Law, Ethics, Professional Guidelines, and their Relationship in Nursing Practice

Law, ethics, and professional guidelines form an important aspect of high-quality nursing care delivery. This article discusses the relationship between law, ethics, and professional guidelines in nursing practice, using a case scenario. It explores the transgressions committed by a nursing student and a registered nurse, the legal and ethical implications of these transgressions, and suggests ways to avoid such transgressions.

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Law, Ethics, Professional Guidelines, and
their Relationship in Nursing Practice-
Dan and RN Jane Case Scenario
Law, ethics, and professional guidelines form an important aspect to high quality nursing
care delivery. Law, professional guidelines, and ethics enable nurses as health professionals to
practice competently with integrity. Law is the written legal standards by the government that
determine who is competent for nursing practice (Birks, Davis, Smithson, & Cant, 2016). Ethics
are standards are moral values that provide basis to what actions, motives, and intentions are
acceptable to how a group or people conduct or behave themselves. Ethics determine what is
right or wrong in the nursing practice. Professional guidelines maintain and direct safe and
clinically competent nursing practice (Chiarella, & Adrian, 2014). Nurses need to understand the
relationship of laws, professional, and ethical guidelines in order to practice within the defined
nursing scope while maintaining safe and competent nursing practice. The following essay
discusses issues of law, ethics and professional standards on governing nurses’ behaviour and
decisions making framework a case study of Dan a student on placement and Registered nurse
Jane the Dan’s preceptor. This involve the identification of the transgressions and potential
transgression by both the nursing student and registered nurse, how the transgressions violates
the Australian Registered Nurse Standards, legal ethical implications of the transgression and
what should have been done to avoid the transgression.
In the case scenario, both Dan the nursing student on placement and RN Jane the
preceptor committed transgressions in the nursing practice. First, RN Jane reported on duty with
hangovers from a previous night out where she arrived home at 0330. RN Jane had shocking
hangover and could barely think. Hangovers have negative effects and impact a nurse
performance that undermines the ability of the nurse to carry out responsibilities and duties in a
safe manner. Secondly, RN Jane took hospital’s medicines for personal use. She pocketed
paracetamol from the medicine room that were not prescribed for her. The medicine she took
was meant for personal use. Thirdly, RN Jane made medication discrepancies when
administering prescription to the patients. Dan pointed out several occasion that RN Jane made

medication discrepancies that are risky to the patients’ health under her nursing care. Fourth, Dan
took photos of a patient and posted them on Facebook and indicated the patient name, the
hospital name and negatively mentioned the preceptor. This interfered with the patient’s privacy
and confidentiality. Dan message on social media also paints nursing profession in a negative
manner that can damage public trust bestowed to the profession.
Dan, the student nurse message on Facebook violated the Code of Ethics for Nurses,
Australian Registered Nurse Standards for Practice and the Code of Conduct for Nurses. The
social media post is a transgression of patient’s confidentiality and privacy. Dan discretely took
couple of photos of the patient’s wound and shared it on Facebook. In the post, Dan used the
patient real name that reveals the patient’s identity. Though Dan was just intrigued by the
situation, it a transgression that violates professionalism of nursing practice. In this case, Dan
violates the Standard 2 of Registered Nurses for Practice of Australia that requires nurses to
engage in purposeful and appropriate therapeutic and effective professional relationships
("Nursing and Midwifery Board of Australia - Registered nurse standards for practice", 2016).
The relationships should be in the context of mutual respect and trust that enables nurses to
optimally undertake nursing care and enhance patient health outcome (Henderson, & Dahnke,
2015). Dan failed to sustain a relationship that differentiates the boundaries that exist between
personal and professional relationships. Dan also fails to communicate effectively and be
respectful to the patient’s dignity and rights for privacy and confidentiality as required in
Standard 2 section 2 of Registered Nurses Standards of Practice of Australia. Dan posting Fred’s
photos on Facebook violates Principle 3 section 5 on confidentiality and privacy that is under
cultural practice and respectful relationships of Code of Conduct for Nurses in Australia. Nurses
have legal and ethical obligations to protect people’s privacy. According to Green (2017)
patients expect nurses to keep any information about them confidential and use the information
for administering nursing care only. Code of Conduct for Nurses Principle 3 section 5 require
nurses to abide by Social Media Policy as outlined by NMBA and ensure usage of social media
by nurses is consistent with legal and ethical obligations to protect patient’s privacy ("Nursing
and Midwifery Board of Australia - Professional standards", 2018). Ferguson (2017) stated that
everything posted on social media is public and nurses should view posts from a public
perspective to avoid posts that can be misconstrued as demeaning or uncaring to a patient. Dan
action to post Fed’s photos on Facebook also violates Value Statement 7 of Code of Ethics for

