Professional Accountability and Patient Safety Case Analysis Report

This report examines a case involving registered nurse Naomi Rayner, who faced disciplinary action due to breaches of professional conduct impacting patient safety. The case details instances of improper patient contact, boundary violations, and unethical behavior, including the misuse of her professional position to engage in inappropriate relationships and provide unauthorized substances. The analysis covers actions and omissions contributing to adverse events, including systemic failures and evidence-based practices. The report concludes by highlighting the importance of maintaining professional standards and the consequences of failing to do so, referencing relevant literature and legal documents. The case underscores the critical need for healthcare professionals to adhere to ethical guidelines and maintain patient safety. This assignment, provided by a student, is available on Desklib, offering comprehensive study tools.

PROFESSIONAL
ACCOUNTABILITY &
PATIENT SAFETY

Table of Contents
INTRODUCTION...........................................................................................................................3
Background of Case.........................................................................................................................3
Action and Omission........................................................................................................................4
System-Based...................................................................................................................................4
Evidence based ................................................................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

Case Link
https://www.caselaw.nsw.gov.au/decision/178481c196ccf6f156b00fea
File Number: 2020/00280581
INTRODUCTION
In healthcare profession patient safety is an very important requirement and this is
determined through professional accountability of practitioners. This means that professional are
accountable for safety of patient. In healthcare professional, registered nurse are frontline
professionals who are responsible for providing and coordinating patient care, educate patients
and manage daily care requirements for patient. Not doing so can result in harm and threat to
safety of patient. Regarding registered nurse, every state and country have different rules and
requirements and they are required to follow rules and regulations required by nation or state. It
is very important that they fulfil their responsibility being careful towards patient and also being
honest towards patient and their safety. This report will discuss about a case involving
suspension of registered nurse because of adverse effect on patient in their care.
Background of Case
The case is of registered nurse Naomi Rayner who was also self-representative in case.
Naomi Rayner was registered as nurse on 1 July 2010 and completed a post graduation
certificate in Mental Health at Edith Cowan University. She was working as community mental
health nurse at Bourke Mental Health and Drug and Alcohol services between 21 January and 12
April 2019. In her case patient A became a client of Mental Health and Drug and Alcohol
services in early February 2019 after being realised on custody for parole (Health Care
Complaints Commission v Rayner [2021] NSWCATOD 29. (2021). Client A has a history of
opioid use and resided in Bourke area, however address of patient was not fixed. Practitioner is
guilty of unsatisfactory professional conduct that includes being engaged in conduct that was
significantly below standards than what is required standard. Standard is reasonably expected
from a professional with equivalent training and experience. Along with this, registered nurse
was also found guilty of being engaged in unethical and improper conduct. Conduct registered
nurse particularly included using personal mobile to contact patient A and leave voice message
on Patient A's mobile phone and asked patient to return her call. In addition to this, she also
answered telephone call from Patient A outside work hours while being intoxicated and met with
Patient A outside work hours and discussed personal issues with patient A. Other than this, she

also get engaged in improper person and sexual relationship with Patient A and failed to observe
proper professional care and used schedule 8 drug Buprenorphine with Patient A and purchased
cigaretted, clothes and food for the benefit of Patient A on several occasions. In addition to this,
registered nurse also made false entry of medical record of Patient A (Pesut and et.al., (2020). in
addition to this few other complaints are also there. As a result of the case decisions made in case
was cancellation of registration of respondent with immediate effect and will not be entitled for
registration as a nurse for a period of three years.
Action and Omission
Actions – The nurse was undertook several actions that contributed to adverse event. Her actions
include, improper and wrong recording of medication for Patient A. giving wrong medication to
Patient A because of negligence and improper observation of condition of patient. In addition to
this, she was also engaged in personal and sexual relationship with Patient A while she was on
her duty at his uncle's house. In this case Patient A was presented with serious health issues and
registered nurse did not maintain adequate boundaries which was necessary in her practice as
registered nurse.
Omission- Mainly the registered nurse did not maintain boundaries with Patient A and this
contributed to adverse events. She also did not fulfilled her responsibility adequately and did not
took adequate care about health of patient that she was responsible for (Poghosyan and et.al.,
(2017). She did not performed and worked according to profession standards of her practice and
also did not gave proper consideration about medication of Patient A and gave him wrong
medication. This means that there were several omissions on the side of nurse which contributed
to adverse event for patient.
System-Based
This case of Ms. Naomi Rayner and Patient A focussed on crossing the professional
boundaries and due to which negative outcomes were obtained with the patient as well as the
practitioner. The nurse was registered under the National Law on 1 July 2010. Shw was much
experienced as she worked as a mental health nurse for 9 years at Drug and Alcohol Services
where Patient A became the client. Patient A was having a medical history of opioid use due to
which a case manager was allotted for the treatment and care. One supervisor was also allotted
for Ms. Rayner to share any problem faced and can take the cost free services (Honeyball, 2018).
There are some professional boundaries under which the nurses have to work and they are not

