Legal and Professional Issues in Nursing: Case Study and Code Analysis

This report delves into the legal and professional challenges faced by nurses, examining two case studies that highlight violations of the Singapore Nursing Board (SNB) Code for Nurses and Midwives and breaches of core competencies. The first case study focuses on an enrolled nurse who administered treatment outside her scope of practice, leading to suspension. The analysis explores the core competencies of enrolled nurses, emphasizing professional, legal, and ethical nursing practices, as well as the management of care and generic skills. It identifies specific principles of the SNB Code that were violated, including practicing responsibly and accountably, promoting professionalism, and practicing self-regulation. The second case study involves a registered nurse who falsified data and demonstrated a lack of integrity in patient care, breaching principles related to respecting patients' rights, practicing responsibly, maintaining accurate records, and upholding public trust. The report also outlines the role of the Complaints Committee in investigating such issues and underscores the importance of due care in nursing practice. The analysis references the Nurses and Midwives Act and emphasizes the significance of ethical conduct, adherence to professional standards, and the maintenance of patient safety within the nursing profession.

Legal and Professional issues in nursing 1
Legal and Professional issues in nursing
Author's name
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Legal and Professional issues in nursing 2
Case study 1
Introduction
The nursing profession is one of the most prestigious professions. This is not only due to
the association with the care of human lives but also the efficiency with which its members
perform. This performance, though individually attained, is guided by strict codes of conduct and
core competencies that ensure the nurses are adequately skilled and capable of managing the
health of people. Failure to adhere to the core competencies may cause the de-registering or
suspension of the named person.
The profession is client-centered and, like many other client-centered professions, its
major focus is to the ‘clients’, who are the community (Gostin, 2010). Thus, its actions are
subject to scrutiny by the clients and therefore it should prioritize them first. Failure to honor the
professional code of ethics and conduct is irreverent to the profession (Milton, 2017).
The case study illustrates the enrolled nurse’s failure to adhere to several core
competencies that resulted in her suspension. Moreover, she treated the patient without
supervision from a Registered Nurse (RN). The nurse operated outside her scope of practice,
hence, failed to meet certain core competencies and generic skills of Enrolled Nurses.
Question 1
Core competencies and generic skills.
Core competencies illustrate the understanding of nursing practice and act as a guide for the
nurses. These core competencies are categorized into domains and include; professional, legal

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and ethical nursing practice; management of care; and professional development (Singapore
Nursing Board, 2018).
Professional, legal and ethical nursing
This domain illustrates an understanding of practices and knowledge in nursing,
accountability, and responsibility of legal obligations in nursing practice. Moreover, it also
involves the demonstration of an understanding and maintenance of ethical nursing practice such
as complacency with the Code for Nurses and Midwives.
This competence domain also recognizes the differences in accountability and roles of the
registered nurse and the enrolled nurse, thus, ensuring both the nurses understand their respective
scope of operation. It also demonstrates the responsibility and accountability of care within their
scope of practice and competence. This allows the nurses to deliver the best possible care to the
patient. Thus, they act true with the vision of care in the best interest of the patient.
The nurse operated independently without supervision or consent from a registered nurse.
It showed that the nurse did not recognize her role in delegated care nor did she respect the
legislative policies and procedural guidelines for nursing practice. The treatment of the patient
outside a health facility not only hindered effective monitoring, but also the maintenance of
proper records. It was very unethical (O’Connell, 2004)
Enrolled Nurses (EN) are guided by regulations put in place by the Singapore Nursing
Board. Understanding their roles and maximally performing to their best creates efficiency in the
system. It also creates accountability since everyone’s role is clear. It ensures that the enrolled
nurses understand the chain of management thus creating a respectful and cohesive working
environment.

