Legal and Professional Issues in Nursing: A Case Study Analysis Report

This report examines legal and professional issues in nursing through a case study analysis. It explores various scenarios, including the absence of a surgeon, improper nurse-patient ratios, incomplete documentation, uncertain medication administration, and nurses' inability to recognize patient acuity. The report delves into the legal and ethical implications of each issue, referencing relevant codes of ethics and legal ordinances, particularly those applicable in Hong Kong. It highlights the responsibilities of nurses towards their patients, employers, and society, emphasizing the importance of ethical conduct, professional judgment, and adherence to established standards of care. The analysis covers topics such as medical negligence, patient safety, and the impact of staffing shortages on patient outcomes, providing a comprehensive overview of the challenges faced by nurses in maintaining ethical and legal compliance within a healthcare setting. The case study involves a patient who underwent surgery and experienced complications, highlighting the importance of proper documentation, communication, and adherence to professional standards to ensure patient safety and well-being. The report concludes with the ethical and legal responsibilities of nurses, highlighting the significance of professional judgment and patient advocacy.

Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
Legal and professional issues in Nursing
Name of the student
Name of the University
Author note

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LEGAL AND PROFESSIONAL ISSUES IN NURSING
Table of Contents
Introduction:...............................................................................................................................4
Key events:.................................................................................................................................4
1. Absence of the surgeon:......................................................................................................5
Legal:......................................................................................................................................5
Ethical:...................................................................................................................................6
2. Improper nurse – patient Ratio:..........................................................................................6
Legal:......................................................................................................................................6
Ethical:...................................................................................................................................7
3. Improper recording in the documents:................................................................................7
Legal:......................................................................................................................................7
Ethical:...................................................................................................................................7
4. Uncertain status of medication administration:..................................................................8
Legal:......................................................................................................................................8
Ethical:...................................................................................................................................8
5. Inability of the nurses to recognize the patient acuity:.......................................................9
Legal:......................................................................................................................................9

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Ethical:...................................................................................................................................9
6. Improper judgment of the nurses:.......................................................................................9
Legal:....................................................................................................................................10
Ethical:.................................................................................................................................10
7. Distress of the female patient:..........................................................................................10
Legal:....................................................................................................................................10
Ethical:.................................................................................................................................11
8. Absence of administration from the hospital authority:...................................................11
Legal:....................................................................................................................................11
Ethical:.................................................................................................................................11
9. Absence of the Nurse-in-charge:......................................................................................12
Legal:....................................................................................................................................12
Ethical:.................................................................................................................................12
Conclusion:..............................................................................................................................13

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LEGAL AND PROFESSIONAL ISSUES IN NURSING
Introduction:
The profession of nursing is the holistic approach to the society and the nurses are
responsible towards their patients, employers and their society. Every nurse should have
distinct ethical feelings on their mind to provide the patients with competent care. Their
loyalty to ethics is also responsible for their contribution to the society and the profession. It
is very important that the nurses have an understanding over various ethical, legal and
professional issues, which they would often face while working in a healthcare facility
(Morton et al. 2017). The Hong code of ethics for the nurses has divided the code into four
main parts. They are respectively Nurses and people (the responsibility of a nurse towards
the patients), Nurses and practice (the responsibility of a nurse to provide the patients with
safe and competent care), Nurses and Profession (a nurse’s responsibility towards the holistic
profession of nursing) and Nurses and society (responsibility of a nurse to the society). A
nurse practicing in Hong Kong would also have to be accountable with the laws relevant to
the profession (Nchk.org.hk 2017).
Key events:
 When Mr. Symes, the patient who underwent laparoscopic cholecystectomy on 21st
May morning, reported that he is experiencing severe abdominal pain, his surgeon
failed to assess him. However, a Medical Officer (MO) was present there who
assessed him and contacted the surgeon. Both of them made a join decision of
prescribing 10 mg morphine to the patient subcutaneously.
 The Extended Day Only Unit (EDOU) was at full capacity that day and only two
Registered Nurses (RN) were the only nurses who was rostered to the attend the night
shift that day. The nurse-patient ratio was improper at that day.

