Introduction


 


In the medical field, there are several dilemmas that personnel such as doctors and nurses encounter in their daily tasks. These dilemmas challenge their moral and ethical fibre as well as their concerns of accountability in carrying out their professional obligations to their patients. This paper will look into the ethical dilemmas and issues of accountability that is associated with the role provided for by registered nurses. According to Buncombe (2000), a Registered Nurse is trained to cooperate with medical practitioners such as surgeons and health care teams in order to carry out safe medical processes with the most favourable outcomes for their clients. However, in engaging in these kinds of activities, the RNs are required to have the prescribed knowledge, capability, and the common sense necessary for clinical practice. For clarity and coherence, the discussions in this paper will be divided into several sections that would individually discuss the specific topics under consideration. Moreover, at the end of the discussions, the author will provide a summation and eventually provide a conclusion regarding the discussions presented throughout the body of the paper. 


 



 


Professional Registration among Nurses


 


Being a part of the medical profession, nurses are inevitably responsible for the welfare of those that acquire the services of their medical facility. Considering this fact, it is imperative for them to adhere to specific norms and standards that will be able to help them more in carrying out their responsibilities. One such standard is the Code of Ethics for Nurses in Australia (ANC 2003). It increases these basic moral obligations of the profession and recognizes the fundamental principles for professional behavior. This underpinning statement text recognizes six Value Statements, two of which particularly makes out the requirement for continuing nursing education after the original training they have acquired in nursing school.  The third Value Statement recognizes that nurses encourage and sustain the condition of quality nursing care for all individuals, indicating that quality nursing care takes account of proficient care granted by suitably arranged nurses who cleave to constant learning and ongoing education as a way of preserving and increasing knowledge and skills.  The fifth Value Statement states that as morally autonomous professionals, nurses are answerable for their clinical decision making and have moral and legal responsibilities for the granting of harmless and proficient nursing care.


 


Another kind of standard that is also in practice in Australia is the ANC Code of Professional Conduct for Nurses. This recognizes that nurses are individually held responsible for the granting of safe and competent nursing care.  Consequently it is the duty of each and every nurse to uphold the competency essential for current practice. This obligation is acquired through continuing instruction to advance knowledge and skills relevant to individual practice conditions.


 


The Scope of Nursing Practice


 


In the case of medical institutions, they are presented with different legal obligations in terms of dealing with the rendering of the services that they offer. One of these includes their duty of care with their patients. The concept of duty of care has been greatly deliberated in the area of common law. Its particular issue is about the causality wherein individuals are affected by prior actions of another. This doctrine is largely influenced in the judgment wherein Judge Atkins delivered. (Donohue v Stevenson [1932] AC 52) In this case, a complaint by a consumer of bottled soft drinks was heeded by the House of Lords. Apparently the consumer held the manufacturer liable to the injury caused by the commodity. The problem at question was whether it was probable to salvage in tort, lacking a contractual bond, since it was not the purchaser that is diagnosed with the injury. The defendants’ line of reasoning was that suppliers’ legal responsibility to customers in tort for substandard commodities was basically unheard of to British law, and there was no lawsuit to be put on trial. The court case considered by the House concerned plainly whether there was, indeed, a case to be heard; there was no definite examination of the evidence. The House resolved, by a meager majority, that there was a case to be put on trial. It held that a principle could be extracted from preceding authorities that any individual could be legally responsible for injury to any other individual, given that particular circumstances were met. Judge Atkins noted that one must take reasonable care to avoid acts or omissions which one can reasonably foresee would be likely to injure his/her neighbor. In this context, the neighbor includes all persons who are so closely and directly affected by one’s act that he/she ought reasonably to have them in contemplation as being so affected when he/she directs his/her mind to the acts or omissions which are called in question. It is in this case that the neighbor principle of the modern law of negligence is established. In the context of the medical milieu, doctors are bound to exercise that degree of care and skill which could reasonably be expected of a normal, prudent practitioner of the same experience and standing. (1956) 1 DRY (2d) 502) The test is objective and will be elevated, as the case may be, to each and every specialty.