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These regulations also consist of measures taken in the event that an enrolled nurse does
not comply. The nurse did not demonstrate an understanding of ethical nursing practices nor did
he comply with the Code for Nurses and Midwives. The Nurses and Midwives Act (1999-2012)
contains the parameters required for a nurse to practice including the institution they are to work
in (Singapore Nursing Board, 2018). However, a patient’s home is not included in the list. It
indicates the nurse failed to adhere to the guidelines put forth by the Board warranting
disciplinary action.
Management of Care
The domain of Management of Care consists of a variety of competency standards that
include but not limited to maintaining a safe environment for the patient such as implementing
infection control procedures. The nurse's treatment of the patient at home might have
unnecessarily exposed the patient to more pathogens than at a health center. The home setting
also could not allow for effective monitoring of the patient’s condition unlike at a health facility
with extensive resources on standby including doctors and RNs available for consultations.
Generic skills
These are skills taught to Enrolled Nurses to enable them to practice and perform
accordingly. Generic skills combined with core competencies are the basis of registration as an
EN. These skills are a prerequisite for registration by the Board, hence, form part of the course
study prior to the completion of the nursing course. They are, therefore essentials and should be
performed competently.
The levels of independence in practice vary and are indicated in each skill. There are
three levels; performing the skills independently; performing the skills independently though

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under the guidance of a Registered Nurse (RN) who is also responsible for the delegation of said
skills; and finally assisting the Registered Nurse. In all these cases, the registered nurse is held
responsible for the actions and inactions of the enrolled nurse.
These skills cover various categories including management of care through intravenous
therapy. However, according to the core knowledge and generic skills, the Enrolled Nurse is
supposed to assist with intravenous therapy through scheduling of 24- hr. infusions and
calculating infusion rates, priming and connecting infusion sets, regulating infusion rate, and
monitoring and observation. They are also involved in operating and monitoring infusion pumps
and equipment (2019). They do not, however, administer the drugs independently only certain
components of medication such as the administration of feet enema and suppositories, as well as,
nebulizers. The nurse’s administration of Glutathione to the patient independently was outside
her scope of knowledge and skills hence failed to practice safely.
The nurse’s actions endangered not only through the ignorance of the rules and
regulations in the code but also by proving unaccountable and inconsiderate of her superiors. The
registered nurse whom she’s supposed to confer with would be reprimanded from her actions.
Question 2
Principles of SNB Code for Nurses and Midwives (2018) breached
The Code for Nurses and Midwives is a tool for the nurses and midwives and guides
them in practice. It sets out the ethical values, professional conduct, and practice standards. It
regulates the practice through several key principles that are meant to ensure the patient safety
and interests are given the first priority and that the practice of nursing/midwifery is safe,
effective and competent.

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In the study, several principles of the Code of Conduct were violated. The first being the
principle directing the nurse to practice in a responsible and accountable manner. This principle
is meant to create accountability and promote responsible behavior. The nurses/midwives are
liable and held accountable for all their decisions and actions during their practice. This is
achieved by recognizing and working within the limits of their competence and scope of
practice. They also must the practice is carried out in accordance with the ethical principles,
organizational policies, and requirements.
The nurse operated outside her scope of practice and used skills that she had not been
taught or authorized to perform. These actions endangered the patient and put him at risk. She
did not put the safety of the patient first. This was a breach of the Code.
Second, the principle involving the promotion of professionalism and upholding the
public trust. This would be achieved by; upholding and abiding by the set rules, standards and
values set out in the Code, being conscious of how their behavior and conduct may influence
others and the profession. The nurse did not abide by the values set in the Code and acted
without consideration of how her actions would affect the patient.
Lastly, practice self-regulation by being accountable to self, people, and the profession by
maintaining competence, ensuring they comply with the regulations stated, and upholding
personal integrity. The nurse showed a lack of integrity when she operated outside the scope of
her practice and did not comply with the guidelines written in the Code.