Nurses in Australia that require nurses to value ethical management of information. Value
Statement 7 requires nurses to respect people’s confidentiality and privacy irrespective of the
medium the information is stored or occurs without compromising safety or health. According to
Codes of Ethics for Nurses Value Statement 7, nurses need to be aware of and comply with
conditions that allow them to share a patient’s information with others. Nurse should also not
divulge information about a patient to any person or organization that is not authorized to have
the information. According to NMBA Social Media Policy, posting patients’ information on
social media violates standards of professional conduct in relation to confidentiality and privacy.
Posting unauthorised patient’s photographs in any medium breaches privacy and confidentiality
of the patient ("Nursing and Midwifery Board of Australia - Social media policy", 2014).
Johnstone (2016) noted that even posting on Facebook group or site even when the privacy
setting of the platform is set to the highest such as closed groups breaches the patient’s privacy
and confidentiality of their information. There exist inherent power imbalance between nurses
and their patients and it is the nurse’s responsibility to maintain professionalism standards that
enhance provision of nursing care (Birks, Davis, Smithson, & Cant, 2016). Patients are
vulnerable due to their conditions and nurses should recognize this vulnerability when engaging
with them (Manfrin-Ledet, Porche, & Eymard, 2015). For instance, Fred was both blind and
elderly patient that made him vulnerable to notice what is happening. Therefore, Dan’s post on
his Facebook page violated Codes of Ethic for Nurses Value Statement 7, Standard 2 section 2 of
Registered Nurse Standard for Practice and Principle 3 section 5 of Codes of Conduct for Nurses.
Dan’s transgression on Fred’s confidentiality at MylocalHospital has possible ethical and
legal future implication. The patient confidentiality and privacy was breached in accordance to
Code of Conduct for Nurses, Australian Registered Nurses Standards of Practice, and Code of
Ethics for Nurses. First, Dan’s behaviour can be declared as unethical and unprofessional
behaviour. Unethical and unprofessional conduct is a conduct that can be dangerous or harmful
to patient health or the public as a failure to maintaining minimum acceptable standards and
prevailing nursing practice (Starr, 2014). Unethical conduct is a behaviour that goes against the
Code of Ethics for Nurses in Australia. The Code outline requires nursing profession
commitment to respect, protect, promote and uphold rights for the people they provide nursing
care (Papastavrou, Efstathiou, & Andreou, 2016). Dan behaviour to share Fred photos was
against nurses’ value of ethical management of information. The Facebook post had total

disregard to the patient’s privacy and confidentiality. This unethical conduct can be reported to
the authority for investigations and disciplinary action. Dan is likely to be reported to the
Nursing and Midwifery Board of Australia (NMBA) to face the Tribunal for breaching parent’s
confidentiality and privacy. The NMBA through Australian Health Practitioner Regulations
Agency (AHPRA) will prosecute the student nurse that can lead to restrictions or limitation to
Dan’s continuity with placement or registration as a nurse ("Australian Health Practitioner
Regulation Agency - Registration Standards", 2018). Another implication of Dan’s conduct that
breached Fred privacy and confidentiality is a lawsuit. A legal action can be taken by Fred or his
family to claim damage against Dan for disclosing his privacy online. The legal action can also
involve the MylocalHospital where the incidence occurred in. Sinclair, Papps, and Marshall,
(2016) established that it the duty a health professional to maintain patient’s confidentiality. Dan
had a duty to maintain Fred’s privacy and confidentiality when providing nursing care. Secondly,
Dan breached confidentiality by not gaining patient’s consent and publically sharing health
information that should only be used in the scope of nursing practice. Breach of confidentiality
can be proven through the retrieval of the Facebook post where Dan uploads a photo of the
patient and indicates the name of the patient. In health care, a patient is considered to be in a duty
of confidentiality in contract when they consult or enter the hospital (Bernoth, Dietsch,
Burmeister, & Schwartz, 2014). Therefore Dan can be legally charged by Fred or someone on
behalf of Fred on the account that he breached the confidentially and privacy of the patient. Dan
therefore faces two ethical and legal implications of a disciplinary proceeding by health
professional regulatory statute and a legal action (lawsuit) by the patient for breaching
confidentiality and privacy.
There are several things that Dan the nurse student should have done to avoid breaching
the patient’s confidentiality and privacy. First, the student nurse should not have mentioned the
patient name or identify the patient in a disparaging manner on the Facebook post. Mentioning
the patient name makes it easy for the public to know who the patient is. These leakages of the
patient information online can start public debate and comments that can lead to bullying and
harassment of the patient (Ferguson, 2017). Avoiding mentioning Fred name would make the
patient on the photographs anonymous protecting the patient’s identify. Secondly, Dan should
not have named the hospital alongside the Facebook Post. Including the hospital name on the
post makes it easier for the public to know the patient and can also damage the hospital

reputation. The post showing a hospital name risk destroying the trust that a health care
institution is bestowed by the public. Indicating the hospital name can also lead to legal action
against the hospital owners or management as it shows negligence or gross misconduct of
professional and ethical standards. For instance, Dan’s Facebook post showed that
MylocalHospital was not providing patients safe and timely nursing care that meets high
standards. Another thing that Dan could have done to avoid breaching Fred’s confidentiality and
privacy is not taking the photos. The photos disclosed the health condition of the patient and
should not be used for personal affairs. According to Westrick (2016) nurses should not take
patients photos with their cell phones because photographs taken by personal devices undermine
professional boundaries that exist between nurses and the people under their care. Therefore,
Dan should have not identified the patient by name or refer him in a disparaging manner, include
healthcare institution, and take photos of the patient with a personal device.
In conclusion, law, regulations and standards of practice play an important role in
governing nursing profession. The Code of Ethics for Nurses, Code of Conduct for Nurses, and
Australian Registered Standards for Nurses outline acceptable legal and ethical conducts for
nurses. From the case scenario, it evident that the student nurse (Dan) and the preceptor (RN
Jane) made several transgressions in the MylocalHospital that undermined patients’ safety,
privacy and confidentiality. Dan’s transgression to post patient’s photos on Facebook was
against the Standard 2 section 2 of Australian Registered Standards of Nursing, Principle 3
section 5 of Code of Conduct for Nurses and Value Statement 7 of Codes of Ethics for Nurses.
Dan can be implicated by NMBA to the tribunal through the AHRPH or a lawsuit be placed by
Fred or someone with Fred’s best interests. Dun could have avoided the breach of confidentiality
and privacy by avoid to take patients photos, not indicating patient’s name or mentioning the
patient in a disparaging manner, and not mentioning the healthcare centre on the Facebook post.
Therefore, it is recommendable for nursing students to understand laws, regulations, and
standards that guide nursing as a profession early enough before going for their first placement to
avoid being implicated.

References
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