Nursing Ethics Case: Analysis of HCCC v Picones, Patient Care

This report provides a thorough analysis of the Healthcare Complaints Commission Versus Picones case, which involved a Registered Nurse (RN) whose registration was cancelled due to professional misconduct. The case centered on the RN's failure to provide effective nursing care and maintain appropriate professional boundaries with three vulnerable patients in a child and adolescent mental health unit. The report details the RN's actions and omissions, including providing unauthorized medication, cigarettes, and access to a mobile phone, as well as failing to intervene in self-harming and sexual situations. The analysis also considers system-based errors, such as ineffective medication charts and inadequate supervision. Furthermore, the report outlines the actions the RN should have taken, referencing NSW Nurses Code of Conduct and ethics, and relevant NMBA standards. The conclusion emphasizes the impact of the RN's breaches on patient well-being and the tribunal's justified actions.

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Name of the Student
Name of the University
Author Note

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Introduction
The case law that has been selected for this essay is the Healthcare complaints Commission
Versus Picones case. The case involved an Registered Nurse (RN) whose registration has been
cancelled by the Healthcare Complaints Commission for professional misconduct. The complaint
had alleged the failure of MrPicones to provide an effective nursing care as well as to maintain
appropriate professional boundaries associated with his care of three vulnerable patients in the
Child and Adolescent Mental care health unit at the Orange hospital in the year 2015. In the
following paragraph, a detailed discussion of the actions, omissions and other factor that leads to
this misconduct has been discussed (hccc.nsw.gov.au., 2020). Along with this, detailed
discussion about the current guidelines that can guide the management in such situation and the
actions that should have been taken by the RN that is Mr Picones that could have prevented the
misconduct from happening has also been discussed bellow.
Discussion
Amongst the 3 patient who was kept under the supervision of the RN, patient A, who was 15
years old, was admitted due to his/her self harm tendency, emotional deregulationandintense
suicidal ideation. Patient B was 14 years and was admitted for 4 and a half period to the unit with
a diagnosis of anorexia, with periods also in the pediatric unit when her weight was dangerously
low. The third patient was patient C who was 16 years old and was admitted to the unit for his
benzodiazepine addiction which had led him to attempt to commit a drug based suicide. The
HCCC requested and was granted permission on the morning of the hearing to submit a further
complaint 4 that Mr Picones had made false and misleading statements to the LHD inquiry in a
letter dated 12 December 2015 refusing to give Phenergan to patients A, B and C.

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Actions and omissions
The first action of misconduct performed by Mr Picones is suppling patient A, B and C with
Phenergan on more than a single occasion, specifically in circumstances where this medication
neither has neither being prescribed nor charted. Patient C, together with patient A and B alleged
that they were also been provided with Phenergan by Mr Picones in more than one occasion
while neither of them were being prescribed or charted to take the medication..
The second action of Mr Pincone included providing Patient C with the access to his mobile
phone.
In addition the two above mentioned actions, the third action that has been performed by Mr
Picones was provision of cigarettes to patient A and C who was 14 years old. This in turn has
allowed the patient to smoke and hence enhanced the risk of deterioration of his health
(hccc.nsw.gov.au., 2020).
The fourth action of the accused is providing patient C with Temazepam, Valium and Tramadol
on multiple occasions when it had not been ordered or prescribed.
The fifth action conducted by Mr. Picones is that he made remarks To Patient B about the
quantity of particular drugs, including Phenergan, required to overdose and also allowing her to
access his phone in order to check the patient’s face book account.
The sixth action of Mr. Picones included taking photograph unauthorized of Patient C with
another patient and the sixth action included inappropriate personal disclose about other staff
members. Additionally, he forbade patient A and B not to disclose his actions since he was afraid
of losing his job.

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While these are the actions conducted by him, that resulted in breaching of the Nurses Code of
Conduct and Code of Ethics, a good number of omissions, that is scenarios where he should have
taken actions but had not taken the same, has also been reported.
The first omission includes declining to take any intervention when the RN had noticed Patient A
was conducting self harming behavior.
Additionally, he also declined to take any action to intervene when he observed patient A in a
sexual situation with another patient and instead of preventing the same, he had made sexual
remarks following the incident.
Finally, he had not kept any written records of the supply of his medication in breach of NSW
Health Policy, Health Care Records – Documentation and Management s 2.4 and 7.6 (Cowin et
al. 2019).
Other factors
While system based errors like mix of skills, ratios or mix of adult and children in the same unit
has been reported that can led to the thought that the accused RN, Mr Picones is not entirely
responsible for his action, the question that how the action conducted by Mr Picones get
unnoticed and how they are allowed to happen for a prolonged amount time is obvious to arise.
One major system based error that can be pointed out in this case is lack of maintenance of
effective medication charts. Considering the fact that it is the responsibility of the management
of a healthcare organization to ensure regular monitoring of the unit, looking after appropriate of
maintenance of effective medication charts, so that any kind of breaches, meditational error and
misconduct performed can be detected in the preliminary stage and eradicated (Furst& Salvador-
Carulla, 2019). Thus, it can be clearly understood that this case also points out the failure of the

