Literature Review on Nursing Ethics and Accountability

This assignment requires a thorough analysis of the current literature on nursing ethics and accountability. It involves reviewing numerous sources to identify key themes, concepts, and best practices in nursing ethics and professional responsibility. The student must critically evaluate the findings and draw meaningful conclusions about the significance of these topics in nursing practice.

Running head: LAWS AND ETHICS IN HEALTH CARE
LAWS AND ETHICS IN HEALTH CARE
Name of the Student
Name of the university
Author’s note

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Case study 1
1. The regulation 52 of the Nurses and Midwives Regulations 2012 (Cap. 209, S 119/2012)
signifies that consent is required from the board before practicing on own account. There are
three provisions for the regulation 52.
1. A registered nurse cannot practice nursing on his/ her own account without written
consent from the board.
2. A registered midwife will not practice nursing on his / her own or with partnership
with another without any written consent from the board.
3. Any person who will contravene the regulation will be penalized with a fine not
exceeding $5,000.
Such provisions are made for the public interest and to deliver a safe care to the public. This
is because SNB offers approval or accreditation only to those nurses and midwives who are
skilled and competent in their own scope practice. It is evident that an incompetent nurse or a
midwife can not only deteriorate a patient’s condition and can also bring about mortality. The
case can turn out to be more dangerous in case of the midwives as lack of skills and competence
may bring about fatal condition to both the child and the mother (Gachoud et al. 2012). Penalties
are imposed upon those contravening the regulations as penalties would help to retain the fear
among the lawbreakers.
2. According to the SNB Code for Nurses and Midwives (2018), the enrolled nurse has
breached the Principle 5, which states that a nurse should practice in a responsible and
accountable manner (SNB, 2018). According to this principle, enrolled nurses should

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understand and abide by the legislative framework of the SNB. The SNB codes of ethics
provide guidelines for the nurses that a nurse should uphold in his/her professional career to
provide a safe care to the patients. The SNB codes of conduct help the enrolled nurses with
the knowledge of responsibility and accountability for the patient care (SNB, 2018).
Nurses and midwives hold positions of responsibility and are therefore accountable to the
care that they provide to the patients (Chadwick and Gallagher 2016). Responsibility can be
defined as the obligation to perform duties using the professional judgment and being
justifiable for his/ her decisions (Scrivener & Hooper, 2011). Accountability refers to the
capability to give proper justifications against any nursing action. It is all about maintenance
of the competency and safeguarding the patient and preserves the standards of the nursing
profession (Gachoud et al., 2012). In general, all the enrolled nurses are legally accountable
or answerable to any kind of decisions they are taking while providing care to the patients
(Lachman, 2012).
It is true that accountability cannot be achieved unless the enrolled nurses has got the
autonomy to practice the right to autonomy is actually provided by the written format
(Krautscheid, 2014). Nurses are accountable to the accreditation body, the patient and their
family. Lack of any legal consent form the board does not provide the nurse with any legal
accountability (Scrivener & Hooper, 2011). In order practice nursing, a nurse should ensure
that she/he has suitable professional indemnity insurance, as each patient has the right to hold
the insurance in case, any violation of the tort of negligence comes in to play (Lachman,
2012). The SNB also thrives to safe guard the nurses with their legal shields. In this case the
enrolled nurses practice nursing without any legal consent from the board. In such a case the
concerned nurse is not accountable if any adverse situation comes up. Hence it is clearly

