ETHICS

822 913 679

Ethics
Student: Ying Liang
Student No: 822 913 679
Date Submitted: November 4th, 2014
NURS 217: Legal, Professional & Ethical Issues in Nursing Practice
Professor: Rosemary Waltkins
Humber College ITAL

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Introduction
CNO has been delegated the authority to regulate nursing practice by Ontario
government to protect the public (CNO, Professional Misconduct, 2014). For the sake of
regulation, it sets up mandatory standards for RNs and RPNs and those who commit professional
misconduct are to be judged accordingly. Unfortunately, Sonia Taylorts, a registered practical
nurse (RPN), is one of them. The Member worked at a Clinic which provided help to clients
from addictions and pain management issues. There had been issues with diversion of Fentanyl
patches in the past. However, some clients were permitted to carry patches home. After a client
was discharged, the Member provided the client ten Fentanyl patches despite there being no
valid prescription. After that, the clients common law spouse was found dead from an overdose
while wearing the Fentanyl patches the Member provided to the client. The incident came to
light when the Member was investigated by the police regarding Client A. There are 3 additional
medication administration errors were found besides this incident when the Member was
investigated by the police regarding client A. The Member gave pt other than what is stated on
prescription. She wrote medication error report, but did not otherwise report the error to doctor
or other stuff (CNO, Discipline Decision, 2014).
In this case, the member failed to meet the standard of practice in multiple ways, such as
failing to meet practice standards, misappropriated medications, failing to keep records,
performing an unauthorized controlled act without appropriate delegation and administrating
medications in a dose other than was prescribed, and failing to report a medication
administration error. The Member was working with vulnerable and manipulative populations
suffering from addictions and pain management issues. Besides the Member, there were other
health care providers involved. The supervisor did not sign a sheet for tapering when client was

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discharged. The pharmacist sent a wrong dose of medication. The Clinic Coordinator only wrote
a note in the EMR but not MAR. Doctor delegated the administration and dispensing of Fentanyl
to nurses but failed to provide formal direction. As far as I can tell, there were some contributing
factors. The Member worked at the Clinic as a full-time staff nurse on the day and weekend shift.
She was overworked at the Clinic and even worse she was the only nurse on staff on one day
when an error happened. In this clinic, there had been issues with diversion of Fentanyl patches
in the past. However, some clients were still permitted to carry patches home. The Clinic
maintained two records for each client receiving Fentanyl patches. After client A was discharged,
his patches were still at the Clinic. The discipline committee's penalty decisions mainly include a
reprimand before the panel. Over all, the penalty as a whole, including the six-month suspension,
24-month employment notification period and the remediation provisions, provides a clear
deterrent to this Member and to others. I agree with this decision because that her repetitive
misconduct were in breach of the Colleges standards and regulations thus not tolerable. The
purpose of this decision is to protect public protection and maintain public confidence. The
penalty can not only make this nurse realize her misconduct behaviour is unprofessional and
unacceptable, but also helps her and other nurses increase their ethical awareness.
In my point of view, the nurse failed to maintain two ethical values according to the CNO
Standard. These are client well-being and maintaining commitments. Firstly, the goal of nursing
care is to promote clients' well-being, which means nurses should apply their profound
knowledge and solid skills to help clients maintain a physical, mental, and psychosocial
wellness. So to speak, at any given moment, nurses should give most priority to clients' interests.
Nevertheless, in this case, the Member gave client B other than what is stated on prescription
without discussing instructions with doctor. Moreover, this nurse administered overdose

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medication to client C without calling the pharmacy to confirm the last dose. Furthermore, when
patients dose was not in delivery, the Member replaced patients medication with someone
elses. As we know, narcotics are controlled medications that should be given on the exact dose
as prescribed. On one hand, patients may suffer from pain or other symptoms if the dose is
insufficient. On the other hand, they may lead to toxic state or death when quantities greater dose
is administrated. As a result, the clients would encounter risk of physical harm or fatal overdose
by this nurses medication error. Therefore, this nurse failed to promote client well-being by not
facilitating the client's health and welfare (CNO, Ethics, 2008). Secondly, nurses should maintain
commitments to clients. This ethic value means nurses' duty is to provide standard practice
according to their or their family members' wishes and needs, without the need to promise. This
includes the family members and significant others as well (CNO, Ethics, 2008). Unfortunately,
The investigation on this nurse is initiated by an incident that a client As common law spouse
was found dead from an overdose while wearing the Fentanyl patches the Member provided to
client A. One of the vital cause of the tragedy is that the Member gave client A ten Fentanyl
patches, despite there being no valid prescription. The Member failed to check the EMR before
dispensing the patches. In short, this nurse failed to maintain this commitment to clients because
of her intentional or unintentional medication error. What is particularly noteworthy is that the
Member not only failed to maintain commitment to clients but also to the nursing profession
(CNO, Ethics, 2008). Nurses have a commitment to the nursing profession. We have the duty to
uphold the standards of the profession, conduct themselves in a manner that reflects well on the
profession, and to participate in and promote the growth of the profession (Professional
Standards, 2002). In order to maintain the privilege of self-regulating, nurses are responsible to
promote nursing to be more effective to meet the publics interests (CNO, Ethics, 2008). To keep

