To retain public confidence, take drug control seriously

The public must have confidence in nurses’ ability and willingness to practise proper medication management. Those who violate that trust rarely get off lightly.

Nurses are entrusted with significant responsibility in relation to the handling, dispensing and giving of medications. Accordingly, it is important that such trust is not abused. The public expects the highest of standards and professionalism from nurses. Hence any breaches are treated as serious and penalties can be significant, so as to reassure the public of safe medication management and maintain its confidence. A recent disciplinary hearing reinforces these points.

On 24 October 2014, a nurse inappropriately administered one tablet of Risperidone each to three patients – B, C and D – from patient A’s Webster pack, did not document the administration of Risperidone to Patients B, C and D, did not discuss his concerns about the medication regime of Patients B, C or D, with any medical practitioner at the hospital and failed to obtain a written order prior to administering the tablets.

For six months leading up to that incident, the nurse had also inappropriately removed Risperidone tablets from a number of residents’ Webster packs and administered the medication, about twice a week, to patients B, C and D. In doing so, the nurse did not discuss his concerns about the medication regime of patients with medical officers, senior nursing colleagues or the patients prior to administration.

The only oral evidence at the hearing was from the nurse. Under cross-examination, he agreed that he gave someone’s drugs to another patient. When asked directly why he took the drugs from patient A, he said “they were there”, and when further questioned responded with “... What [do] you want me to say?” The tribunal was left with no satisfactory explanation. He accepted that in acting as alleged on 24 October 2014, he was not acting in accordance with hospital protocols. He made no assessment of the patient, did not administer the medication from the appropriate container, did not check the relevant medication charts and took it upon himself to dispense medication against policy and good clinical and medical practice. When asked why he acted in this way, and whether it was easier to have less disruptive patients, the nurse said there were some patients who had an ability to reason, but others could not.

In relation to the six-month period in 2014, during which the nurse had taken medication from some patients’ supplies to give it to others, the nurse said it was his usual practice to act in this manner and give patient A’s medications to each of patients B, C and D on a number of occasions and agreed that he made no records of this. Further, he agreed that he was aware patient B had not been prescribed Risperidone and admitted not seeking approval from a medical officer to give it to patient B. The nurse’s only ‘justification’ for his actions was that he thought such medication may help patient B.

As part of the nurse’s acknowledgement, he accepted that his conduct was totally inappropriate nursing practice and was potentially unsafe. He agreed that the medication was not prescribed nor recorded, and therefore was dangerous, particularly in circumstances where the patient did not have their full wits about them and could not communicate. He agreed that accurate records were critically important in a hospital, and that he knew it then and knew it at the time of the hearing. Finally, he said his behaviour was unacceptable and that he made a stupid decision, but did not know what to say to explain why he did it.

In the exercise of a tribunal’s ‘protective jurisdiction’ it is required to take into account the maintenance of the standards of the nursing profession, the preservation of public confidence in the nursing profession and the protection of the community. The tribunal referred to an earlier court decision, which stated: “ … It may also be noted that the protective purpose may operate in different ways. First, by its direct effect upon the practitioner, the order will either remove that practitioner from membership of the profession (by disbarment or suspension) or will provide a deterrent against the repetition of such conduct (in the case of a fine or reprimand). There are also important but indirect effects to be considered. First, the order reminds other members of the profession of the public interest in the maintenance of high professional standards. Secondly and more specifically, it may give emphasis to the unacceptability of the kind of conduct involved in the disciplinary offence. Thirdly, by speaking to the public at large, it seeks to maintain confidence in the high standards of the profession. The underlying purpose is not self-aggrandisement on the part of the profession, but a recognition of the social value in the availability of the services provided to the public, combined with an understanding of the vulnerability of many who require such services.”

The tribunal when discussing assurance for the public and professional colleagues made the following comment “… One element of deterrence is providing an assurance to the public that serious lapses in the conduct of … practitioners will not be passed over or lightly put aside, but will be appropriately dealt with.”

Before the tribunal made a determination, the nurse submitted that he had “suffered enough”. He had been without a job since his employment was terminated (despite applying for more than 300 jobs), and stated that he was finding it difficult to cope financially. Yet it was his intention to re-register in the future, as he wanted to redeem himself. Taking the nurse’s submissions into account, the tribunal ordered that:

• He was guilty of unsatisfactory professional conduct and professional misconduct
• He was publicly reprimanded
• He was disqualified from registering as a nurse for a minimum period of two years from the date of the decision.

The decision highlights that significant penalties apply, even if nurses admit the allegations, plead guilty to the charges and throw themselves at the mercy of the tribunal for leniency in sentencing.

Scott Trueman is a lecturer in the School of Nursing, Midwifery and Nutrition at James Cook University.

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