Professional Accountability in Nursing: A Case Study

This essay discusses a case study on professional accountability in nursing, focusing on a registered nurse who was suspended for unsatisfactory professional conduct. It explores the key actions and omissions that led to adverse outcomes for the patient, as well as the system-based factors contributing to the adverse outcome. The essay also suggests actions to prevent similar errors in the future.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction:
Professional accountability is an important professional behaviour needed by registered
nurse to promote safety of patient. Professional accountability means to be accountable for one’s
activities by explaining the reasons for them and supplying normative grounds to ensure the
action is justified. This professional behaviour is needed by registered nurse to critically review
nursing actions and take critical steps to promote safety of patient (Aveling, Parker and Dixon‐
Woods 2016). Any breach in professional conduct is associated with strict consequence and even
cancellation of the registration of registered nurse. This essay looks into a case where a
registered nurse, Vicki Tripodis was suspended from her registration for six months because of
unsatisfactory professional conduct and professional misconduct. The essay discusses about the
key actions taken by that resulted in adverse outcomes for patient and the impact of several
factors behind contributing to the adverse outcome for patient. The essay gives discussion
regarding insight relevant action that the registered nurses should have taken to prevent the
adverse outcome.
Brief synopsis/overview:
Vicki Tripodis, a registered nurse was suspended from registered practice for six months
following the complaint from the Health Care Complaints Commission. The event that led to this
legal action was that while working as a nurse in the Medical Subacute Unit at the Correctional
Complex on the night shift of 5 February 2015, Vicki Tripodis was providing care to patient A
who had recently undergone a total laryngectomy. She failed to perform full set of observation
during her shift and did not undertake two hourly visual observation of the patient. Her failure to
make appropriate clinical record and no supervision during self-administration of the nebulised

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saline resulted in death of patient A because of pulmonary embolism (Health Care Complaints
Commission, 2018).. The following link gives full details about the case:
http://www.hccc.nsw.gov.au/Publications/Media-releases/2018/RN-Vicki-Tripodis---
Suspension-and-reprimand-for-Professional-Misconduct
Actions/omission contributing to adverse outcome for the patient:
According to the Health Care complaints Commission, Vicki Tripodis was involved in
five omissions that led adverse outcome for patient A. Firstly, Vicki failed to perform full set of
observation during her shift. Patient A had a history of lower limb amputation and laryngeal
cancer and since the patient has recently undergone a laryngectomy, it was necessary for nurse to
conduct full set of observation to identify any adverse effect of the surgery on vital signs of
patient. She failed to perform observation related changes in blood pressure, temperature,
respiration and oxygen concentration. Monitoring vital sign is a crucial aspect of nursing care as
acts as an important indicator of patient’s clinical condition. Conducting full set of observation
helps to detect harm to patient leading to deterioration of patient condition (Johnson, Mueller &
Winkelman, 2017). According to the standard 4 of the registered nurse for practice by Nursing
and Midwifery Board of Australia (2016), registered nurse have the responsibility to conduct
comprehensive and systematic assessment and use the collected data to inform practice.
However, Vicki’s negligence to complete the full vital sign observation resulted in delay in
identification of deterioration in patient and taking appropriate response to promote safety of
patient.
The second omission by Vicki Tripodis was that she failed to undertake two undertake
two hourly observation of patient A’s including changes in breathing and airway status of patient

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between 5th February 2015 to 6th February 2015. One of the problems found in patient
undergoing laryngectomy is that patient may develop respiratory difficulty because of the effect
of surgical swelling and newly formed laryngectomy stoma. To detect such issues in patient, it is
necessary to perform observation of respiratory status ½ hourly for the first 2 hours and then
engage in observation of respiratory status after every two hours overnight (Pudner, 2005; Castro
et al. 2018). However, in the night between 5th February 2015 and 6th February 2015, Vicki did
not conducted any such two hourly observation. The main reason cited was that this was not
required for the patient. Hence, omission of this nursing responsibility might be one of the causes
behind deteriorating health status. Another major negligence committed by Vicki was that
instead of being vigilant about necessary observation to detect any clinical deterioration in
patient, the nurse asked the patient to knock up if he needed any assistance. The reason cited for
this was that the patient was in a state to use the knock up system. However, this was a false
justification given by the nurse because as per detailed examination of the case, the patient A has
a history of being abusive with staffs and refused to comply with medical treatment. Therefore,
considering such history of patient, the registered should have taken extra precaution to complete
all necessary observation.
Another action by Vicki that resulted in professional misconduct allegation for her was
that she did not supervise patient during self-administration of nebulised saline. By this action,
she failed to perform her duty of care as in such circumstances it was necessary for the nurse to
visually and verbally check if Patient A required any assistance during self-administration of
nebulised saline or not. According to the Midwifery Board of Australia (2016) standard 3.1,
registered need to respond in a timely manner to the health and well-being of patient and actively
engage in the profession. However, by not taking any interest in supervising Vicki, the nurse’s

