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Ethical Values in Nursing Practice

Student No: 810 121 269
Date Submitted: Tuesday, November 4th, 2014
NURS 217: Legal and Ethical Concepts
Humber College ITAL

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Ensuring that excellent patient centered care is provided safely, no matter the situation, is
the foundation of nursing practice. Without patient centered care, the nursing profession loses its
credibility and patients would not recover to their optimum level of functioning. The case I am
presenting portrays the dangers of negligence associated to poor patient centered care. It is on a
nurse that overlooked the care of a patient which led to that patients death. The patient being
cared for was seventy years of age, admitted to the unit with a primary diagnosis of congestive
heart failure. She was diabetic and a hypoglycemia management clinical protocol was set in
place to assess blood glucose readings every two hours if the reading was between 4.4 and 8.3,
and every one hour if the insulin dosage was changed and administered. The member did not
assess the blood glucose readings and increase the insulin rate by one unit as per protocol and as
a result, the patients blood glucose levels fell below one. Records confirm that the patient
experienced irregular cardiac rhythms and a code blue was initiated at 0650 hours, which was too
late for the patient. It was documented that the patient died at 0650 hours, which was incorrect.
The patient was pronounced dead on September 8th, 2010 at 0714 hours as a result of
hypoglycemia and hyperinsulinemia related to insulin management for diabetes (Discipline
Committee of the College of Nurses of Ontario, 2012).
Allegations
The allegations against the member comprise of failing to assess blood glucose levels at
the frequency necessitated, failing to regulate the degree of insulin to be administered hourly,
recording erroneous blood pressure readings, failing to assess blood pressure readings, failure to
provide care provided based on fluctuations in blood pressure and cardiac rhythms, failure to
request a code blue when necessary, failure to notify the physician and resurgence group the
patients diabetic state and diagnosis, failure to document patient care provided in addition to

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medication administered, and incorrectly documenting the time the patient was pronounced
deceased. Also, the member was found guilty of driving under the influence of alcohol, driving
with a suspended license, and one count of assault. The member did not notify the College
pertaining to his previous criminal offenses. He was reportedly on the phone throughout his shift
and stated he was not busy when asked about his priorities. He suffered from a long-term health
condition during the course of the events (Discipline Committee of the College of Nurses of
Ontario, 2012), but the illness is not specified. The decision of the discipline committee was
suspending the members registration for one month, have him attend three meetings with a
nursing expert to discuss the misconduct, inability to practice in the community for twelve
months, and other requirements the member was to comply with during the meetings with the
nursing expert. I disagree with the decision as there were numerous instances of negligent
behaviour throughout his entire shift which are inexcusable. Even if he exhibited signs of guilt
for what occurred, I believe a stiffer penalty should have been implemented such as a longer
registration suspension time so the member could have additional time to reflect on his
misconduct.
Ethical Values Violated
A nurse practicing in the province of Ontario has an obligation to adhere and follow the
practice standards and guidelines that are established by the College of Nurses of Ontario. It is
beyond question that the member violated many components of the ethics practice standard, but
what was evident was the nurses inattention to client well-being. Under the client well-being
ethical value (Ethics, 2008), Promoting client well-being means facilitating the clients health
and welfare, and preventing or removing harm. The nurse unequivocally precipitated harm to
the patient by not assessing her blood glucose levels punctually, ultimately leading her to become

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hypoglycemic, which is a potentially fatal medical emergency. According to (Lewis et al, 2014),
loss of consciousness, coma, and death can occur from untreated hypoglycemia. Hence, he
should have actively assessed the patient for changes in her blood glucose level and understood
the potential dangers of severe hypoglycemia as there was a hypoglycemia management clinical
protocol to be followed that the nurse was aware of. The actions of the member, which I would
consider appalling and reprehensible, defame the nursing profession as a whole because the
fundamentals of nursing practice is situated on client well-being and contentment. Health care
professionals must make every plausible attempt to protect human life (Ethics, 2008). His
previous offenses from driving under the influence of alcohol, an assault charge, and driving
with a suspended licence, are in my perspective, indicators of apathy towards human life and are
intrinsic violations of the respect for human life ethical value.
It is apparent the member did not uphold his commitments as a health care professional
for many reasons, and the overall census is that many of the professional standards were
infringed upon, which does not meet the expectations and obligations of the nursing profession.
For instance, under the accountability professional standard (Professional Standards, 2002),
Each nurse is accountable to the public and responsible for ensuring that her/his practice and
conduct meets legislative requirements and the standards of the profession. The member had an
obligation to monitor the patients vital signs and respond to the changes that the patient was
experiencing in cardiac rhythms, blood pressure, and glucose level which unfortunately led to the
patients death. Under the maintaining commitments ethical value (Ethics, 2008), Nurses are
obliged to refrain from abandoning, abusing or neglecting clients, and to provide empathic and
knowledgeable care. With this being said, not only did the nurse contravene the professional
standards, but his actions are considered a form of abuse, more specifically, neglect. Nurses can

