal and
ethical analyses of this situation, reporting to placement or work while impaired as a result of
drugs or alcohol has very serious implications to the facilitator or the health facility. Before this
case study, I never realized how serious it is to report on placement or practice while intoxicated.
Drugs have effects that impair an individual ability to take instructions and execute an action

appropriately and it the responsibility of the facilitator or employers to take action and notify the
health complaints entity (Tembo, Burns, & Kalembo, 2017). I was astonished how National Law
puts a lot of weight to student nurses attending training while intoxicated. I felt disbelief on the
implications of a facilitator or employer failing to notify AHRPA about impaired students. From
the discussion, the National Law categorizes intoxication by drugs or alcohol as a notifiable
conduct and it mandatory for employers to make the notification to the AHRPA (Medical Board
of Australia, 2017). Impaired students expose the public to substantial risks and they should not
be allowed to undertake their training in that condition (Edwards, & Crisp, 2017). Nurses need to
act ethically and present patient’s best interest. Therefore, it important for facilitators to report
impaired students to AHRPA to avoid adverse implications to the health facility. In my future
practice, I will be keen to observe students on placement to ensure they do not attend training
while impaired to avoid the health facility being implicated by the authority and exposing the
public to risk.

References
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