Case Law Analysis of Professional Accountability in Nursing: Ethics

This essay examines a case law involving four registered nurses and the death of a patient in a psychiatric intensive care unit (PICU). The analysis focuses on the actions and omissions of the nurses during both day and night shifts, highlighting failures in observation, documentation, and communication. System-based factors, such as staffing shortages and inadequate policies, are also discussed as contributing to the adverse outcome. The essay references evidence-based literature, including NSW health policies, to outline the actions that should have been taken by the nurses to prevent the patient's suicide. The paper concludes with the importance of adhering to responsibilities and having skills for identifying adverse events to manage any complications for the patients, and the consequences of professional misconduct.

Running head: PROFESSIONAL ACCOUNTABILITY
CASE LAW
Name of the Student:
Name of the University:
Author Note:

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Introduction
In any healthcare settings or organisation, registered nurses (RNs) are the frontline
executive who provides direct care to patients and their families. They are responsible for
multiple-element, such as delivering error-free care or effective therapeutic communication to
ease the pain of the patients and improve the overall health outcome. Therefore, it is expected
from the nursing professional to effectively follow the rules and regulation while delivering
their duties and responsibilities. They should not conduct any malpractice or practice any
illegal administration towards the care of patients. One such example can be sharing the
medical records without any permit. Such practice or any related illegal health-related issue
would lead in suspension or even worse that is a cancellation of registration for nursing
professionals. Thus, the nurses need to adhere to the guidelines and provides effective care to
the patients. This paper would discuss the case law on four registered nurses. This essay
intends to examine the case and relevant evidence-based approaches for preventing the
adverse effects by the nursing professionals.
Case References: In this case, the decision was made on two stages, and thus, two
different paper on the same case was reviewed. (Caselaw.nsw.gov.au 2020)
Link: [https://www.caselaw.nsw.gov.au/decision/5c8b2f34e4b02a5a800bf4e3 and
https://www.caselaw.nsw.gov.au/decision/5cb7c8e9e4b0196eea40634b]
Background of the Case
The case is concerned about the death of a patient. Her name was Ahlia Raftery, who
was 18 years old and took her life. She was admitted to the Psychiatric Intensive Care Unit
(PICU), and she was an involuntary patient. The reason she was transferred to PICU was
because of her higher chances of suicide. It has been found that she had used bedsheet of her
room as a noose and hung herself by the door of her room. The incident took place within

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6:30 am to 7:30 am on March 19, 2015. There were a total of three shifts and thus, six
registered nurses were responsible for her wellbeing. As the incident occurred in the morning,
four nurses were held accountable. The incidence includes relative odd behaviour of the
patient. She was standing behind the door in the poorly lit corridor and staring towards the
nursing station without any movement. This was the way the patient attempted suicide. Mr
Lily, Ms Drinkwater and Mr Davies were held responsible, and their registration was
cancelled.
Action and Omission in the Night Shift
The night shift timing is from 11 pm to 7 am. Mr Davies and Ms Drinkwater were on
duty, and Ms Drinkwater was the in-charge (NIC) of the night shift. The major action that led
to the adverse events were lack of insight and observation by these nurses who were available
in the shift. These nurses fail to handover the details of the patient to the upcoming day shift
in the appropriate time. Mr Davies has left early before the shift ends by 6:48 am. However,
he signed the observation sheet of stating 7 am. In addition to this, during the night shift, the
observation sheet was signed and filled by Ms Drinkwater; however, from midnight till 5 am,
the observation sheet was filled by some other nursing staff. In the same time, that same
particular nurse has signed an observation sheet of three other patients. The major omission
that led by these nurses were not filling the observation form. They received only verbal
observation from the afternoon shifts nurses. The nurses were informed by the afternoon
shifts nurses that the patient is at high risk of suicide. Additional information about
attempting suicide in the previous ward was also informed. However, all this information
were not recorded. Another omission is Mr Davies signed in multiple observation form in the
same period.

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Action and Omission in Day shift
The day shift starts from 7 am and ends at 3 pm. Mr Lily and Ms Than were on duty
that day. Mr Lily was a nursing manager and also NIC for the day shift. The major action that
the nurses did was lack of observation. Ms Than got to engage with another patient while
observing Ahlia from a distant. Mr Lily had taken the walkover at 7 am, which was
considered a grey area. Another major and significant action that has contributed to the
adverse effect towards the incident that the staffs from the night shift did not pass the relevant
information to the staffs of the morning shift. Thus, their actions led to professional
misconduct. The nurses from the day shift were assuming that the patient is awake and is
standing behind the door of her room. The omission led by Mr Lily was not being able to
supervise and manage the activities of these nurses. Mr Lily had relied on his assumption,
and there was no such observation done at 7 am. As a nursing manager, he was responsible
and accountable for the effective monitoring and observation of the patient. Due to multiple
combinations of elements and factors, it has been clear that the observation was taken from
distant. However, it was advisable that the observation is very crucial and must be taken in 15
minutes.
System-Based
The major reason for this adverse effect was the lack of managerial skill in the
nursing manager. Another major system based factor was a scarcity of the nursing
professionals in the PICU. Each nurse needs to follow and observe multiple patients at the
same time. Thus, it would lead to a lack of administration along with the observation skills
among the nursing professionals. The observation form was not properly filled by the nursing
professionals, and there were no such monitoring and evaluation of the observation form.
This practice has encouraged the nursing professionals for not adhering the regulations and
guidelines for filling the observation form. The lack of communication or clarity of