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evident that the nurse has breached the standards, as she has practiced nursing without any
consent from the regulatory body and she has also applied intravenous medications
independently at patient’s home. Normally it is the duty of an enrolled nurse to refrain from
practices where he/ she has not developed competence or has not received appropriate
training (Krautscheid, 2014). It should be remembered that as per the law no EN can apply
IV medications without notations and they can only do so in the supervision of the RNs and
if they have completed intravenous medication administration training (Krautscheid, 2014).
The nurse have also breached principle 6 that states that nurses should advocate patient
safety and should be aware of the current clinical practical guidelines (SNB, 2018).
An enrolled nurse should be aware of his/ her limitations in the scope of practice and
should understand the differences in the responsibility of an RN and an EN as long as the
situation demands. It has to be remembered that administration of IV medications needs
proper training as there are several factors that has to be taken care of such as the drug dose,
drug timing, and the intactness of the IV line (Cerit & Dinç 2013). IV drugs might not be
compatible with certain drugs and may interfere with their mode of action. The role of the
nurses is expanding with time, but these shifting boundaries are actually leading some nurses
anxious about their legal accountability and responsibilities (Krautscheid 2014). Apart from
specific situations that law does not allow the nurses to take up the responsibilities that are
not suitable for a particular designation (DeBourgh & Prion 2012).
Responsibility is equal to the duty of care in law and the duty of care applies from
simplest to the most complex type of care such as bathing a patient to a complex surgery
(Scrivener & Hooper, 2011).

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It is the legal liability of each and every health care professional, to their patients. Whenever
a task is assigned to an enrolled nurse, it is the RNs that assure that the delegation has been
appropriate (Cerit & Dinç 2013). In this case it can be seen that the EN have practiced
independent nursing and have also administered IV medications without any supervision by
an RN. She should have thought that a small mistake on her part could have not only caused
adverse outcomes like mortality, but could have also jeopardized her professional career.
The core competencies for the enrolled nurses consist of 3 competence domains. In a
nursing career, a nurse should be abiding by all the competencies. Breaching of any of the
competency skills would hamper the both the professional development of the nurse and
his/her commitment towards the nurses (CORE COMPETENCIES OF ENROLLED
NURSE, 2018). The case study reveals that the nurses have breached the domain 1 which
states regulation regarding the professional, ethical and legal nursing practice. It is known
that a nurse would understand the legislative framework at first, the role of the regulatory
organizations and its effect on nursing practice. The primary purpose of any regulating body
is the protection of the public and giving structure and function to the nursing bodies (Dossey
et al., 2012). The stringent laws and the regulations are enables no compromise with the sills
and competencies (Gastmans, 2013). The legislative framework set up the professional
standards for the nurses as it is the professional standards that actually describe the level of
care in each level of nursing (DeBourgh & Prion, 2012). The competency domains help to
reflect a desired and standard level of conduct with which the nursing performances can be
compared with. It should be remembered the health care litigation is developing and patients
are preparing themselves to assert their own legal rights (CORE COMPETENCIES OF
ENROLLED NURSE, 2018). A critical appreciation of the legal, professional and ethical

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framework is necessary to generate professional awareness among the enrolled nurses
(Dossey et al., 2012). The legal standards of the nurses are actually the embodiment of the
collective knowledge of nursing required by an enrolled nurse to maintain the proficiency. In
the previous decades before the growth of professional nursing practice, nurses were judged
by the same standard of care like an ordinary man or woman (DeBourgh & Prion ,2012).
With time the duty of the nurses has increased along with the responsibilities and the
accountabilities Complex health care and the growing population has made the duty of nurses
more critical (Chadwick & Gallagher, 2016). With more complex health care medical errors
have also increased causing morbidity and mortality. The competency indicator under the
competency domain 1 states that EN should support, cooperate and collaborate with the team
members while caring for a patient. In this case also the EN could have seeked help from her
per senior nurse or RN while applying the sensitive medications. Another important
competency indicator related to this case study is the maintenance of a legible and clear
records and documentation, as those can be used to confront any legal cases related to
patient’s life. They are the only medical evidences against any allegations. It is evident that
the nurse had been practicing nursing, probably for increasing her personal income. The
nursing codes of ethics enable a nurse to keep the patient’s interest above all to ensure a safe
care. It is clearly seen that the nurse had taken part in an activity that conflicts healing and
caring. Another domain of the core competency skill is the management of care. Enrolled
nurses should participate in the implementation, development, evaluation and documentation
of a planned nursing care (Lachman, 2012). In this case study the patient had not worked
under the supervision of any RN and has administered the IV education. The management of
care ensures to provide a safe environment for the clients, that is maleficience. Another