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 The nurses did not properly document the observations after assessing Mr. Symes.
Only one observation was documented, that too without any reference to the status of
the abdominal pain of the patient.
 The nurse did not record any of the analgesia administration on Mr. Symes. The day
RN did not found any records of the drug administration when she commenced her
work.
 Two of the other male patients were in distressed condition during the shift of Nurse
Prior apart from Mr. Symes. The nurse could not recognize the critical acuity of the
patients.
 An upset female patient was distressed about her bed arrangement. She was angry and
was continuously wailing over the problem. This was upsetting the total environment
of the hospital ward.
 The female patient and her husband have reported the issue to the hospital
management. However, the management has not taken any measures to resolve the
situation.
 The case study does not provide any information about the nurse-in-charge. However,
it is recommended that ne nurse-in-charge must be present in every ward of a hospital
every time (Haber and Singh 2014).
1. Absence of the surgeon:
Legal:
All physicians have a legal duty over the patients to provide them with certain
standards of care. When a physician agrees to provide a patient with proper treatment, the
legal duty of the doctor over the patient is created. The surgeon who performed the
laparoscopic cholecystectomy on the patient Mr. Symes is legally bound to see the patient if

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the patient needs him in distress. When the MO called him, he attended the call but he did not
find it necessary to access the condition of the patient at that time.
Ethical:
It is also the ethical duty of a doctor to see a patient in distress (Guinane et al. 2013).
Any medical practice can be implicated as a holistic approach towards the society and it is
said that it is the duty of a doctor to see a patient in distress (Kangasniemi et al. 2014). When
the patient reported that he is suffering from severe abdominal pain, the surgeon being his
doctor and his primary treatment provider refused to come to see the patient, which is against
the ethical duty of a doctor.
2. Improper nurse – patient Ratio:
Legal:
The Australian Nursing and Midwifery federation has strongly recommended that one
nurse should be present for every four patients to provide every patient with adequate care
(Shekelle 2013). It is also said that if the ward consists of many high acuity patients, then one
nurse must be allocated to provide care for the smaller number of patients (Zhu et al. 2012)
(Butts, and Rich 2012). It is also recommended that there should be one nurse-in-charge per
ward to direct the whole system of caregiving. According to the code of ethics and
professional conduct for nurses in Hong Kong standard 5.2, it is the ethical obligation of the
nurses is that, they are responsible for their own standards of practice (Nchk.org.hk 2017).
Due to the shortage of the nurses in the ward, the present nurses could not maintain their own
standard of practice.

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Ethical:
There is a shortage in the number of nurses in the healthcare sector all over the world.
This is the reason carrying out the ethical obligation properly is hard for the nurses. The first
ethical obligation any of the nurses face is their duty to protect the patients from any potential
harm. Due to the shortage of the nursing staff, it gets difficult for the remaining nurses, as
they have to provide care for several patients at once. The nurse – patient ratio is never
maintained due to this. The hospital ward mentioned in the case study only had two nurses at
the night duty (with 12 patients and 3 critical patients) whereas the required nurse – patient
ratio is one nurse per four patients.
3. Improper recording in the documents:
Legal:
Incomplete and improper documentation actually demonstrates that the nurse
provided the patient with inadequate care (Alspach 2013). If something bad happens to the
patients, the incomplete documentation is used as a legal document to provide evidence that
the nurse have not properly treated the patient. This could bring legal complication to the
career of a nurse. If a nurse produce any incomplete documentation of clinical records, the
nurse can lose the license to practice (Joel 2013). In the case study, the nurses have not
produced any proper documentation of the patient’s condition.
Ethical:
According to the code of ethics and professional conduct for nurses in Hong Kong
(4.2), the nurses have to ensure the individual safety and will have to practice safe and
appropriate care to the patients (Nchk.org.hk 2017). In this case study, the nurses have not