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Question 3.
Role and function of the Complaints Committee
The Complaints Committee’s primary role is to investigate any complaints or
information with respect to matters involving:
1. The conviction of nurses or midwives of an offense that renders him/her unfit to remain
on the Register or practice as an Advanced Practice Nurse.
2. Any misconduct, or negligence, of a registered nurse, registered midwife, enrolled nurse
or Advanced Practice Nurse which renders him/her unfit to remain on the Register or to
practice. ("Nurses and Midwives Act - Singapore Statutes Online", 2019)
3. The physical or mental fitness of a registered nurse/midwife, enrolled nurse or Advanced
Practice Nurse to perform his/her functions. (Nurses and Midwives Act, 2012)
Case Study 2
Question 1
In this case study, the Registered Nurse not only falsified data but also proved to lack
integrity and was irresponsible in the management of care. The nurse breached several principles
from the Code for Nurses and Midwives which act as guidelines for professional conduct, ethical
considerations as well as practice standards.
Among the principles breached include the first principle which is the respect for
people’s values, needs, and rights. Health care is a right and by failing to take the correct

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parameters, the nurse denied the patients proper healthcare which jeopardized their safety. She
did not respect the patients under her care.
Another principle breached was to practice in a responsible and accountable manner. The
nurse was irresponsible in her practice. She was not only unethical but also put the patients at
risk. She created an unsafe environment for the patients that would have negated the purpose of
the profession to provide competent care with consideration for the patients.
She also breached the principle to maintain clear and accurate records. She did not take
the time to collect the correct data, thus provided false records. Failure to provide accurate data
put the patients at risk of wrong health management thus making it unsafe for them.
The principle of professionalism and upholding the public trust. The nurse’s performance
did not uphold the reputation of the profession. Her performance was disrespectful and sharply
contrasted with the guidelines and values set in the Code. Her actions were inconsiderate and did
not take into account the effect and influence they would have on others and the profession.
She also breached the principle to practice self-regulation. This would include practicing
within her level of competence and scope of practice which she did not. She indicated a lack of
integrity to ensure the safety of the patients under her care.
Question 2
A nurse's primary role is the provision and maintenance of due care to the patient. This is
done by ensuring a safe environment for hospitalized patients and protecting them from
avoidable injury (Kerridge et al., 2009). Behavior and actions that puts the patients at risk are
deemed negligent and may be liable for malpractice suits. Due care ensures the patient accesses

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the highest standards of care they proper assessments, monitoring and treatment methods to
ensure a quick recovery (Australian Institute for Health and Welfare, 2018).
The breach of due care is recognized as professional misconduct and warrants
disciplinary action. The nurse in the case study breached due care by providing inaccurate
information and failure to monitor the patients under her care. She failed to correctly assess her
patient and provided falsified information which would have resorted in the wrongful treatment
of the patients. Lack of monitoring might have even resulted in a loss of life which is a criminal
offense (Ministry of Law, 2014).
The nursing profession acts as a platform for advocacy of proper health care practices
(Spenceley et al., 2006). This entails actively seeking out information on current trends and
nursing practices that ensure the proper care of the patients. O’Keefe stated that patient rights are
a hallmark for advocacy of nursing case, hence, nurses must be urged to strive to maintain
outstanding patient care with inclusion of their rights in today’s health care system (O’Keefe,
2001). Failure to protect the health of the patients and engaging in practices that jeopardize
patient safety becomes professional misconduct and disrespects nursing as a profession.
Self-regulation and integrity form the basis of nursing. The ability to recognize one’s
faults and self-reflect leads to competency in nursing. This is also a principle in the Code for
Nurses and Midwives. It demonstrates the ability to perform competently with regard to the
administration of care. Integrity ensures that all processes involving the patients such as proper
data collection, assessments, monitoring, and proper record-keeping, are done with utmost
efficiency and competency. However, haphazard and incorrect records are detrimental and are
indicators of a lack of integrity and respect for the profession.

