Вы находитесь на странице: 1из 7



Understanding Ethical Issues in Nursing Practice Through CNO Disciplinary Hearings

Nirjhari Chhaya
NURS 217 - ONF
November 13th, 2015


Understanding Ethical Issues in Nursing Practice Through CNO Disciplinary Hearings

In every profession there is always an opportunity on ethical issues to arise. An ethical
issue that is evident in the nursing profession is professional misconduct. Professional
misconduct includes activities such as abuse, inappropriate behaviour, negligence, incorrect
administration, etc. The CNO Discipline Committee is responsible for holding hearings and
making decisions in matters of professional misconduct. A case that displays ethical issues in the
nursing profession is the case of DM. In this case, DM committed many activities that resulted in
professional misconduct. These activities included failing to document observations,
administering incorrect amounts of insulin, administering medication early, failing to administer
nutrition through a feeding tube, and attempting to administer to a patient oral medication that
had already been handled and/or mouthed by another patient, inappropriately. The decision of the
Discipline Committee was as follows: she was required to do a refreshes course, which entailed
all basic nursing skills, and had to pass with 65% in both a clinical component and a written
examination. Once she finished the course, she was required to attend three sessions with a
Nursing Expert, who would assess if DM has met all the requirements to proceed in her nursing
career. She would also need to inform her new employers of the decisions for a period of 24
months and the employer would perform random audits to assess DMs practice. According to
the Discipline Committee, the penalty was appropriate because it met the goals of rehabilitation,
remediation, specific, and general avoidance. DM agreed to the charges, the decisions of the
Discipline Committee, and the penalty (College of Nurses of Ontario, 2013). The decision of the
Discipline Committee was correct because DM was at fault and she needed to be penalized for
her malpractice to ensure that reoccurrence of such activities does not happen again. This case


contravenes ethical values; however, two strategies that would be beneficial in this situation
include implementing a double check policy and having workshop on proper documentation.
Ethical Values
Ethical values are an important part of the nursing profession as they guide nurses to use
their judgement and choose the right course of action. The case of DM contravened some ethical
values. Firstly, the value of maintaining commitment is breached. According to the CNO
Practice Standard: Ethics, Maintaining commitments means keeping promises, being honest
and meeting implicit or explicit obligations toward their clients, themselves, each other, the
nursing profession, other members of the health care team and quality practice settings (2009).
DM, throughout her practice, violates this value by failing to document her observations,
administering wrong amounts of insulin, administering pre-handled medications, and
administering medication early. Therefore, she failed to maintain commitment to the client,
nursing colleagues, or other team members, to oneself, the nursing profession, and quality
practice settings. Secondly, the value of client well-being was infringed. The Practice Standard:
Ethics document by CNO says that the goal of client well-being is to prevent or remove harm
and facilitate health and welfare and that all nurses need to put client well-being above all other
objectives (2009). DM failed to put the clients well-being above anything else when, even after
realizing that she had made medication errors, she chose not to do anything to facilitate the
health and welfare of these clients. She also failed to provide nutrition through a feeding tube
and did not document the clients progress. With respect to the errors previously stated, DM also
contravened the value respect for life. CNOs Practice Standard: Ethics states that, Respect for
life means that human life is precious and needs to be respected, protected and treated with
consideration (2009). DM failed to respect, protect, and treat with consideration, the lives of the


humans she was caring form and put their lives at risk. Overall, DM failed to follow the ethical
values to guide her to select the correct course of action. In doing so, she created many ethical
conflicts that needed to be resolved.
Strategy One
Strategies need to be developed in order to prevent situations like this one from
happening again. One of the more prevalent problems in this case was the incorrect
administration of insulin. A policy that would prevent inaccurate insulin administration is a
double checking insulin policy. With this policy in place, when a nurse is required to administer
insulin, he or she must first check with another nurse if the measured amount is correct and if the
amount that is drawn into the insulin syringe is correct. According to Conroy, Davar, and Jones,
Double checking, where two nurses check before administration, is one mechanism introduced
to minimise errors (2012). Having this policy in place will minimize errors related to insulin
administration. Even with the benefits of the policy, there is a negative consequence. Nurses will
have to take time out from the care of their patients in order to double check the insulin dose.
However, it will not take long and it will not be of high inconvenience to the double checking
nurse. According to the CNOs Practice Standard: Medication, in order to ensure safety, nurses
must take appropriate action to resolve or minimize the risk of harm to a client from a
medication error or adverse reaction and collaborate in the development, implementation and
evaluation of system approaches that support safe medication practices within the health care
team (2015). The double check policy is in accordance with CNOs medication standard as it
will prevent medication errors and it will support safe medication practices. In order to
implement this policy, all the nurses on the unit need to be informed of the policy. The first step
would be to hold a workshop with the nurses on the unit to inform them of the requirements of