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properly documented the reports of Mr Symes. This breaches their ethical duty to provide
safe care for the patient. If a nurse properly document the condition of the patient over their
duty, the doctors and the other nurses finds it helpful to take care of the patient from such
point.
4. Uncertain status of medication administration:
Legal:
If a nurse does not register the status of medication administration, it can easily fall
under some of the Hong Kong Law ordinances like the Hong Kong Bill of rights ordinance
(383), medical health ordinance, Hospital Authority Ordinance (113) and Nurses Registration
Ordinance (164) (Nchk.org.hk 2017). If a nurse is accused of not providing the medicine to
the patients properly, he or she can lose his or her registration to work as a nurse.
Ethical:
As the profession of nursing falls under a license of privilege, there are some
additional professional responsibilities of a nurse including drug safety and medication
administration. As the nurse is the primary caregiver of the patient, he or she holds
professional responsibility of his or her own action. Every state of every nation provides the
nurse with codes of ethics to avoid the consequences. The Hong Kong Code of ethics
standard 5.2 clearly states every nurse has to provide the patients with best standard of care as
possible (Nchk.org.hk 2017). Handing over a patient with unsure status of drug
administration to other nurses is not a proper example of best standard of care. Ethically it is
also wrong to hand over the logbook of a patient, which does not mention if the patient
received his or her medication.

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5. Inability of the nurses to recognize the patient acuity:
Legal:
The nurses always have to produce responsible nursing judgments and produce action
according to that judgment. In that case, Nurse Prior has failed to recognize the severity of
the condition of the patients, which puts all the patients in dangerous condition. If any of the
patients is harmed due to, the nurse’s inability of judging the severity of condition, the
hospital and the government holds the legal right to terminate the registration of the particular
nurse (Urden, Stacy, and Lough 2015).
Ethical:
As the ward has only two nurses and there were many patients in that ward for the
nurses, it is understandable that the nurses had a hectic work to keep up with all the patients.
Apart from Mr. Symes and the woman patient, two other male patients were also distressed
during that time. It is the ethical duty of the nurses to provide the best possible standard of
care to the patients whatever the circumstances is (standard 4.5) (Nchk.org.hk 2017). The
Hong Kong code of ethics also directs the nurses to ensure that the standard of practice is in
synchronization with the standard of profession (Standard 5.2) (Nchk.org.hk 2017). The
nurses could not maintain the ethical codes during the time of their duty. As four of the
patients were in distressed condition, the environment of the whole ward is also chaotic and
must be uncomfortable for the other patients as well. The ethical duty of the nurse to maintain
the environment of the situation was also breached as well.
6. Improper judgment of the nurses:

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Legal:
The improper judgment of a nurse put any patient at risk (Fowler, and Davis 2013).
The patient Mr. Symes was in pain after his surgery and when the nurse assessed him, she did
not document the severity of the patient’s abdominal pain. Any incomplete documentation
can put the nurse in legal bounds as the patient’s family and the hospital can accuse the nurse
of showing irresponsibility (Huston 2013).
Ethical:
According to the Hong Kong Nursing standard 4.3 and 4.4, the nurses are accountable
and hold the responsibility of producing professional nursing judgment. The nurses failed to
judge the condition of Mr. Symes as he was complaining of severe abdominal pain. The
nurses was ethically irresponsible for the condition of Mr. Symes as they did not properly
documented the medication administration of the patient, so, it can be possible that she did
not inject the morphine to the patient. It is against the ethics of a nurse to put a patient in such
a condition (Kim, Kang, and Ahn 2013).
7. Distress of the female patient:
Legal:
The nurses did not take any step to solve the problem of the female patient. The whole
incident can drag both the hospital authority and the nurses in legal trouble. The patient and
the family have the legal right to go to the court and accuse the hospital authority and the
nurses for incompetent service.

