Professional Accountability And Patient Safety

This paper examines a typical case of professional misconduct involving a registered nurse and two patients, highlighting the implications for patient safety and professional accountability. The nurse engaged in a sexual relationship with one patient and engaged in inappropriate behavior with another. The paper discusses the charges against the nurse, the impact on patient safety, and the systemic errors that may have contributed to the misconduct. It also explores the ethical and professional responsibilities of healthcare professionals and the importance of maintaining trust and confidentiality in patient care.

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PROFESSIONAL ACCOUNTABILITY AND PATIENT SAFETY
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This paper examines a typical case of professional misconduct involving a registered
nurse Mr Timothy Buckby and two of his patients identified as Patient A and Patient B
presented the State Administrative Tribunal of Western Australia by The Nursing and
Midwifery Board of Australia and filed as case number VR 91 of 2014 accessed via link
address http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/wa/WASAT/2015/19.html?
stem=0&synonyms=0&query=buckby. The board accused Mr. Buckby of having a sexual
relationship with Patient A in February 2012 and went ahead to contact her even after she
was discharged and engage in sexual acts with her. Patient A was a 48-year old voluntary
mental inpatient admitted at Joondalup Health Campus Mental Health Unit between 12th
February 2012 and or about 27th February 2012. The patient had been admitted to the Unit
for treatment of Post-Traumatic Stress Disorder (PTSD) following a road accident in April
2011 and workplace distress. Patient B was a 55-year-old lady suffering from depression and
was admitted to the facility on 22 June 2012.
In its submissions before the tribunal, the board professed that one evening, Mr.
Buckby, then an employee of Joondalup Health Campus in West Australia state, made his
way to Patient A’s room where he sat on her bed before caressing her. Later, on an ensuing
night, the Respondent went into Patient A's room, shut the entryway, kissed Patient A,
pushed his groin against her and constrained her to contact his penis. On another event, while
Patient A was an inpatient at the unit, the Respondent went into Patient A's room conveying
towels and shut the way to the room. While in Patient A's room, the Respondent instructed
Patient A to rests on the bed and secured her mouth with his hand, following which he had
sex with her. On a few events following this occasion, the Respondent went into Patient A's
room on the falsification of conveying towels and contacted and kissed Patient A. Following
Patient A's release from the unit on 27 February 2012, the Practitioner on numerous
occasions called Patient A for sex. Amid different discussions between the Respondent and

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Patient A following her release from the Unit, the Respondent unveiled secret patient data,
including data identified with the demise of a youthful female patient at the Unit, to Patient
A.
Later, Patient B was admitted to the unit as a voluntary patient. Shortly after her
admission to the Unit, Patient B was crying. The next day, the Respondent came into Patient
B's room and expressed his worries over the latter’s condition especially the previous day and
said that he wished to give her a hug, which she gave in. From that day, the Respondent
would consistently go to Patient B's room on the unit and close the entryway, following
which he and Patient B would kiss and embrace one another. On a few events during Patient
B's admission at the Unit, the respondent would leave his rostered shift on the Psychiatric
Intensive Care Unit at Joondalup Health Campus (PICU) and go to the Unit to meet Patient B
in her room. On 9th July 2012, Patient B informed a resident psychologist, that she was
having a 'toss' with the respondent and that they had been kissing in her room. Staff at the
unit additionally got an independent report of the connection between Patient B and the
respondent from Patient B's roommate at the unit. The matter was taken up by the Nursing
and Midwifery Board of Australia and Mr. Buckby was later found guilty of all the charges
leveled against him by the board and was subsequently reprimanded, disqualified from
practice for seven years and slapped with a bill of all the Board’s coasts.
The practitioner faced several counts of professional misconduct including; entering
into an intimate association with Patient A when he knew, that Patient A was in an incapable
mental state; engaging in a sexual association with Patient A; telephoning Patient A on
various occasions thus transgressing his professional boundaries with the patient; and visiting
at Patient A's home on two events. As pertains to Patient B, the respondent was indicted for
hugging and kissing Patient B while she was an inpatient at the unit when he knew or should
sensibly have known, that Patient B was of a vulnerable state of mind, as well as engaged in

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sexual delinquency with Patient B. As such, the medical attendant acted in abuse of the rules
for keeping up proficient limits distributed by the Applicant; acted in spite of the Code of
Professional Conduct for Registered Caregivers in that he neglected to safeguard the trust
accorded to medical caretakers by individuals getting care; acted in an issue conflicting with
the Code of Ethics for Nurses; and breached patient secrecy by unveiling data about patients
on the unit to Patient A
The nurse failed to ensure the patient safety engaging in sexual intercourse. This act
exposed the patients to physical health risk such as infection of STIs. In the process, the
practitioner exposed the nurse to even more health risks emotional trauma included
(Chadwick & Gallagher 2016). This was in turn a violation of the second conduct statement
of the Code of Professional Conduct for Nurses in Australia. According to this guideline,
medical caretakers' essential duty is to give safe and equipped nursing care (Swiggart 2016).
The nurse also failed to counsel the patients on having intimate relationship with
fellow patients or medical caregivers. Conduct statement number seven of the Code of
Professional Conduct for Nurses in Australia requires medical personel to reinforce the
prosperity, sound health and knowledgeable decision making of persons seeking care
(Standing 2017). Probably, if the patients had been counselled on this, they would have
known the appropriate steps to take other than mere feeble resisted that was overwhelmed by
a simple threat.
Mr Buckby failed to observe his professional boundary as contemplated in the Nurse's
Guide to Professional Boundaries in Australia when he used Patient A’s personal details such
as her children and residents to threaten her into submission. In addition, the practitioner
telephoned both of his victim patients at their home and arranged for a meetings with them
for purposes of sexual benefit. Medical caretakers have a duty to keep up an expert limit
among themselves and the individual being thought about, and among themselves as well as