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responsibilities among the nursing professionals has also contributed to the system based
errors that lead the adverse incidence. The suicide was done within the premise of the
healthcare settings or her bedroom. The handle of the door can be considered as a system-
based error as the handle had been used as a ligature point by the patient. Another system-
based error can be considered as poor policies or regulations. There was no such policy
within the healthcare settings that involve the particular regulations for closely observed
patients. The nurses were allocated in the same usual manner, and there were no special care
or extra staff provided for the closely observed patient. In this case, as well, the nursing
professional had to observe multiple patients. For illustration, Ms Than was busy addressing
to another patient while observing Ahila from far.
The literature on Evidence-Based Approach
The major action was not maintaining the observation towards the patient and along
with that did not provide relevant entries of the patient. The patient was in a closely observed
category as she had already attempted suicide in her previous ward. However, the observation
was taken from distant and also not in every 15-minute interval. The skill of observation is
very crucial as it is the major attribute which led the nurses to identify any adverse changes
that occur to the patient and act accordingly (Kourkouta and Papathanasiou 2014). In the
recent NSW health policy, multiple guidelines describe the relevant information of the mental
health inpatient guidelines. As per the policy of NSW, observation is multifaceted, and it
includes therapeutic communication with the patient (Greenfield et al 2015). In this case,
both the attribute were missing, and there was a lack of therapeutic communication with the
patient as well.
For managing the suicidal risk and administration of the patient in the mental health
setting or unit, the NHS policy includes multiple guidelines which must be implemented in

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the healthcare unit. The first observation level must be constant, which must be practice when
the patient is in the highest risk for suicidal. Here, nursing professional must keep a one-
metre distance from the patient and not more than that. The patient must be under continual
visual observation. The second level of observation is observation in every 15 minutes
interval. If the patient is in high risk, then this protocol must be followed by the nursing
professionals in the healthcare setting. The next level is observation every 30 minutes, here
the observation must be random and checking for the location along with the activity of it.
The last two kinds of observation included in the policy are observation every hour and
observation within two hours interval (NSW 2017).
The major action by the nursing profession was lack of documenting and lack of
clarity in the responsibilities that have led to the adverse incidence to the patient. It is the
primary and basic responsibilities of the nursing manager in the healthcare setting for
ensuring that every staff within his administration should have clear knowledge and
responsibilities for delivering care to the patients. Another major attribute of the nursing
manager is that they need to randomly observe or review throughout the shift and tries
resolving any issues that have arisen (Merrill 2015). The major and important aspect is
documenting the observation effectively without any misguidance or negligence (Wang, Yu
and Hailey 2015). It was the basic problem of the case law. Besides, it is important to note
that each level of observation would need a different type of observational form.
The existing policy of the healthcare setting or mental health setting must be revised
accordingly to achieve the optimal health outcome of the patients. The health organisation
must take strict action towards the healthcare professional for any professional misconduct
within the premise of healthcare settings. Another evidence-based approach is the effective
allocation of nurses within the unit. The poor practice of allocation of nursing staff would
lead to adverse incidence and effects (Bjerregård et al 2016). Effective training is necessary

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for nursing professionals in the healthcare setting for understanding and having in-depth
knowledge of professional misconduct.
Conclusion
From the above discussion, it can be concluded that the nursing professionals must
adhere with their responsibilities and should have relevant skills of identifying any adverse
event that would help in managing any consequences or complications to the patient. As the
nursing professionals were responsible for providing care to the patients, their behavioural of
professional misconduct would lead them in loosing of their registration for practice. Three
nursing professionals’ registration has been cancelled, and they cannot request to review it
before 12 months.

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References
Bjerregård Madsen, J., Kaila, A., Vehviläinen‐Julkunen, K. and Miettinen, M., 2016. Time
allocation and temporal focus in nursing management: an integrative review. Journal of
nursing management, 24(8), pp.983-993.
Caselaw.nsw.gov.au, 2020. HCCC V Drinkwater (No 2); HCCC V Lilly (No 2); HCCC V
Davies (No 2); HCCC V Than (No 2) - NSW Caselaw. [online] Caselaw.nsw.gov.au.
Available at: <https://www.caselaw.nsw.gov.au/decision/5cb7c8e9e4b0196eea40634b>
[Accessed 10 April 2020].
Caselaw.nsw.gov.au, 2020. HCCC V Drinkwater; HCCC V Lilly; HCCC V Davies; HCCC V
Chan - NSW Caselaw. [online] Caselaw.nsw.gov.au. Available at:
<https://www.caselaw.nsw.gov.au/decision/5c8b2f34e4b02a5a800bf4e3> [Accessed 10 April
2020].
Greenfield, D., Hinchcliff, R., Banks, M., Mumford, V., Hogden, A., Debono, D., Pawsey,
M., Westbrook, J. and Braithwaite, J., 2015. Analysing ‘big picture’policy reform
mechanisms: the Australian health service safety and quality accreditation scheme. Health
Expectations, 18(6), pp.3110-3122.
Kourkouta, L. and Papathanasiou, I.V., 2014. Communication in nursing practice. Materia
socio-medica, 26(1), p.65.
Merrill, K.C., 2015. Leadership style and patient safety: implications for nurse
managers. JONA: The Journal of Nursing Administration, 45(6), pp.319-324.
NSW, 2017. Engagement And Observation In Mental Health Inpatient Units. [ebook] NSW
Health Policy maker, pp.1-20. Available at:

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<https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_025.pdf> [Accessed
10 April 2020].
Wang, N., Yu, P. and Hailey, D., 2015. The quality of paper-based versus electronic nursing
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of medical informatics, 84(8), pp.561-569.