Legal and Professional Issues in Nursing.

Legal and Professional Issues in Nursing
1. Introduction
In Australia, the Code of Ethics relating to nursing profession was created to improve clinical
practice abilities (Black, 2016). The primary reason to apply such codes is to identify
standard code of ethics and professional duty that the nurses should follow in day to day
nursing care. The current contextual report attempts to portray the relevant code of ethics and
other regulations and legal aspects that are required for nursing activities.In light of the
ongoing emphasis in Australia upon patients' "rights" and "duties," the issue of accreditation
is the most significant issue from the health consumer’s point of view (Laufer, 2017).
Accreditation is the reason for guaranteeing accountability and, or more specifically,
standards of practice. Unless there are specific accreditation criteria and proper disciplinary
systems set up for the continual oversight and maintenance of professional standards, there is
a real worry for the adequate protection of the interests of the health customer. Directly
linked with the issue of accreditation is the issue of professional accountability (Laufer,
2017). The article recognizes the significance of professional accountability to guarantee
worthy acceptable professional standards of practice.
The real concern here lies not just with the formal establishment of standards of practice for
each discrete specialty of nurses, however, more significantly, the educational necessities for
nurses in order to legitimize their position with their clients. Any slip on their part will put
both the registered nurses in a wide range of legal issues and could land them in a tricky
situation when they may have to lose their registration for practicing (Katsikitis et al., 2013).
In the current context two registered nurses in the rural clinic were either not aware of the
legal issues attached to their profession or were too much negligent in their discharging of
nursing care. They erred in all the aspects of professionalism which will be covered in
subsequent paragraphs.
2. Background
An investigation was conducted in May 2016 by the Professional Standards Committee
(PSC) regarding the role of two registered nurses in a rural clinic. A six-month-old baby
suffering from bowel obstruction was wrongly diagnosed in the rural clinic as suffering from
gastroenteritis and when the condition of the baby deteriorated, a medical team correctly
diagnosed the problem and without taking any risk shifted the patient to a tertiary clinic
where unfortunately the baby died.
The complaint claimed that the nurses were negligent on managing or communicating with
the pediatrician regarding the worsening of the patient’s condition or maintaining proper
clinical records of observation for reference. Charges of unsatisfactory professional conduct
were made against both the nurses due to the demise of the patient. A separate PSC hearing
also charged the pediatrician with unprofessional conduct.
The hearing observed that in the act of nursing the nurses did not demonstrate the knowledge,
expertise, judgment or care expected. This was largely below the standard that practitioners
were sensibly expected to have knowledge, experience, and raised serious remarks about the
clinical thinking ability of experienced nurses.

Specific findings included poorly made and inadequately documented observations about
urinary yield. Poor application of the significance of nursing care to the baby patient to
assess the quantity of urinary yields of a baby, inability to properly understand and evaluate
the hydration status of the patient with little relevance to data of fluid balance, poor reflex
and lack of understanding of the potential effects of dehydration, failure to communicate the
patient's critical condition to the pediatrician, lack of clarification on the urgency of
transferring the patient to a better clinic and inadequate communication with the ambulance
service.
The inquiry verdict held both the nurses responsible for the lapses and that a reprimand
should be issued to both nurses to be registered in their registration, but since one of the
nurses did not have a valid registration, the punishment would be recorded in the registration
if she applied for registration in the future.
3. The Body
3.1 Discussions on Legal and Professional Issues
Professional misconduct is unacceptable professional conduct of a serious nature to
legitimize the suspension or cancelation of the registration of a practitioner or it may be more
than an incident of unsatisfactory professional conduct that constitutes a sufficiently serious
act when the proceedings are reviewed together to legitimize the cancelation of the
registration of a practitioner (Birks, Davis, Smithson & Cant, 2016).
A reprimand is issued by a professional standard committee or tribunal as a chastisement for
conduct; a formal execution. Notices issued since the beginning of the national scheme are
published in the register of general practitioners. Conditions that may be imposed on the
registration of a Performance Review Panel, the Professional Standards Committee or the
Tribunal may impose conditions for registration ("Australian Health Practitioner Regulation
Agency - Glossary", 2016). The Council may impose temporary conditions under immediate
action, conditions when a practitioner concurs with them following a performance assessment
of the conditions upon the recommendation of an impeded registrant panel in agreement with
the practitioner.
A condition is intended to limit the practice of a health care professional in some way to
protect the public. Conditions can be placed on the professional's registration for disciplinary
reasons, once a PSC or a tribunal has found out that a professional has departed from the
accepted professional standards. Conditions can also be placed in a professional record for
reasons that are not disciplinary. For example, the board may set conditions for the
registration of a professional who returns to practice after a break. The current conditions that
limit a nurse are published in the registration records (Koutoukidis, Stainton & Hughson,
2016). When an assessment body decides that they are no longer required to guarantee a safe
practice, they are removed and discontinued. Examples of conditions include requiring the
professional to complete a particular supplementary training or education within a specified
period, performing a particular period of supervised practice, doing or abstaining from a
practice related to practice, administering their practice on a particular way, report to a
particular person at certain times about the practitioner's practice, or not employ, engage or
recommend a particular person or class of persons.

