Analysis of Registered Nurse Misconduct and Preventative Measures

This report provides a detailed analysis of a case involving a registered nurse's misconduct, specifically focusing on sexual misconduct with patients, which led to disciplinary actions. The report examines the nurse's actions and omissions, highlighting the violation of professional boundaries and ethical codes. It identifies contributing factors such as power imbalances, poor self-discipline, and systemic issues within the healthcare setting. Furthermore, the report explores the impact of such misconduct on patients, including emotional distress and loss of trust. It references relevant literature, including studies on the prevalence of sexual misconduct among nurses and its consequences. The report outlines preventative measures, such as adherence to codes of conduct, maintaining professional boundaries, and the implementation of reporting mechanisms. It also discusses the role of policies and guidelines in mitigating the risk of misconduct and promoting patient safety. The conclusion emphasizes the importance of adhering to professional standards and the need for continuous improvement in healthcare practices to protect patients.

Nurses Health Care Practice
University
ASSESSMENT 1 92444
Name
Date

Introduction
The Nursing and Midwifery Board of Australia –NMBA performs fundamental functions as stipulated
by the health practitioner’s regulation of national law. The NMBA offers regulation among practicing
nurses and midwifery services in Australia and plays a fundamental role in ensuring that the public is
protected from harm. The fundamental role of NMBA details formulation of standards, professional
codes, guidelines setups and practice standards for safe practices for both nurses and midwives
across Australia.
This review is informed from the basis of tribunal disqualification of nurse professional misconduct
concerning transgression behavior and inappropriate relationships with patients in the year 2018.
The Victorian Civil and Administrative Tribunal made a reprimand to Mr. Munyaradzi Makoni, a
former registered psychiatric nurse and disqualified him from registration for one year after the
admission of transgression behavior with two female patients. A notification was made in the year
2013 to the Australian Health Practitioner Regulation Agency from Monash health related to a
former patient who had engaged in a sexual encounter with Mr. Makoni. The occurrence led to the
nurse engaging and making contact with a psychiatric patient. The nurse engaged in a sexual
relationship with the patient. Tribunal proceedings were undertaken and a reprimand was made and
disqualified for one year in applying as a nurse. This professional misconduct based on the tribunal
assessment was grave and could end the career of the registered nurse (NMBA, 2020).
Based on the case study review above this assessment seeks to understand the actions of the
registered nurse on the two patients he made contact while in the nursing profession, further,
underlying contributing factors and relevant preventive measures applicable for the case.
Registered nurses action on patient adverse outcomes
Sexual misconduct among nurses often occurs during practice and occurs when they come in contact
either physically or through emotional proximity with the patients. Nurses are obliged to maintain
the professional discipline to avoid sexual misconduct occurrence. Sexual contact between health
care practitioners and the patients has been a long-standing public health issue which often causes
increased and considerable harm to the patients. These effects lead to the lowering of self-esteem
and the decline of emotional wellbeing (Kunyk and Deschenes, 2018).
Sexual misconduct among nurses or other allied health care practitioners against the patients often
portends a serious ethical problem that needs no toleration. These unethical events ought to be
viewed as 'never events' in care delivery. Ethical behaviors and code of practice have been outlined

to regulate these adverse events. Nurses or any health care staff who commit sexual misconduct
with patients ought to face serious punishment (Dubois et al., 2017). These exploitative behaviors
have been demonstrated to greatly hamper the patient public trust and confidence in the health
care continuum. The underlying consequences of these actions often negate aspects of license
disqualification especially in instances where there is a sexual violation as described in the case study
above relating to psychiatric nurse Mr. Makoni.
There is a need for clear definitive measures incorporated into the health care practice, professional
codes of conduct and state laws defining sexual practices. This habit needs to be rated as
foreseeable danger hence preventive and adequate caution being undertaken (Banja, 2014). In
applying the nursing codes of conduct, nurses need to ensure that they maintain professional
boundaries with anyone including patients. The code of ethics offers a clear direction; under
principle 4.1,(a) nurses need to recognize the imbalance of power which often exists among nurses,
people in care and significant others to maintain professional boundaries. By virtue that Mr. Mukoni
was offering mental care to the patient, it is a clear presumption that to some extent, he took
advantage of the patient medial state and invaded her privacy hence engaging in a relationship with
her later on. Prolong treatment phase with the patient could have an increasing and contributing
aspects towards the care process and engaging in the relationship with the patient.
Further, under principle 4.1 (d), dictates that nurse and other health care practitioners need to avoid
having sexual contact and relationships with the persons whom they have entered into a
professional relationship. This is regarded as unprofessional towards care practice. By not adhering
to this basic guide and principle led to engaging the patient in a sexual relationship hence bridging
trust and code of practice. Thus poor self-discipline in this context was a bigger contributively factor
for the patient's state of actions on the patient.
Contributing factors
In a study conducted by NCSBN in an analysis spanning over 10 years (NCSBN, 2014), with data of
53,361 nurses were found to be of good discipline among these about 636 were categorized as
having sexual misconduct, engaging in sex with a client, sexual abuse and bridge of sexual
boundaries. From this assessment sexual misconduct among nurses was established as a non-issue.
The prevalence of sexual misconduct among nurses has not been established, however, it is
established hat about 38%-52% of health care staff know their colleagues who have engaged in
sexual conduct with patients (Evans, 2010). The impact created on patients is often deleterious, and
the majority of the health care practitioners have attributed various factors to this behavior. These

