Professional Accountability in Nursing: A Case Study Analysis

Running head: PROFESSIONAL ACCOUNTABILITY
Professional accountability
Name of the student:
Name of the University:
Author’s note

1PROFESSIONAL ACCOUNTABILITY
Introduction:
Professional accountability is an important competency desired by nursing staffs which
means being answerable to oneself and others for ones action. Hence, it demands delivery of care
in accordance with set care standards and taking considerations to ensure that patient safety is
maintained (Slatyer et al., 2016). When desired practice standards are not maintained and nurses
deviate from their duty of care, it is often associated with adverse event or even death for patient
(Grant, 2017). Hence, such breach of professional accountability leads to harmful professional
consequence for nurse. The main purpose of this essay is to give an overview of such case
related to professional misconduct. The case involved a registered nurse was involved in
professional misconduct leading to death of patient and she was suspended from registration for
six months. The essay critically analyses the nursing action that makes that led to the adverse
event, the impact of system based factors on adverse events and the strategies that a nurse should
have taken to prevent the adverse event for patient.
Brief synopsis of the case:
The case is about Vicki Tripodis, a registered nurse whose registration was suspended for
six months because of complaint regarding alleged professional misconduct in relation to the
care of patient A. The complaint against Vicki Tripodis was made by the Health Care
Complaints Commission and the case was placed before the Civil and Administrative Tribunal.
The nurse involved in providing care to patient A the Medical Subacute Unit at the Correctional
Complex on the night shift of 5 February 2015. The patient had undergone a total laryngectomy.
The key actions that she missed during the care of patient A included failure to perform full set
of observation, failure to conduct two hourly visual observation, asking patient to knock up for

2PROFESSIONAL ACCOUNTABILITY
assistance, lack of supervision during patient’s self-administration of nebulised saline and failure
to make proper clinical records. The consequence of this action was that this resulted in the death
of patient because of pulmonary embolism. Further details regarding the case can be taken from
the following link:
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:
Vicki Tripodis registration was cancelled because of five omission or failure to take
relevant actions for Patient A. The first issue of negligence identified was that Vicki failed to
perform full set of observation for patient A after laryngectomy. She was required to check vital
signs like blood pressure, temperature, respiration and oxygen concentration to identify any
changes in vital signs and detect clinical deterioration in patient. However, inability to complete
this action resulted in delay in immediate care and death of patient. According to the Nursing and
Midwifery Board of Australia (2016), one of the professional responsibilities of nurse is to
conduct systematic and comprehensive assessment of patient and use the data to inform practice.
However, Vicki failed to conduct any such assessment for patient A leading to delay in detection
of deterioration in patient’s condition. Brekke et al. (2019) argues that vital signs like respiratory
rate, pulse and blood pressure are essential part of assessment of hospitalized patients and
changes in vital signs facilitates early detection of preventable outcomes that is the key to timely
intervention. However, avoiding vital sign assessment led to delay in timely intervention and
death of patient A.

3PROFESSIONAL ACCOUNTABILITY
The second omission by Vicky was that she failed to fulfil her responsibility of
conducting two hourly observations for patient. During the night shift of 5 to 6 February 2015,
assessment of patient’s A airway status was required after every two hour. Based on the
organization’s policy and clinical responsibility outline in code of professional conduct for nurse,
Vicki had the duty to take care of patient at regular intervals (NSW Health, 2018). Hence,
inability to do so made her care go below the standard. In patients undergoing laryngectomy,
surgical swelling and newly formed stoma often result in respiratory difficult. In such case, it is
necessary to conduct observation of airway and respiratory after every two hours overnight.
Vicki failed to understand the critical condition of patient and the importance of two hourly
observation (Castro et al., 2018).
Another act of negligence was that instead of personally monitoring the patient for
deterioration throughout the night, Vicki asked patient A to knock up if he needed any
assistance. Considering the history of patient A, who was an aggressive patient and he often
refused treatment, this action of Vicki was not permissible. In her explanation, Vicki justified
that he was in a condition to use the knock-up system. Despite this, it is evident that Vicki failed
to go through patient record and understand that overnight observation was a responsibility for
her. As Vicki was an aggressive and difficult patient, extra precaution was needed by her. Forbes
and Watt (2015) defines that initial history and physical examination lead to identification of key
issues in patient and stability it promptly ensuring better outcomes.
Another act of professional misconduct by Vicki included failure to supervise during self-
administration of nebulised saline. As a registered nurse, it was her duty to administer nebulised
saline at 12 am and 4 am. However, she failed to observe that patient was self- administering
saline nebuliser herself during the night shift. In addition, while maintaining clinical record too,