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The nurse, through her actions, created disharmony in the healthcare team. Through
falsification of the charting parameters, her colleagues would provide care substandard care to
the patients while also putting them and the institution in jeopardy of malpractice.
Core competencies and Generic skills
Core competencies of Registered Nurses are organized into four domains. They include
professional, legal and ethical nursing, management of care, leadership and nursing management
and personal development (Singapore Nursing Board, 2018). These core competencies are
indicators and guidelines to practice nursing. These domains are accompanied by competency
standards, with each standard being a representation of a major function to the performance of a
Registered Nurse.
The nurse fails to meet several domains and competency indicators. The first being the
professional, legal and ethical nursing. This domain involves demonstration and understanding
of the professional and legal guidelines in the nursing practice. It also involves demonstration
and maintenance of ethical nursing practice. More so, it also demonstrates the understanding no
knowledge used in care, accountability, and responsibility in regard to the guidelines set.
She fails to maintain clarity and legibility in the documentation and records which is one
of the competence indicators. She also practices contrary to the legislations set by the institution
and the national board. She also lacks accountability and is irresponsible in providing care to the
patient outside her scope of practice.
Second, the management of care. This domain involves the demonstration of a holistic
provision of care, maintaining a safe environment for the client and application of strategies to
promote health and prevent illnesses. The nurse’s actions fail to meet the management of care.

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She creates an unsafe environment for the patients under her care. She demonstrates not only
incompetence but also interferes with the care provided to her clients. She interferes with the
work of her colleagues who are indirectly affected through her provision of inaccurate data. This
creates disharmony in the provision of healthcare putting the patients at risk.
4.Management
Personal accountability ensures that one is responsible not only to himself/herself but also
to the people he/she associates with (Riley & Beale, 2010). It also showcases integrity to do
what’s right despite what others might say. Falsifying charting parameters puts not only the
patients at risk but also, the other healthcare providers as well as the institution and could have
adverse consequences which are avoidable.
It is personal accountability that would make me confront the nurse and push for the
reassessment of the patients and the recording of proper charting parameters. Failure to which
warrants launching an official complaint to the institution and reporting to her to the Nursing
Board (Singapore Medical Council, 2018).
5.Principles of the SNB Code for Nurses and Midwives (2018) that guide the decision
The first principle of respect for people’s rights, needs, values and culture. Everyone has
the right to the provision of proper healthcare. This includes the correct recording of charting
parameter, proper diagnosis, treatment, and monitoring. Moreover, complacency with
professional conducts and value guidelines in the Code for Nurses and Midwives ensures proper
management of healthcare (Ministry of Health,2018).
Advocacy in the best interest of the people. Advocacy entails speaking out on actions and
behaviors that support the rights and interests of the people (Jugessur & Iles, 2009). This

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includes reporting and confronting those whose actions endanger the safety of the patients
(Oliviera, 2017). This safeguards the people from receiving incompetent care that puts them at
risk. It also makes sure that clinical practices that could unduly compromise peoples’ safety are
mitigated (O'Keefe,2001).
Practice in a responsible and accountable manner. This principle is meant to secure
patient safety by making sure the nurse/midwife is accountable for his/her actions and that those
actions are in accordance with the Code. It involves the identification of risks and promotion of a
safe environment for the patients as well as the healthcare providers (Johnstone, 2009) It also
involves alerting the appropriate authorities of any situations that endanger the safety of the
people. Moreover, this principle advocates for the provision of accurate, relevant and evidence-
based records which are vital for the provision of effective and proper care.
Maintaining competency in the care of people. This principle involves ensuring
competence in the profession by various means such as providing honest and constructive
feedback to colleagues for the improvement of their practice. It also involves practicing care
within the scope recognized by the Board and ensuring that the practice is based on prevailing
clinical practice guidelines. This creates an environment which is not only safe for the people but
also ensured that the best care possible is delivered.
Maintenance of clear and accurate records. Records in healthcare are vital for the
provision of dependable and efficient healthcare. It is, therefore, crucial that accurate charting
parameters are recorded as they help in decision-making towards proper management of care.
This should be done competently and in time. They should also abide by the guidelines. Proper
records are, therefore, a priority to ensure proper patient care as well as help reduce negligence in
healthcare.