the policy and to hold practice session of implementing the policy. The second step would be to
monitor the use of the policy over the course of a few months to ensure that the nurses are
abiding to the policy. If the nurses forget to abide by the policy, an in-service would be held to
remind them of the requirements. The final step in implementing the policy would be to evaluate
the outcomes in order to assess its effectiveness.
Strategy Two
Another reoccurring problem in the case of DM was documentation. DM failed to
document assessments, interventions, and evaluations of her care. In order to ensure that all
nurses document and document correctly, a documentation course needs to be implemented on
the unit. This course would comprise of three parts: an educational session on documentation,
practice documentation scenarios, a clinical evaluation of documentation, and a remedial course
if they do not meet the needs of the main course. In the education session on documentation, the
nurses will be taught about the different methods of documenting on their unit and what
information they need to include in their documentation. Once they complete this education
session, they will get to practice their documentation skills using scenarios. Their documentation
of the practice scenarios will determine if they need further education or if they have the
knowledge and skills to move on to the final part of the course. In the final part, nurses
documentation in clinical practice will be evaluated to reflect on their strengths and
shortcomings. Once the evaluation if over, nurses will be informed about the areas they need to
improve on. After one month the clinical documentation will be evaluated again to observe the
improvements and deficiency. If there are deficiencies, the nurse will have a remedial course to
go over the shortcomings and will be evaluated on practice documentations. By implementing
this program into clinical practice, the nurses documentation can be supervised. According to the


CNO Practice Standard: Documentation Revised, there are three standard statements to guide
nursing documentation and they include communication, accountability, and security (2008). The
documentation course will ensure that the nurses have the knowledge of these standard
statements and they abide by them. The goal of the program would be to guarantee accurate
documentation; however, there will be some setbacks to the program. Firstly, the program will be
time consuming. Secondly, the nurses will need to be closely monitored in their documentation.
Lastly, even though the person monitoring the nurses will be a part of the unit, he or she will see
all the patient information in the documentation, which may be considered a violation of privacy.
Every program has its pros and cons, but the only way to find its effectiveness is to implement it
and evaluate the outcomes.
The case of DM was a complex case with many professional misconducts. It contravened
ethical values including maintaining commitment, client well-being, and respect for life. Two of
the main professional misconducts committed by DM were incorrect administration of insulin
and failure to document findings. Strategies to solve these misconducts include implementing
double check policy and a documentation course, respectively for the two misconducts. The
CNO disciplinary hearings give insight into the kinds of ethical problems that arise in nursing
practice. In order to solve these ethical problems, it is important to educate one about the
different ethical issues and conflicts that can occur. The CNO Practice Standard: Ethics provides
an ethical framework to guide nurses in indentifying and resolving ethical situations (2009).


College of Nurses of Ontario, (CNO). (2013). Discipline Decisions. Retrieved November 01,
2015, from http://www.cno.org
College of Nurses of Ontario, (CNO). (2008). Practice Standard: Documentation Revised.
Retrieved from www.cno.org
College of Nurses of Ontario, (CNO). (2009). Practice Standard: Ethics. Retrieved from
College of Nurses of Ontario, (CNO). (2015). Practice Standard: Medication. Retrieved from
Conroy, S., Davar, Z., & Jones, S. (2012). Use of checking systems in medicines administration
with children and young people: many hospitals employ double checks when
administering medication to minimise the risk to children, who are more vulnerable than
adults to errors, But this practice has resource implications, say Sharon Conroy and
colleagues. Nursing Children and Young People, 24(3), 20+. Retrieved from