To ensure the safety of patients it is fundamental to distinguish a deteriorating patient,
escalating and reacting suitably, communicate changes and patient emergency to the
appropriate authority, mention observations and specific details and ensure continued
professional learning and ask the expert concerned if there is any doubt ("Recognizing and
Responding to Clinical Deterioration | Safety and Quality", 2016).
Timely and appropriate identification and response by healthcare professionals to the
worsening condition of a patient is essential for optimal patient outcome and shirking of
preventable harm. National regulatory authorities, the Australian Health and Safety
Commission of the Departments of Health, State, Territory and Federal Health, Health
Facilities and Institutions have all perceived the significance of implementing frameworks,
guidelines and procedures to encourage rapid recognition of the aggravating patient and
appropriate mechanisms for responding and escalating such conditions. Factors that can
impact identification and response include the level of knowledge and ability of health
professionals, organizational culture, and evaluation and review tools parameters.
3.2 “Ethical code of conduct for nursing”
According to the Code of Ethics for Nursing, highlighting quality services and respecting
values and dignity for others is essential for nurses ("A Guide to the General Practice Group-
Australian College of Nursing," 2017). In this area, it is also crucial for nurses to appreciate
the diversity of people, to appreciate well-informed decision-making and to evaluate the
safety culture in the nursing profession (Cherry & Jacob, 2016). This can only support the
delivery of health services to patients. Before that, nurses should be very involved in the
nursing field as it will only support best practices. In this case study both the nurses have not
followed code of ethics of nursing. They were very casual in approach and not serious
enough to observe the deterioration of the patient condition.
3.3 “Professional code of conduct for nursing”
Professional nursing codes have been developed to determine the minimum standard of
conduct by which health professionals can act professionally. It states that nursing should be
done in a safe and efficient manner using healthcare standards (Fry-Bowers, 2017). In
nursing practice, all nursing legislation should be followed, and nurses should also consider
values and beliefs during care provision. It thus shows that the nursing process must be
transparent and ethical in order for patients to receive attention (Griffith & Tengnah, 2017).
Professional Code of Conduct says nurses should not act against the rules and should always
practice in the best interests of patients. Furthermore, safe nursing practices should be
promoted and there is no room for complacency and casualness in the profession. In this case
study both the nurses have not shown in the true sense professionalism in their approach.
They did not monitor the worsening condition of the baby and moreover when everything
went wrong they tried to pass on the liability to some other hospital without giving full details
of the case. The hospital was right to initiate disciplinary action against both of them and they
were reprimanded for their casual act.
As per NMBA, nurses have to follow the following seven standards (NMBA, 2016):
1. Critically think and analyze nursing. 2. Engage in therapeutic and professional relations. 3.
Keep the ability to practice. 4. Implementation of reviews. 5. Develop a nursing plan. 6.

Provides quality care that is safe, appropriate and responsive. 7. Evaluate results to inform the
practice of nursing.
In this case study, the following sub-clauses apply (NMBA, 2016). The nurse registered
1.4 Complies with common law, legislation, guidelines, policies and other practice-related
standards or requirements when making decisions. Both nurses were unaware of the legal
consequences of the patient's fatal outcome due to the lack of communication to the physician
about the patient's complications and not maintaining clinical records or observations.
1.5 uses ethical frameworks in making decision. The nurses did not use any ethical
framework in their decision to treat the patient. When their moto is to serve the patient, they
could have saved the life of the baby had they taken due care to inform the doctor about
worsening of the patient condition in time.
1.6 keeps accurate, comprehensive and timely evaluation, planning, decision making, actions
and evaluation documents. There was a total failure from both nurses.
3.1 considers and responds to other people's health and well-being in a timely manner with
regard to their ability to practice. The first diagnosis was wrong and when the problem was
discovered, it was too late for the rural clinic to solve the problem, which ultimately resulted
in the patient's death.
3.4 accepts responsibility for decisions, actions, behaviors and responsibilities related to their
role and other actions to which they have delegated responsibility. Both nurses are
responsible for the patient's death.
3.6 is actively engaged in the profession. The nurses were relaxed in their approach and did
not maintain clinical records.
3.7 identifies and promotes the integral role of nursing practice and has been acquired to
influence better human health outcomes for humans. Nurses have not fulfilled this clause.
6.1 Provides comprehensive, safe, high-quality practices to achieve agreed goals and
outcomes that meet the needs of human health. The nurses have not provided safe and quality
practices.
6.2 practice within their scope. They did not maintain clinical records.
6.5 practices consistent with applicable nursing and health guidelines, standards, regulations
and legislation. They did not practice according to health guidelines.
7.1 evaluates and monitors progress towards expected goals and results. They did not monitor
progress.
7.3 identifies, documents and communicates with the relevant people additional priorities,
objectives and results. They did not document any clinical records.
Accountability implies that the nursing authorities, their bosses and people in general are
responding to the general population in their care. Caregivers are responsible for their
decision, activities, conduct and tasks, including documentation, in their maternity jobs
("Nursing and Midwifery Board of Australia - Home", 2016).