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LEGAL AND PROFESSIONAL ISSUES IN NURSING
Ethical:
The female patient was distressed because she was in a room with many male
patients. The patient was in distress because of her religious views. According the Hong
Kong code of ethics 1.1, the nurse is ethically bound to serve all patients irrespective of their
gender, religion, cast, ethnicity, political background and socio-economic status (Nchk.org.hk
2017). The Hong Kong code of ethics 1.4 also states that, a nurse have to respect the view,
beliefs and customs of every individual (Nchk.org.hk 2017). By not reporting the incident,
the nurses have also disrespected the religious belief of the patient. The all over environment
of the hospital was also hampering because of the situation and the nurses are ethically bound
keep the ward environment therapeutic for all the patients.
8. Absence of administration from the hospital authority:
Legal:
As the hospital, management has ignored the patient’s plight to change the room
because of her religious views. The patient and her family can also file a lawsuit against the
hospital administration.
Ethical:
The key duty of the hospital administrators is to hold the main responsibilities of a
healthcare facility to keep all the responsibilities functioning efficiently (Chan et al. 2012).
The work of the hospital management is to strategize, lead and manage the medical service
(Grohar-Murray, DiCroce and Langan 2016). When the female patient and her family
reached to the hospital management themselves, they did promise them to solve the problem
as soon as possible. However, they did not change the patient’s seat as promised. It is also the

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responsibility of the hospital to respect the view and belief of a patient. Nevertheless, the
hospital authority forgot their ethical duty and ignored the patients. They also forgot their
work ethics of keeping the hospital functioning at its best as they did ignore them, which
caused enormous distress in the ward.
9. Absence of the Nurse-in-charge:
Legal:
Every ward of a hospital should have a Nurse-in-charge, who generally directs the
whole situation in a proper way (Chan 2013). The absence of a nurse-in-charge can put the
life of the patients at risk if the other inexperienced nurses of the ward could not maintain the
completely critically distressed condition of the ward (Cohen et al. 2014). In this case
scenario, it is not mentioned that if a nurse-in-charge was present in that situation and the
nurse patient ratio was 1:6 which was also distressing for the nurses (Sullivan 2012) (Parahoo
2014). If any of the patients files a lawsuit over the loss, they have encountered because of
the distressed condition of the ward; it can put the hospital authority in legal trouble.
Ethical:
Not having a nurse-in-charge in the ward shadowed the judgment of the other nurses
present in the facility. The distressed condition of the ward jeopardized the safety of all the
patients. The Hong Kong code of ethical standard 4.6 states, the nurses cannot take any
actions, which may put the patients at risk or jeopardize the situation. Absence of the nurse-
in-charge left both the RNs with huge responsibility over their duty. Moreover, the absence of
the other nurses at this scenario has also made the nurses to provided compromised care to
the patients. The Hong Kong code of ethics 4.7 states that a nurse can raise objection over the
practice, which lowers the allover standard of the care-giving process. However, the nurses

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LEGAL AND PROFESSIONAL ISSUES IN NURSING
did not object about it to the hospital authority. This is also a breach of the ethical
responsibility of a nurse according to the Hong Kong code of ethics for the nurses standard
4.7(Nchk.org.hk 2017).
Conclusion:
If anyone looks at the healthcare industry, one can perceive that legal and ethical
issues are prevalent in the profession of nursing. Many nurses do not even have formal
education in the legal and ethical issues, which could arise in a hospital situation. This can
harm the overall condition of the healthcare facility as they can unknowingly be breaching
many legal and ethical codes related to the profession of nursing. As the nurses works with
the patients from different strata of the society in an environment, which is extremely
dynamic, legal and ethical issues can arise. The nurses can avoid the situation by rising
awareness about all possible legal and ethical issues.

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