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domain of the core competency skill is the management of care. Enrolled nurses should
participate in the implementation, development, evaluation and documentation of a planned
nursing care to the patient. In this case study the patient had not worked under the
supervision of any RN and has administered the IV education. The management of care
ensures to provide a safe environment for the clients. That could be done by doing the
procedures under the controlled clinical settings, under the surveillance of the nurses and the
doctors, participating in the continuous quality improvement and the activities that would
assure the qualities. It is necessary to practice its own level of competence, but that does not
mean that the clients should be practicing nursing without any accountability to the
regulating board (Affara & Al-Jabri, 2016).
Case study 2
1. The principles of the codes of conduct help the nurses to take ethical and justifiable
decisions in case of complex care. It acts as a guideline in order to avoid any professional
misconduct and to preserve the public interests. As per the case study, the registered
nurse APT have been found to be breaching Principle 6, which states that a nurses should
be able to practice a competent care in the people, Principle 8, that promotes
professionalism and uphold trust of the public. Principle 9, which states practicing self
regulation among the nurses (SNB, 2018).
3. The case study shows that that the registered nurse caused a grievous hurt to a patient with
the serious rib injury. According to the principle 6 of the nursing codes of ethics, nurses

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should constantly polish their skills; self evaluate and indulge them in lifelong learning to
improve the quality of care. The registered nurse here has caused grievous hurt to the patient
causing him a fracture on the left 6th and 7th ribs, left periorbital hematoma, left mastoid
hematoma and left chest wall bruise. As a nurse she should have tried to uphold her
professional responsibility. According to Chadwick and Gallagher (2016), critical thinking
and the application of evidence based care is extremely important to provide a safe care to
the patient. Informed decision making is another aspect of safe nursing practice. Each and
every patient has got their right to know about their treatment regimen starting from the tests
to complex live saving surgeries. A registered nurse should never practice beyond her scope
under any circumstances and should be clear of her professional boundaries. It seems that the
enrolled nurse have misused his/her professional status. The concerned nurse was never
perturbed about his/ her career while doing the wrongful deed or was not at all concerned
with the reputation of the profession as a whole (Chadwick & Gallagher, 2016). Public's
perception about a nurse is generally a compassionate figure, showing high level of
consciousness and ethics when it comes to the provision of care (Affara & Al-Jabri, 2016).
As per the nursing codes of ethics, nurses should maintain beneficence and maleficence, that
is keep the interest and safety of the patient in the forefront. This act has greatly undermined
the patient's trust and interest, hence breaching of the principle 8 (SNB, 2018). If there were
presence of any workplace hazard that can endanger the health of the people, then that could
have been reported to the higher authority. Nurses should deter themselves from any activity
that may endanger a person’s life. A responsible registered nurse should value safe nursing
practice and should be able to avoid situations where the treatment would be impaired
(Affara & Al-Jabri, 2016). Nurses pose legal and moral rights for practicing in a safe

