Professional Accountability and Patient Safety: A Nursing Case Study

This essay examines a case study involving a registered nurse, Mr. Thulani Nkomo, whose registration was cancelled due to unprofessional conduct, specifically a sexual relationship with a patient at Queanbeyan District Hospital. The essay analyzes the nurse's actions and omissions, highlighting the violation of professional boundaries and the potential adverse outcomes for the patient. It discusses how the nurse failed to maintain a professional distance, leading to disciplinary action. The essay emphasizes the importance of ethical conduct, patient safety, and the consequences of boundary violations in healthcare, referencing relevant literature and policies. It also explores the factors contributing to the adverse outcome and outlines actions the nurse should have taken to prevent the misconduct. The essay concludes by underscoring the significance of maintaining professional boundaries and the impact of such misconduct on the nurse, patient, and healthcare workplace.

RUNNING HEAD: NURSING 0
Professional Accountability April 2
2020

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The medical sector is a worthy zone. Medical professionals grind themselves to save lives. Few
medical professionals neglect the seriousness attached and involved with their profession and
make mistakes. If a medical professional makes a mistake on sense of duty it is extremely
dangerous because there is a human life involved in every step. Healthcare centres all over the
biosphere should consider providing quality service to the service users and try avoiding
mistakes to save more lives and help more patients to recover from health issues. This essay has
involved a case study in which a medical professional's careless behaviour and journey
professional boundary resulted in registration cancellation. This essay will analyse the case and
identify what the nurse's omissions were and why the nurse should not have established a sexual
relationship with a female patient. This essay has also highlighted how the situation could have
been different if the nurse had not crossed his professional boundaries at the healthcare centre.
Direct link to the case is as follows.
https://www.caselaw.nsw.gov.au/decision/5d1be344e4b02a5a800c21ac
The Tribunal found unacceptable unprofessional conduct and qualified misconduct. Mr. Thulani
Nkomo, a registered nurse got his registration cancelled because of his unprofessional behaviour
in the duty hours and was engaged in an improper personal and eventual sexual relationship with
a female patient that required regular opioid analgesia and assistance with personal nurse care
(wales, 2019). The Commission alleged that in 2011, while employed at Queanbeyan District
Hospital, Mr. Nkomo engaged in an inappropriate condition. The Commission further suspected
that Mr. Nkomo continued to fail to maintain proper professional boundaries with the same
patient. After the patient’s release from the hospital the registered nurse was connected to her
next seven months beyond professional limits. Mr. Nkomo admitted some of the particulars of
the objection. After evidence was heard, Mr. Nkomo made flattering admissions. On 28 February
2014, the Committee reproached the practitioner and ordered that his registration will be
cancelled for 18 months. The Tribunal further ordered that the practitioner is forbidden for 18
months from providing the health facilities on public, private or volunteer basis in medical,
hospital, nursing and midwifery facilities and community fitness services. The committee
published its decision on 28th February 2014. The registered nurse was guilty of professional
misconduct and unsatisfactory professional behaviour. The registered nurse established a sexual
relationship with a patient while he was on duty at Queanbeyan District Hospital. The applicant

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gave evidence and in cross-examination, the registered nurse admitted to the professional
misconduct and made unsatisfactory professional conduct at the time of duty. The registered
nurses expressed regret for his actions. The community and tribunal was impressed by the
registered nurse’s honesty and cooperation in the case. The tribunal made the following decision
relating to the registered nurse. The Application for reinstallation was granted with a few
conditions. The Applicant is not to work in any mental health facility or dedicated mental health
unit for at least 12 months from the date he recommences employment as a registered nurse.
The applicant must engage in a mentoring relationship for at least 12 months from the date he
recommences employment as a registered nurse. The registered nurse mentor or mentors must
be approved by the nursing and Midwifery Board operated in Australia.
The listed nurse was expected to take care of the patient professionally but he got involved with
the patient on personal levels (Dall, 2010). Healthcare professionals are trained to treat the
patients equally and take patients as a responsibility (Waterbury, 2001). The registered nurse got
involved with the patient emotionally and physically that was highly unprofessional behaviour.
The unprofessional conduct starts to affect other workers' performance as well. It can destroy
ideal associations established by employers and employee (Pugh, 2011). Any behaviour or
conduct that unfavourably affects the ideal working of teams is considered to be unprofessional.
The unprofessional misconduct by the particular nurse will wrongly influence the remaining
staff. The registered nurse should not have involved himself with the female patient that was in
the hospital for opioid analgesia and assistance with personal nurse care. The registered nurse
was punished with 18 months of registration cancellation later decreased to 12 months because
of his honesty and cooperation during the hearing. The registration cancellation was decreased
with terms and conditions.
Medical professional limits are the gaps between the nurse’s authority and the service user
exposure (Green, 2017). The influence of the medical professional comes from the nurse’s
professional situation and contact to sensitive individual evidence. The alteration in private facts
the registered nurse knows about the patient against personal facts the patient knows about the
nurse creates a disproportion in the nurse-patient association. Nurses should make every possible
effort to cure the imbalance and safeguard a patient-centred association (Høye, 2010). Limit
crossings are short-lived expeditions across professional ranks of behaviour that may be