entail post-traumatic stress disorder, depressive disorder, confusion, relationship issues, use and
misuse of drugs and increased levels of dependencies.
Nurses are tasked with the role of establishing and maintaining an appropriate level of boundaries in
heir professional relationship with the patients. While receiving care from the nurse, more often
patients expect nurses to be professional, knowledgeable, ethical, skillful and respectful towards
them. Despite these aspects of the code of conduct, opposite occur. Nurses, in essence, are not
supposed to engage in sexual or romantic relationships with patients. It is often understood that the
sexual association of patients and nurses is often unethical, abusive and contrary to the law. In the
nursing profession, it is regarded as a breach of trust (AbuDagga et al., 2019).
Nurse patient relationships allow the nurse with the power over the patient owing to their
professional position to access, awareness of and search for patient privacy information. Nurses
always need to consider the underlying risks of power imbalance before engaging in any relationship
with former or current patients. Power imbalance often varies in the care continuum however it is
dependable on various factors; duration of the nurse patients association, private information
sensitivity and the vulnerability of patients (McNair, Fantasia, and Harris, 2018).
In assessing systematic health care factors, a wide variety of factors have led to sexual harassment.
The underlying hierarchical structure, male dominance and conducive climate which tolerate the
transgression have been observed. In the medical field, studies shave shown a high incidence rate of
reporting of gender and sexual occurrences (Adams, Darj, Wijewardene and Infanti, 2019). The
majority of the health care organizations are doing little efforts in litigating such acts, this was
evident in the case study. The sexual occurrence was reported a long time ago, however,
organizations cannot detect and take mitigating measures to prevent from escalating.
Poor reporting and survey tools in many organizations have often led to insufficient and inadequate
information on the complexity of sexual misconduct. Engaging in survey and usage of aggregated
data reports based on harassment information needs adequate reporting throughout the
organization. These measurements allow the organization to improve on weak linkages and follow
up on progress. Poor policy documents defining the direction of safety in health care organizations
are the motivating factors leading to the occurrence of these behaviors (Millbank, 2019).
Preventive measures
Currently, in Australia, the mitigation measures undertaken to manage sexual misconduct in health
care institutions have shown significant results. Colleague reporting has increased to about 50% in

the past year with a high proportion of health care practitioners reporting sexual misconduct
increasing. The Australian Health Practitioner Regulation Agency-APHRA report has shown that
mandatory notifications have risen against medical practitioners in the year 2019/2019 compared to
previous years. These figures project the upward trend of health care professionals in reporting their
colleagues who put pat6eitn states at risk (Faulkner and Jimerson, 2017).
Various factors have been attributed to these increase and surge in report making; the meToo
movement, awareness campaigns among the patients on their rights have increased tremendously.
NSW state has put in place policies and procedures which offer guidance to health care practitioners
nurse included on the reduction of harm and impact on sexual misconduct in the care settings.
Guiding policy on managing misconduct was established in 2018 on guiding on how health care
practitioners guide themselves in care settings and maintaining discipline and respect to those in
their care. The policy document offers directions on the management of misconduct among health
care staff at NSW health service and other visiting practitioners (NSW, Online 2020).
Another fundamental aspect of preventing measures is adherence to the code of conduct for nurses.
Nurses need to adhere to the nursing code of conduct principle 4.1 clauses 'a' and'. This clause
recognizes that often inherent power imbalance occurs between patients and nurses, thus there is a
need for maintaining professional boundaries. Further, the avoidance of sexual relationships with
which care is offered is key. These relationships are often unprofessional leading to misconduct
(NMBA, Code of Practice, 2020).
These guidelines offer preventive measures for health care practitioners and registered nurses to
always know and understand the boundaries. The codes of conduct and policy guides are critical
elements that every health practitioner needs to adhere to and often remind themselves while in
duty. Self-discipline and respect for the rule of law play a fundamental role in enabling preventive
mechanisms on patients in the care practice (Birks, Davis, Smithson & Cant, 2015).
Conclusion
Registered nurses need to engage in productive professional standards as defined by various
standards of practice, codes of conduct and ethics. Registered nurses need to engage in person-
centered care coupled with preventive, curative, supportive and restorative elements of care. This
practice entails an understanding of the health and well being of the patients. Registered nurses
need to be always accountable and adhere to standards of practice and other policy guidelines
which guide on their dispensation of duty. They need to engage more collaboratively and
comprehensively to promote the well being of patients. Their engagement in sexual misconduct is a

critical concept which needs to be addressed with care. Maintaining professional practice is the core
call for all health care practitioners. From the case review, it is evident that the psychiatrist nurses
bridge the professional relationship with the patients leading to the occurrence of sexual misconduct
with his patients. The laid down guidelines, codes of practice and policy guidelines addressing the
contributing factors need to be adhered to in the health care practice.

References
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by nurses reported to the National Practitioner Data Bank. Public health nursing, 36(2), pp.109-117.
Adams, E.A., Darj, E., Wijewardene, K. and Infanti, J.J., 2019. Perceptions on the sexual harassment
of female nurses in a state hospital in Sri Lanka: a qualitative study. Global health action, 12(1),
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Banja, J.D., 2014. Preventing sexual attacks in healthcare facilities: Risk management considerations.
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