The relevant clauses are more or less interlinked and are part and parcel of the professional
code of conduct. The nurses are answerable to the patient, the relatives of the patient, their
employers or court when there is a mishap on account of lapses on their part. Since their role
is crucial for the survival of patients, they should be extra careful while discharging their
duties.
Critical nursing is a key component of care and professional responsibility. Those habits of
for trust, relevant point of view, imagination, adaptability, interest, intellectual integrity,
instinct, receptiveness, constancy, and reflection are shown in critical thinking in nursing
(Hughes 2008). Critical thinkers in nursing, practice psychological skills in analyzing,
applying standards, recognizing, searching for information, logically justifying, anticipating
and transforming knowledge (Scheffer and Rubenfeld, 2000).
3.4 Legal Issues- Civil Law:
The legal problems relating to nursing practice generally apply in civil law. The following
civil issues are particularly relevant to nursing and clinical supervision. Negligence refers to
harm to another person due to a lack of reasonable care. For negligence, there are four
elements to be observed (Lynch, Hancox, Happell & Parker, 2009). As per legal terms both
the nurses were negligent in their duty.
1. Duty of Care: The presence of a relationship involving a duty of care from one person to
another must be documented. The nurses did not document any observation of the patient.
2. Obligation to care: The expected or required standard of care was not given. The nurses did
not provide required standard care.
3. Damage, as evidenced by loss or damage, may be physical, psychological or economic.
There cannot be more damage than death of the patient in the present scenario.
4. Direct cause and effect: the breach caused or significantly contributed to the damage
suffered. The initial diagnosis was wrong and the doctor could not correct the same as the
nurses did not update him the developments of the patient.
From the case study, it is amply clear that they have violated the civil code of conducts and
can be prosecuted for violation.
4. Conclusion
The issue of nursing practitioners raises medical-legal and ethical implications that have a
major impact on all healthcare professionals. The modern nursing culture in Australia reflects
the nurses' desire to acquire more knowledge about legal and regulatory processes. This
change in focus is also reflected in nursing education, with bachelor's degree courses
comprising more discrete units of law and ethics. In fact, the role of the nurse as an important
member of the health care team is changing fast. In many ways, it is often only through the
input of a nurse as part of the health care team that important ethical principles have been
deliberately brought up, discussed and addressed.
Legal and ethical problems prevailing in the health and in particular nursing sector, when
nurses contact patients on a daily basis. Many nurses have no formal training in legal and
ethical matters, so that when they arise in the medical context, they are often unqualified for

addressing these problems ("Ley and Professional Careers Problems," 2009). While legal and
ethical guidelines as well as professional guidelines command the conduct of professionals,
training in the field are necessary and the risk of any decision on a patient should be given
due attention. In order to protect from failures, nurses should be guided by code of ethics and
professional codes in their profession. The two nurses of the rural clinic were too casual in
their approach of nursing care resulting in death of the baby. The nursing job involves
devotion and their job is crucial for saving the lives of the needy. If there are lapses, the
outcome will be most unpleasant. To protect the lives of the patients as well as their own jobs
they should know the legal aspects of nursing and apply in their nursing duties.
The moral issues depend on patient profiles, improvement of therapeutic innovation and
health specialties, since the nurses are in every day contact with patients in dynamic
environment. Moral awareness involves a sound reflection of what explicit situations are to
be taken and adhere to the standards of this conduct. Professional, personal, social, cultural
and political factors describe care. All specialists keep on having a key duty to promote
health, to act to the greatest advantage of the patient, to prevent illness, to remove suffering
and to extend services beyond the individual to their family and society.
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