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unintended, thoughtless or even purposeful while trying to meet a special therapeutic need of the
patient. Limit crossings can outcome in reappearance to established boundaries but should be
calculated by the nurse for possible contrary patient consequences and allegations. Repeated
limit crossings by the medical professionals should be evaded.
Getting professionally involved in sexual wrongdoing is a punishable action. Form of boundary
violation includes any sexually depreciating behaviour, troublesome or reasonably understood as
sexual actions by the patient. Sexual misconduct by a medical professional is a particularly
serious and criminal offense. No medical professional is allowed to establish a personal
relationship with the patient (Gentile, 2018).
In a fitness care setting or workplace, nurses need to behave in a certain manner (Hayes, 2017).
Mr. Nkomo had to behave in professional boundaries as well but he neglected the professional
boundaries and got involved with the patient on an emotional and physical level. The registered
nurse must have controlled his emotions at the time of duty and should have kept it professional
with the female patient. Healthcare professionals have to maintain a certain emotional distance
with the patients to avoid any complications. Mr.Nkomo should have maintained a professional
distance as well. He failed to maintain the distance and had to face registration cancellation
(Griffith, 2013).
Mr. Nkomo's professional misconduct made many people suffer. The first person to suffer was
himself. His nurse registration was cancelled. The second person that had to go through a tough
situation was the female patient. The registered nurse also let down his healthcare workplace
colleagues and the superiors. The hospital's goodwill was wrongly affected because of the
unprofessional behaviour of the registered nurse. People must have started thinking the hospital
staffs are unprofessional and careless.
A patient that approaches a doctor or medical professional trusts the medical professional with
their life. Patients show blind trust in doctors and nurses and return, medical professionals, must
provide the best and quality service to the patients and help them recover and make them return
to their normal life. The healthcare profession is considered to be a noble profession because
they aid in saving human life. Crossing the medical boundaries is extremely unprofessional and

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medical professionals involved in the misconduct must be punished. According to the present
case, the registered nurse received the penalty because of his immature behaviour.
Nurses are the most trusted in the healthcare sector. Nurses are the ones that provide care to the
patients 24/7. Nurses are ones that treat patients and help the doctors aw well in providing care
service. According to the case, the registered nurse let down the entire healthcare workplace and
the patient involved in the case also left with a wrong impression of the healthcare workplace.
The registered nurses just have monitored the female patient and should have maintained a
professional relationship with her. Involvement with the female patient personally was
disrespecting the duty. Healthcare professionals are not allowed to establish any relationship
with the patients. Professionalism is not all about how you behave or how expert you are in your
job. It is also about getting the job done correct. It is therefore hard to tell that someone is
unprofessional by just merely depending on their skills. According to the case, the registered
nurse was skilled in his job but failed in controlling his behaviour at work and had to face a
penalty. The registered nurse was honest and accepted the entire allegation made in the past.
Because of his honesty, his registration cancellation duration was decreased with terms and
conditions. There is no mercy for unprofessional behaviour in the medical workplace.
The only system based error that was recognized as the healthcare workstation should take
regular counselling for the nurse to keep them aware of the seriousness attached to the
profession. It is also essential for healthcare workstations to improve the worth of the
surroundings (Yousri, 2011). The nursing counselling by the superiors will benefit is a quality
improvement as well. Personal involvement with any patient is highly unprofessional and it
should be made very clear in the nurse that personal involvement of nurses with the patients will
not be tolerated and the particular nurse involved will have to take a direct registration
cancellation penalty.
This essay has analysed a case in which a registered nurse established a sexual relationship with
a female patient. This essay has analysed a case and expressed what the nurse's omissions were
and how the nurse should not have crossed the boundary line. This essay has also decorated how
the conditions have been controlled by improving the worth of the fitness care centre through

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medical professionals or nurses' counselling. It is essential for health care professionals to act
mature and handle patients with care at the fitness care workstation.
References
Dall, T.M..C.Y.J..S.R.F..M.P.J., 2010. The economic value of professional nursing. Medical
care, (1), pp.97-104.
Gentile, K., 2018. Assembling justice: Reviving nonhuman subjectivities to examine institutional
betrayal around sexual misconduct. Journal of the American Psychoanalytic Association, 66(4),
pp.647-78.
Green, J., 2017. Nurses’ online behaviour: lessons for the nursing profession. Contemporary
nurse, 53(3), pp.355-67.
Griffith, R..&.T.C., 2013. Maintaining professional boundaries: keep your distance. British
journal of community nursing, 18(1), pp.43-46.
Hayes, J.A., 2017. Values-based nursing and fitness to practice issues. Springer, 1, pp.175-89.
Høye, S..&.S.E., 2010. Professional and cultural conflicts for intensive care nurses. ournal of
advanced nursing, 66(4), pp.858-67.
Pugh, D., 2011. A fine line: The role of personal and professional vulnerability in allegations of
unprofessional conduct. Journal of Nursing Law, 14(1), p.21.
wales, N.s., 2019. Health Care Complaints Commission v Nkomo [2019] NSWCATOD 106.
summary report. south wales: Case law New south wales.
Waterbury, J.T., 2001. Refuting patients’ obligations to clinical training: a critical analysis of the
arguments for an obligation of patients to participate in the clinical education of medical
students. Medical education, 35(3), pp.286-94.
Yousri, T.A..K.Z..C.D..F.R., 2011. Lean thinking: can it improve the outcome of fracture neck of
femur patients in a district general hospital?. Injury, 35(3), pp.1234-37.