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other people, for example, the individual's accomplice and family and other individuals
designated by the individual to be engaged with their consideration.
The ruling hints at possible system-based errors that could have led to the professional
misconduct. First, the fact that male medical practitioners were allowed to enter the rooms of
female patients and lock themselves inside without company of another nurse is considered a
systemic flaw. Rogue medical caregivers could easily abuse this loophole just like Mr
Buckby did. Sellman and Snelling (2016) and Fullan et al. (2015) notes that that female
nurses when compared with males show more prominent by and large empathic responses,
self-revealed sentiments and observations to social enduring. As such there ought to have
been a second nurse and better a lady especially the odd hours the respondent used to enter
the patients rooms. Secondly, the fact that the practitioner used to deviate from his roster to
attend to non-scheduled patients in other sections hints at a possible supervision error as
another factor that could have led to this incident. Hospital administration should ensure strict
adherence to staff routines so as to remain accountable of each of the staff’s whereabouts as
well as their activities (Milliken & Grace 2017; Preshaw et al. 2016). Lastly, the author
observes that prior to admission, the patients were not counselled on the and given reporting
procedures. From the chronology of events, patient B learnt later that she could seek help
from the resident psychologist regarding her situation. This implies that she was oblivious of
the incident reporting frameworks and procedures that existed in the facility until after she
had been abused. To ensure safety for patients and prevent such incidents from happening,
the hospital administrator should create public awareness to keep patients informed especially
with regard to their safety and security while in the facility (Kangasniemi, Pakkanen, &
Korhonen 2015).
The nurse contrary to the existing nursing ethics engages in sexual relationship with
his patients, knowing well that the patients were disturbed and patient B suffered from PTSD

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and depression. The practitioner should have followed statement one of the code of practice
which allows medical attendants to refer cases which their competency does not allow them
to handle. The fact that Patient B needed somebody close to talk to does not imply that she
needed somebody for sex as may have been interpreted by the defendant. In his assessment, if
he lacked sufficient expertise to handle Patient B in her condition, he should have referred her
to the psychologist.
The nurse failed to provide safe, appropriate and quality services to his patients as
required by the standard number six of the Registered Nurses Standards for Practice (RNSP)
On the contrary, he made the nursing environment insecure and unsafe issued threats such as
“Be quiet or you'll get into trouble” to his patients. This amounts to patient bullying, sexual
assault and failure to provide to provide safe and competent practice (Grace 2017; Harrison
2018) as per the first conduct statement of the Code of Professional Conduct for Nurses
(CPCN).
The practitioner disclosed patient information thereby breaching the conduct
statement five of the code of practice. According to the Privacy act 1988, from which the
Guidelines to the National Privacy Principles 2001 draws its origin, nurses have both legal
and ethical mandate of treating information acquired from a patients with utmost
confidentiality. Omission of this consideration puts the patient’s privacy in jeopardy (El-sol
& Mohmmed 2018). The practitioner should have instead kept secret any information gotten
from a patient and refrained from sharing it with any third party (Cannon & Caldwell 2016).
Patient B, had been admitted at the facility due to Post Traumatic Stress Disorder
emanating from a road carnage she was involved in and more and office bullying. From the
evidence presented, the patient had developed extreme fear for authorities. By doing what he
did, the practitioner, being a figure of authority added more fear and distress to the patient. If
the nurse had behaved accordingly, the patient would have gained some level of trust and

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respect for authoritative figures as opposed to fear which she already suffered from.
Furthermore, sexual abuse is one of the causes of PTSD and given than the patient already
suffered this order the respondent’s acts only served to deteriorate the patients’ conditions
further. Sexual abuse can have an assortment of short-and long term consequences for a
victim's emotional wellness (Berwick 2015). Numerous survivors report flashbacks of their
attack, and sentiments of disgrace, segregation, stun, disarray, and blame (Butts & Rich
2019). Individuals who were casualties of assault are at an expanded risk of depression,
PTSD and anxiety (Bee et al. 2015). Research shows that handling the patients professionally
and in accordance to the laid down guidelines promotes quick recovery.
The general public lays its trust in the hands of professionals including their safety
and private information. When details of leakage of confidential data and abuse of office
emerge, this trust is lost and damages the reputation of public health facilities (Aveling,
Parker, & Dixon‐Woods 2016). Medical practitioners should refrain from all outlines forms
of professional misconducts to keep patients
Every employee irrespective of his or her gender, age, rank or social standing bears a
professional responsibility of conforming to all the ethical and integrity obligations that come
with a given office or work position (Austin 2016). This paper analysed a sample case of
professional misdemeanour in which a nurse was indicted for disclosure of patient
information and having sexual intercourse with his patients. System-based factors that could
have led to the incident as well as mitigation strategies were looked at. The paper wind up by
looking at the correlation of the case and its relevance to existing policies, guidelines and
standards in Australia.

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