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environment, without any fear for their own safety. The concerned registered nurses APT
should have realized that the concerned patient is vulnerable to injuries and a nurse should
have the power to detect and prevent any avoidable human errors (Gastmans, 2013). Nurses
can actually prevent such errors by continuous monitoring, early detection and early
management of the conditions. It is evident that the registered nurse did not have the
necessary competent training to take care of the patient and ensure that the nurse deliver the
care based on the clinical practice guidelines (Gastmans, 2013). Furthermore the nurses are
entitled to preserve the reputation of their profession and hence should maintain the standards
and the codes set out by the professional bodies. Nurses should always comply with the
mandating reporting of any adverse conditions before the further continuation of the
treatment, keeping the patients interest on a priority basis (Tingle & Cribb, 2013). The focus
of a registered nurse should be public protection and self regulation assures that the patients
are receiving the safe and ethical care from registered and qualified nurses. Self regulation is
an important attribute towards the development of the self competence (Affara & Al-Jabri,
2016). Generally self regulation in the profession of nursing can be regulated by the
professional itself or directly by the regulating body. One of the best way to self regulate is to
ensure that the nurses bear a proper accreditation, comply with the regulatory policies. On the
other hand a professional may self regulate him or herself by increasing self awareness in
herself. In this case the nurse should have practiced the nursing within her own competence
level, hence breaching of principle 9.
2. According to SNB Code (2018), professional misconduct can be defined as the act of
omission which constitutes the deviation from a particular code, bringing down the

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reputation of the nursing profession and abusing the therapeutic and the professional
relationship with the patients.
A registered nurse is said to have committed professional misconduct if he/she is
found to have been falsifying the records, abusing a client physically, verbally or
emotionally, issuing documentation having false or misleading information. It can also be
referred as committing any task that is normally regarded as dishonorable task as per the
nursing profession (Kangasniemi et al. ,2015). In this case it has been found that APT
nurse have physically harmed the patient, (he had caused serious rib injury to the patient),
which is against the professional conduct of the respectable profession of nursing (Tingle
& Cribb, 2013). A registered nurse should be able to foster a therapeutic or curative
relationship with the patient unlike this case study. Care to a patient should not only
remain confined to applying medications and other physical care, but also should include
the spiritual and the mental support provided to the patient.
3. Professional conduct can be defined as the manner in which a professional behaves while
being in the profession. Each and every professional have their specific professional
conduct (Kangasniemi et al., 2015). These professional conducts actually guides the
professionals to identify the areas of improvement in the clinical practice as well as to
deliver a patient centered care and to maintain work place safety (SNB, 2018). It is the
stipulated professional conduct of each of the nurses that helps to promote the best
possible outcomes and mitigate the exposure to the harm. Reflecting on the establishment
of the therapeutic and the relationship of trust between the patients is necessary to
provide a comprehensive and holistic care (Dinç & Gastmans, 2013). Nurses should
respect the dignity and the integrity of the patient. Verbal or physical abuse breaks that

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relationship of trust between the patient and the health care professionals and also
contributes to declining of the clinical setting (Kitson et al. ,2013). Nurses neither have a
responsibility to harm or exploit the patients and intent to provide them with a quality
care (Dinç & Gastmans, 2013). Trust is the most vital factor and once it is lost, it
becomes very difficult to re-establish the trust once again (Reader & Gillespie, 2013).
Patient neglect has long been a concern in a clinical setting. Patient neglect generally
have two aspects, first is the procedure neglect, where a health care professional fails to
achieve the standards of care (Dinç & Gastmans 2013). Second is the caring neglect, that
refers to the acts that leads the patients to believe that the staffs posses an uncaring
attitude towards them (Reader & Gillespie 2013). The reason for the patient neglect is
mainly due to the negligence of the nurse and often due to some organizational factors
such as high work load and the nurses burnouts, although no such evidences have been
provided in the case study. Nurses should not indulge themselves in any work that might
bring about disrepute in nursing (Kitson et al., 2013). In this case the APT nurse has
failed to achieve both the aspects and have therefore been penalized for the misconduct.
Nursing is the most trusted profession and hence they also have to indulge themselves in
patient advocacy to decide the type of care provided to the patients (Reader & Gillespie,
2013). Furthermore the registered nurses often have to be the part of multidisciplinary
teams where they have to show their professional skills beyond their scope of practice. In
order to avoid any kinds of human errors any such practice should be done in front of an
expert health care professional. Although the case study did not provide any information
about how the professional misconduct have been made, but proper assessment in front of
exerts might have avoided the mishap.

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