allowed to cross those boundaries as this can impact the patient’s health as well as the reputation
of the nurse.
The nurse or the practitioner was felling very lonely and depressed and was seeking the company
of a male. She chose the option to get in contact with Patient A as he was the only one that time
for her whom she found talking. She went to the Patient A’s Uncle’s Home and took the number
of Patient A, called him and even dropped a message to call her. Patient A called her after the
working hours when she was not supposed to pick up the call. But, as she was seeking a male’s
company, she picked up the call and that also when she was intoxicated at a local RSL Club. He
After the request of Ms. Rayner, Patient A came to meet her at the club. She started discussing
her personal issues with the patient which was completely inappropriate. She had no genuine
professional or medical reason to call Patient A but she called and started crossing the
professional boundaries. She was found misusing her power as a practitioner (Curtis and et.al.,
2019).
As a nurse, she got the trainings and proper supervision in which she was told that the
professionals need to keep the professional and personal identities separate and must maintain
the appropriate boundaries but Ms. Rayner misused the professional power as the patient was
depended on her for improving ongoing health. Patient knows that being a case manager she will
work for his best interest instead of her personal gain (Parsons, Everingham and Kemp, 2019).
But, in order to fulfil the mental, emotional, physical needs, Ms. Rayner involved the patient in
the sexual activity by forcing him to take drugs. This was completely against the professional
rules of the system. The responsibility of the practitioner is to iprove the health of the patient but
Ms. Rayner did the opposite. This not only put the patient-nurse relationship at risk but also
breaches the trust of the patient and could cause severe harm. Though, in the therapeutic
relationship, nurses are supposed to ask personal questions to the patient, which is not ethically
or legally wrong but RSL was not a place to discuss these issues or problems (Civil and
Administrative Tribunal New South Wales, 2021). She had crossed her professional boundaries
which not only ruined the image of her position but also ruined the health of the patient.
Evidence based
Ms. Rayner could have taken support from the supervisor who can solve the issues and
even the practitioners were a part of EAP which was Employee Assistance Program in which

they can seek free confidential advice. She could maintain her good health and well-being in
order to perform her duties as practitioner effectively. She must have maintained healthy and
professional relationship with the patient but instead she ruined the relationship for the sake of
her personal gain. The nurse had already signed NSW Health Policy directive under which she
was supposed to follow the ethical and professional standards (Smyth, 2019). Her sexual
relationship with Patient A was completely breach of her responsibility for maintaining the
professional boundaries. This could create media attention as well as can ruin the career, family
and the working relationships. She has accepted and signed the employment conditions in which
it was clearly mentioned that she cannot be involved in such sexual relationships. As a case
manager, she must have worked for the best interest of the patient instead of seeking for her
personal gain. She was already aware of the medical records of the patient then also she gave
cigarettes and drugs to develop intimacy which was completely against the NSW policies and her
responsibilities as a practitioner and case manager (Caselaw, 2021).
CONCLUSION
On the basis of above discussion, it can be concluded that Naomi Rayner failed to
perform her duty adequately and undertook several actions that were not appropriate for her as a
registered nurse. It was highly expected that she perform her duty whilst maintaining profession
standards and she did not maintain her professional standards and her conduct went significantly
below standards. However, right consideration and taking other actions on time would have
avoided development and emergence of adverse event.

REFERENCES
Books and Journals
Honeyball, F. (2018). Safety of delivering chemotherapy by community nursing staff supervised
by telemedicine in remote New South Wales (NSW).
Smyth, D. (2019). Exploring undergraduate nursing students' knowledge and attitudes of the
management of patients with a drug and/or alcohol substance use disorder: An
Australian perspective. Australian Nursing and Midwifery Journal. 26(6). 63.
Parsons, R., Everingham, J. A., & Kemp, D. (2019). Developing social impact assessment
guidelines in a pre-existing policy context. Impact Assessment and Project
Appraisal. 37(2). 114-123.
Curtis, K. & et.al., (2019). Identifying areas for improvement in paediatric trauma care in NSW
Australia using a clinical, system and human factors peer-review tool. Injury. 50(5).
1089-1096.
Pesut, B & et.al., (2020). Nursing and euthanasia: A narrative review of the nursing ethics
literature. Nursing ethics. 27(1). 152-167.
Poghosyan, L & et.al., (2017). Primary care providers’ perspectives on errors of omission. The
Journal of the American Board of Family Medicine. 30(6). 733-742.
Online
Caselaw, 2021. [ONLINE]. Available through :< NSW Caselaw>
Civil and Administrative Tribunal New South Wales, 2021. [ONLINE]. Available through :<
Health Care Complaints Commission v Rayner - NSW Caselaw>
Health Care Complaints Commission v Rayner [2021] NSWCATOD 29. (2021). [Online].
Available Through:
<https://www.caselaw.nsw.gov.au/decision/178481c196ccf6f156b00fea>.