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be found liable for negligence if the following criteria are established: (1) The nurse (defendant)
owed a duty to the patient (plaintiff); (2) the nurse did not carry out that duty; (3) the patient was
injured; and (4) the nurse's failure to carry out the duty caused the injury (Potter et al, 2014).
There is absolutely no place for neglect in nursing practice and by exhibiting abuse, it directly
violates the ethical value of maintaining commitments as a nurse. Cases such as this one
deteriorate the relationship between that nurse and client and erodes the publics confidence in
the aptitude and skills of nurses in general, which discredits the nursing profession.
Proposed Solutions
I advocate that nurses be educated to the fullest extent regarding facilitating client wellbeing and preventing abuse akin to patients receiving health teaching from nurses regarding
health promotion and disease prevention. This can transpire in the form of educational sessions
on the dangers and consequences of client abuse and how errors in practice can be considered as
such. According to (John Wiley & Sons Ltd, 2012), educational meetings can result in small
to moderate improvements in professional practice and, as would be expected, smaller
improvements in patient outcomes. I believe that any improvements, slight or extensive, in
patient outcomes are beneficial and should be looked highly upon as we adopt higher standards
of learning. Within these sessions it is essential that emphasis be placed on how the College of
Nurses handles situations encompassing abuse and their zero tolerance for abuse in any shape or
form. Although nurses must know their role as healthcare professionals, educational sessions
may offer time for reflective practice and bring about concerning topics that may be of
discussion so strategies can be implemented with future issues to ensure competency is upheld.
My view about the members carelessness and negligence stems from the members
personal phone calls and how they were put above the patient, demonstrating inept practice. The

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member was seen on his phone numerous times throughout his shift which seemed to be a
persistent distraction that contributed to his poor nursing practice. An additional method to deter
this type of behaviour is banning the use of nursing station phones and the use of cellphones for
personal calls during ones shift, unless for an emergency situation. Cell phones are proven to be
a distraction in various areas in life and the health care environment is not oblivious to it.
Mobile communication technology comes with risks such as electromagnetic interference, loss
of confidentiality and data security, distraction/noise, infection control, and cross-contamination
(Gill et al, 2012). Many hospitals have banned cell-phone usage, but I propose that this be
applied to all hospitals across the province so that patients well-being are not left at risk due to
the oversight of a nurse and the distraction of personal phone calls. Instead, units should be
equipped with computers that contain information pertinent to nursing care, such as drug books
and nursing interventions if needed. If any nurse were to violate this rule, appropriate
disciplinary action should be taken.
Conclusion
To summarize, eliminating negligent behaviour within nursing practice is important in the
advancement of the profession. If errors continuously remain in practice, it discredits the
profession as a whole and nurses lose the credibility that they have strived to attain because the
public loses confidence in them. The member decided to move his attention away from the
patient and redirect it towards his personal life with his phone which left the patient vulnerable,
particularly since she was critically ill. He did not assess the blood glucose levels as ordered, did
not respond to changes in cardiac rhythms and blood pressure, and did not document information
correctly. In addition, not informing the college of his previous criminal offences including
driving under the influence, assault, and driving with a suspended licence is an act of dishonesty

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which directly contradicts what is ethical in nursing practice. The decision of the discipline
committee, especially the suspension time from practice for one month, I believe was not severe
as his actions are completely degrading to the nursing profession. As a nurse, he maintained a
commitment to uphold the standards of the profession, which he clearly disregarded at the cost of
a patients life. Personal phones should be prohibited while practicing so implementation of a
strict cellphone ban while practicing for all nurses in Ontario is what I believe is appropriate.
Also, being able to establish sessions when nurses are able to speak out about their practice and
participate in civil discourse about concerning behaviour within their practice is another way of
advancing the nursing profession and eliminating negligent behaviour. There are numerous ways
to prevent unwanted behaviour in the nursing profession, but in the end we must realize that the
heart of our practice is the client and client centered care.

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References
College of Nurses of Ontario (2008), Ethics, pp. 1-24. [PDF] Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario (2002), Professional Standards, pp. 1-16. [PDF] Retrieved from
http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf
Discipline Committee of the College of Nurses of Ontario (2012), pp. 1-17. [PDF] Retrieved
from
http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2013/John
%20Derek%20Gordon,%209533001,%20Nov.12.2012.pdf
Forsetlund, L. (2009, April 15). Continuing education meetings and workshops: Effects on
professional practice and health care outcomes (Review). Retrieved October 25, 2014.
Gill, P., Kamath, A., & Gill, T. (2012, August 27). Distraction: An assessment of smartphone
usage in health care work settings. Retrieved October 24, 2014, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/
Lewis et al, Sharon. Medical-Surgical Nursing in Canada. 3rd Edition. Mosby Canada, 2014.
VitalBook file. Pageburst.
Potter, Perry, Ross-Kerr, Wood, Astle, Duggleby, Patricia, Anne, Janet, Marilynn, Barbara,
Wendy. Canadian Fundamentals of Nursing. 5th Edition. Mosby Canada, 2014.
VitalBook file. Pageburst.