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management of Orange hospital to prevent the breaching of the Nurses Code of Conduct and
Code of EthicsThe management of nursing personnel in hospitals or clinical facilities by the
service providers is responsible. They supervise the care of patients, take policy and budget
decisions, develop job schedules, schedule meetings and take personnel decisions.First of all, it
is the role of nurse manager to keep up to date reports of each and every patients in a specific
units along with the keeping records of the medications provided to them (Moore, Sublett &
Leahy, 2016). Lack of surveillance on vulnerable patient which is highly crucial was not
performed and inadequate supervision on the action of each patient is evident from this case.
Secondly, when Mr Picones was detected to perform unauthorisedactivities for the first time and
was allowed to continue his job, the nurse manager should have kept a more strict surveillance of
his activity of prevented this breaches from happening.
Along with the nurse manager, other nurses who were stipulated to take care of the three patients
also share the responsibility to report any kind of discrepancy in the health of the patients. They
are also supposed to keep as strict vigilance of the actions and where abouts of the patients,
especiallypaediatric and vulnerable healthcare service uses. As per the NSW Code of conduct,
vulnerable patients are not supposed to left alone by the service providers so that any wrong
action by the patients like unapproved consumption of an medicine, self harming activities and
sexual activities can be prevent (Ingham-Broomfield, 2017). Thus it can be clearly understood
that the patents were not supervised strictly that enable them to perform the above
mentionedactivities.
Actions should have been taken by the RN

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A good number of actions that should have been taken by the accused RN, Mr.Picones keeping
alignment to the NSW Nurses code of conduct and ethics can be pointed out. In order to avoid
breaching the NMBA standard 1.4 that is “ A Registered nurse should complies with legislation,
regulations, policies, guidelines and other standards or requirements relevant to the context of
practice when making decisions” Mr. Picones should have prevented himself from providing the
patents with medications like Phenergan and other medicines when they are not charted or
prescribed by the physician (nursingmidwiferyboard.gov.au., 2020). Phenergan is considered to
an antihistamine with sedating effect and this medication should only be given when being
prescribed by doctor in order to prevent adverse impact on the health of the patient.
Secondly, Mr.Picones, in order to prevent the allegation of misconduct, should have followed the
NMBA standard 1.5 which is “using ethical frameworks when making decisions”. Instead of
providing the patents with cigarette and mobile phone, he should have discourage such actions as
a Registered nurse following the mentioned NMBA standard (Cowin et al., 2019). Provision of
mobile phone is strictly prohibited during the treatment phase in order to prevent any kind of
adverse influence on the patient from outside (Ingham-Broomfield, 2017). In addition to this,
provision of any gadgets for communication while treatment of a patient is going on also bears
the risk of violation of confidentiality of the patient. Providing patent with cigarette can impose
highly native impact on the patient’s heath and thus should have been restrict himself from
providing cell phones and cigarette to the patients along with strictly prohibited by Mr.Picones as
a RN. Considering the fact that all the three patients were from the paediatric unit, Mr Picones as
the RN should have establish effective relationship with them in order to develop a bond of trust
and discourage them from using mobile and consuming cigarettes (Furst & Salvador-Carulla,
2019).

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The accused RN has also breached, NMBA standard 1.6. As a RN he should have maintained an
accurate, comprehensive and timely documentation of the actions taken by him (Cowin et al.,
2019)..Also , instead of declining to intervene the self harming action of patent B and sexual
situation with another patient by patient A, as a RN he should have immediately intervene,
intervene the action and report the same to the nurse manager. As per the NSW Nurses Code of
Conduct and NMBA standard 6.6, an RN should use appropriate processes for identifying and
report any potential and actual risk system issues and where practice may be below the expected
standards (Fisher, 2017).
Conclusion
From the above discussion, it can be concluded that the accused have not only breaches NSW
Nursing code of conduct and Code of Ethics which possess the potential to impact negative
impact on the heath as well as well being the patients. Hence, justified action against him has
been taken by the tribunal in order to prevent him from engaging in such activities in future. As
final verdict, The Tribunal made three proactive orders that includes cancelation of the
registration of Mr. Picones on an immediate basis, preventing him from applying for a review of
the cancellation order for a period of 12 months and preventing him from undertaking any health
service as defined by section 4 of the Health Care Complaints Act.

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References
Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019).The relevance of nurses and
midwives code of conduct in Australia.International nursing review, 66(3), 320-328.
Fisher, M. (2017). Professional standards for nursing practice: How do they shape contemporary
rehabilitation nursing practice?.Journal of the Australasian Rehabilitation Nurses
Association, 20(1), 4.
Furst, M. A. C., & Salvador-Carulla, L. (2019). Intellectual disability in Australian nursing
education: Experiences in NSW and Tasmania. Journal of Intellectual & Developmental
Disability, 44(3), 357-366.
hccc.nsw.gov.au. (2020). RN Kevin Picones – Registration cancelled for professional
misconduct - NSW Health Care Complaints Commission. Retrieved 26 March 2020,
from https://www.hccc.nsw.gov.au/Publications/Media-releases/2018/RN-Kevin-
Picones---Registration-cancelled-for-professional-misconduct
Ingham-Broomfield, R., 2017.A nurses' guide to ethical considerations and the process for
ethical approval of nursing research.Australian Journal of Advanced Nursing, The, 35(1),
p.40.
Moore, L. W., Sublett, C., & Leahy, C. (2016). Nurse managers’ insights regarding their role
highlight the need for practice changes. Applied nursing research, 30, 98-103.
nursingmidwiferyboard.gov.au. (2020). Nursing and Midwifery Board of Australia - Registered
nurse standards for practice. Retrieved 26 March 2020, from

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https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-
standards/registered-nurse-standards-for-practice.aspx