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action suggests lack of accountability towards sae practice and poor engagement in care of
patient. Another omission was that she failed to make appropriate clinical record thus violating
her duty towards timely documentation of assessments as per 1.6 of the NMBA standards of
practice. Hence, failure of Vicki to demonstrate professional behaviour and fulfil the
responsibilities of care at critical point of care resulted in adverse event for patient.
System based factors contributing to the adverse outcome for the patient:
The review of legal proceedings for Vicki Tripodis gives suggestion regarding the impact
system based issue on contributing to adverse event for the patient. For example, when Vicki
Tripodi was asked to explain the reason behind her action, she revealed that her nursing
performance went below standard care because of culture of the prison hospital and because of
aggressiveness of the patient. The key system based issues highlighted by the nurse by this
justification is that prison hospital does not have adequate safety culture in place to ensure that
all nurse are competent in handling very aggressive and difficult patient. The clinic where the
incident occurred might have lacked appropriate culture for care control and collaborative work.
For example, Foster, Bell and Jayasinghe (2013) supports that prison hospitals are underprepared
to deal with safety issues of patient as they are more concerned with security rather than health
care. Another major barrier for health care staffs in providing effective care in prison hospitals is
that it has stressful environment and there is no occupational health support mechanism to ensure
that patient supervision is handled by team of qualified staffs. The support provided is informal.
Hence, lack of appropriate culture and forum for communication between staff might be the
cause behind poor participation and engagement of Vicki in patient A’ care.

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The registered nurse Vicki’s confession that her care fell below professional standard
because of difficult and aggressive patient suggest another system based limitation leading to the
adverse event. This included lack of education and training for nurse to deal with difficult
patient. There is a possibility that Vicki stayed away from regular assessment and care of patient
because of lack of skills to manage such difficult patient. This limitation suggest that the prison
hospital lacked system wide support to ensure that each nurses are recruited after appropriate
training on skills needed to handle difficult patient and they get adequate support to manage risk
in relation to handling such patient. According to Ramezani et al. (2017), patient’s aggression is
a major problem in mental health and prison based setting. The review of challenges in nurse’s
empowerment in the management of patient’s aggression revealed that there are many
organization barriers such as limited human resource, mandatory shift, lack of motivation
triggers and shortage of protective equipments that result in poor motivation of nurse towards
management of patient’s aggression. The study also revealed poor culture of prevention and poor
quality of supervision in managing aggression has negative impact on professional performance
and safety outcome of patients. Hence, this kind of organizational limitation might be present in
the prison hospital too resulting in adverse event for the patient.
Although no other system based factors has been highlighted in the case; however there is
a possibility that lack of technology based support might have led Mrs. Vicki to ignore the risk
associated with ignoring development of clinical record for patient. For example, the clinic
where the event occurred might not have effective system in place for recording electronic
clinical record of patient (You et al. 2015). In many hospitals, computerized prescriber order
entry (CPOE) is linked with clinical decision support (CDS) to reduce the likelihood of adverse
event. Hence, lack of such technology might have resulted in Vicki’s lack of knowledge