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this honourable profession, nurses should make efforts to improve their ability to provide the
highest quality health care and avoid humiliating this title (CNO, Ethics, 2008). If some one
commit misconduct as this Member did, fail to check doctors order or report medication error to
doctor, are breach of CNO ethnic standards about the nursing profession commitment.
In my point of view, there are two strategies could be adopted to prevent these misconducts
from reoccurring. One is focused further education on nurses and the other emphasis on
management of clinic facilities. To begin with, it is an effective method to give nurses further
education in order to increase their ethical value awareness. Nursing skill is far from enough
when we talk about professional care. Actually, it is a life-long learning process. Nurses are
expected to meet ethical values, abide by right documentation requirements, and be familiar with
scope of practice and authorizing mechanisms, etc. All those above are aimed at maintaining
client safety and well-being. There are lots accessible resources of available on line like the CNO
Code of Ethics, CNO documents, CNO Quality Assurance Program (Lilley, Harrington, &
Snyder, 2011). Nurses should update their knowledge to enhance their competence for ethical
nursing practice. In doing so, nurses can increase their awareness of inappropriate behaviour
committed by themselves or other stuff. They would self report or report other risk practice of
colleges. Meanwhile, nurses could realize that they would get punishment for their misconduct,
like CNO Discipline Committee's decision about the nurse in this case. Through further learning,
nurses could eliminate the risk factors and obtain a safe quality care to the patients. The other
strategy focuses on administration of the clinic. The facilities should take some effective
reformation to establish a safe working environment for the nurses. The person in charge of the
clinic should set up clear, precise, and feasible policies. Once the policies are ready to carry out,
there should be a strong emphasis on following policy. In this case, if there is a clear-cut

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delegation direction for the nurse or if the director followed up in time, the error might not
happen. Personally speaking, I highly recommend the nurses can have a reasonable shift
arrangement. The Member in this case, over-work is one of the contributory factors. She worked
during weekdays and weekend as a full time stuff. Even worse, sometimes she is the only nurse
stuff on duty. This is not a reasonable shift arrangement for the nurse to practice safely with
vulnerable populations. Based on the above analysis, what happened on this nurse can be less
possible if organization of the clinic could be improved.
Conclusion
In conclusion, this essay discussed the issue of nursing professional misconduct and
ethical values. The nurse in this case was found to have committed repetitive medication errors
including failing to meet practice standards, performing an unauthorized controlled act without
appropriate delegation, administrating medications in a wrong dose, and failing to report
medication administration errors. As a result, she was investigated by the Discipline Committee
of CNO and received a penalty of six-month suspension, 24-month employment notification
period, and forced further education with two experts. I agree with this penalty decision since the
nurses repetitive misconducts are unprofessional and unacceptable thus are not tolerable. The
penalty decision can not only make this nurse be more aware of medication error but also helps
her and other nurses increase their ethical awareness. In this case, she contravened two main
ethical values including client well-being and maintaining commitments (to clients and to the
nursing profession). In my opinion, to prevent a situation like this, nurses should enhance their
ethical awareness and regulate themselves through obtaining further education. On the other
hand, the organization of the clinic should be improved. The person in charge should set up

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effective directions and proper shift arrangement to ensure a safe working environment for the
nurses and finally protect the clients interests and minimize the risk of errors.

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References
College of Nurses of Ontario (CNO). (2014). How We Protect the Public: Discipline Decisions
JF675298, Retrieved November 2, 2014 from
http://www.cno.org/en/protect-public/discipline-decisions/
College of Nurses of Ontario. (CNO). (2008). Practice Standard: Ethics.
Retrieved November 2, 2014 from
h
ttp://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario (CNO). (2014). Reference Document: Professional Misconduct.
Retrieved November 2, 2014 from
http://www.cno.org/Global/docs/ih/42007_misconduct.pdf
Lilley, L. L., Harrington, S., Snyder, J. S., & Swart, B. (2011). Pharmacology for Canadian
Health Care Practice. (2nd ed.). Toronto: Mosby Elsevier.