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regarding the patient’s non-compliance with medical treatment. Appropriate prompts would have
reminded her regarding the need to maintain clinical record of patient on a regular basis.
Actions to prevent the error:
The review of Vicki Tripodi’s suspension from registration for six months suggest that
such disciplinary action was taken because of failure of the nurse in completing necessary
observation for patient and taking appropriate action to clinical deterioration of patient condition.
From this perspective, the key action that was necessary for the nurse to implement included
carrying out vital observation of patient on a regular basis and ensuring that all the data were
recorded in a paper or clinical record.
Mathioudakis et al. (2016) supports that maintaining continuity in clinical record is significant
for patient care as it helps in informed decision making for patient management, assessment of
risk for patient and promoting continuity of care. This action is also relevant with the NSW
policy on recognition and management of patient who are clinically deteriorating. The NSW
policy imposes a mandatory requirement of implementation NSW health standard observation
chart and ensuring that vital signs of all patients are recorded (NSW Government, 2013). Hence,
similar action by the registered nurse Vicki Tripodis would have helped her to identify key risk
for patient A and prevent the adverse event of death.
Considering the fact that Patient A’s was experiencing difficulty in maintaining his
airway, the nurse should have engaged in increasing the frequency of observation for patient.
This would have helped her to detect risk of pulmonary embolism and take necessary clinical
action to reduce the risk. This action is relevant with NSW policy directions on frequency of
observation for patient. According to NSW Government (2013) policy directive on clinical

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deterioration, in the absence any monitoring plan, all the patient have the responsibility to set of
vital sign observations at least 3 times a day. However, it also mandates that the frequency of
observation should be increased based on patient’s condition and clinical judgment or evaluation
of risk. Hence, if Vicki was attentive to review clinical record and conduct two hourly
observations for patient, he could have prevented deterioration of patient A’s condition. No
adverse event contributing to the death of the patient would have occurred.
Conclusion:
To conclude, the essay gave an insight into a case where a nurse had her registration
cancelled for six months because of involvement in adverse event related to death of a patient
because of clinical deterioration. Vicki Tripodis’s registration was cancelled because she failed
to conduct vital sign observation for patient A, maintain clinical record and provide assistance
during self-administration of nebulised saline. She ignored her responsibility to conduct two
hourly observation overnight for the patient after undergoing laryngectomy. The factors
contributing to errors revealed negligence of nurse in meeting proessional practice standards and
lack of organization support to promote safety of aggressive patient. Hence, the case
demonstrates that lack of accountability to maintain patient safety and comply with local policies
for preventing clinical deterioration resulted in suspension of Vicki Tripodis from her
registration for six months.

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References:
Aveling, E.L., Parker, M. and Dixon‐Woods, M., 2016. What is the role of individual
accountability in patient safety? A multi‐site ethnographic study. Sociology of health &
illness, 38(2), pp.216-232.
Castro, M. A., Dedivitis, R. A., Salge, J. M., Matos, L. L., & Cernea, C. R. (2018). Evaluation of
lung function in patients submitted to total laryngectomy. Brazilian journal of
otorhinolaryngology.
Foster, J., Bell, L., & Jayasinghe, N. (2013). Care control and collaborative working in a prison
hospital. Journal of interprofessional care, 27(2), 184-190.
Health Care Complaints Commission (2018). RN Vicki Tripodis – Suspension and reprimand for
Professional Misconduct. Retrieved from:
http://www.hccc.nsw.gov.au/Publications/Media-releases/2018/RN-Vicki-Tripodis---
Suspension-and-reprimand-for-Professional-Misconduct
Johnson, K. D., Mueller, L., & Winkelman, C. (2017). The nurse response to abnormal vital sign
recording in the emergency department. Journal of clinical nursing, 26(1-2), 148-156.
Mathioudakis, A., Rousalova, I., Gagnat, A. A., Saad, N., & Hardavella, G. (2016). How to keep
good clinical records. Breathe, 12(4), 369-373.
NSW Government (2013). Recognition and Management of Patients who are Clinically
Deteriorating. Retrieved from:
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_049.pdf

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Nursing and Midwifery Board of Australia 2016. Registered nurses standards for practice.
Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-
statements/professional-standards/registered-nurse-standards-for-practice.aspx
Pudner, R. (Ed.). (2005). Nursing the surgical patient. Elsevier Health Sciences.
Ramezani, T., Gholamzadeh, S., Torabizadeh, C., Sharif, F., & Ahmadzadeh, L. (2017).
Challenges of Nurses’ Empowerment in the Management of Patient Aggression: A
Qualitative Study. Iranian journal of nursing and midwifery research, 22(6), 442.
You, M.A., Choe, M.H., Park, G.O., Kim, S.H. and Son, Y.J., 2015. Perceptions regarding
medication administration errors among hospital staff nurses of South
Korea. International journal for Quality in health care, 27(4), pp.276-283.