 


The Legal Responsibilities of the Nurse in Relation to Drugs and Poisons


 


As nurses, they are also required to handle dangerous substances that require care and cautious provisions. These substances take account of drugs and poisons. Their duties are covered in the Drugs, Poisons, and Controlled Substances Regulations of 1995. To illustrate, Regulations 7(1) (b), 7A (1) (b), 8(1) (b) and 9 (a) of the said law have need of “all reasonable steps” to be acquired to determine the identity of an individual. In these directives, the expression “take all reasonable steps” is employed to offer adaptability of approach in accordance with the conditions. An objective examination has to be implemented to the specific conditions as to whether or not the procedures acquired were adequate. Such an examination would involve bearing in mind if the procedures acquired would be appropriate to those an ordinary capable individual, or member of the profession, would acquire if placed in that condition.


 


Commonly, for an individual to “take all reasonable steps to ensure a therapeutic need exists,” there are specific elements to be taken into account.  One is with regards to the individual who demands the provision of, or to the individual for whom it is planned to set down or provide the substance. Another is the medical or medication history of the individual. This would be to ensure that the right drug is given and that the patient is actually presenting symptoms or characterized state of the illness. Similarly, the need to be informed of any previous or existing drug therapy is required to avert any contra prescription to the drugs to be given. Moreover, indications of mistreatment or abuse of medicines/drugs should also be noted. With regards to the substance applied for or recommended to be supplied, its suitability for the treatment of the presenting symptoms or described condition, it’s possibility for mistreatment or abuse.


 


The moment an individual is familiar to the practitioner and the therapeutic requirement has been established beforehand, less effort may possibly be necessary in “taking all reasonable steps to ensure a therapeutic need exists”.  Nevertheless, for a new patient, a more methodical and systematic attempt might be necessary to suit this requirement, particularly where there is grounds to suppose drug abuse or misuse. In such conditions, “all reasonable steps” might take account of probing the patient; and verifying the patient’s account by getting in touch with the supposed preceding suppliers.


 


The Confidentiality of Patient Information & Possible Defamation


 


A patient is compelled to offer personal data to Registered Nurses and other health care professionals to facilitate the admission to health care. Nevertheless, revelation of personal data places the patient in danger of their confidential information being revealed. There are ethical in addition to legal requirements to guarantee that the patient’s right to privacy is preserved. Nurses protect information found out in the circumstance of a professional relationship, and guarantee it is shared external of the healthcare team simply with the individual’s informed consent, or as may be lawfully necessary, or where the failure to reveal would bring about considerable harm. All registered nurses are anticipated to maintain the health information of patients. It is the responsibility of all health care providers to guarantee that the privacy of personal information is upheld.  


 


There may possibly be exemptions to the responsibility of maintaining the patient’s right to privacy. Under specific instances disclosure of private information may possibly be necessary. For example, the law necessitates a registered nurse to turn up assumed child abuse, particular infectious diseases, and discharge data under the influence of a court order. In the infringement of the legal and ethical duty to uphold confidentiality, the facility/department director or administrator is supposed to be notified. The moment personal information is revealed with no approval, the patient may possibly bring the case to court, a registered nurse could be filed a suit for negligence, infringement of privacy or defamation. A professional nursing licensing body/association may possibly provide disciplinary actions in opposition to a nurse claiming that the nurse has violated client confidentiality.


 


Professional Misconduct and the Possibility of Disciplinary Action


 


Another legal issue that they have to contend with is the probability of medical negligence. Since the RNs are now directly taking in hand with the medical operations to the patient, they are similarly subjected to this kind of legal problems. A lawsuit of this legal enormity has been significantly influential in deciding court cases regarding medical negligence. Clinical negligence is defined as several action or lapse which goes amiss of a criterion to be predictable of the reasonable man, in this context, the medical practitioner. It is indispensable to demonstrate that no matter what the nurse did or did not do fell below the benchmark of a convincingly knowledgeable RN in that discipline of medicine. The RNs will be able to protect the compensation claim effectively, if it can confirm that an accountable organization of highly regarded doctors in the related discipline would have functioned in an analogous approach. This connotes that a judge will examine verification from professionals and come to a decision whether the measures taken were apposite. In a clinical negligence case, it is posited that the burden of proof for the suit is laid on the hands of the petitioners.


 


Another important thing to consider is the causation of the suit. It is deemed indispensable to ascertain that the failure by the medical practitioner in reality instigated the damages complained by the petitioners. The claim of negligence among medical personnel such as the RNs needs to satisfy three elements in order for the claimant to collect the appropriate damages. These include the duty of care, breach of the duty, and the causation of the injury. The first element denotes that the claimant has to prove that he/she has been admitted to a hospital where the defendant doctor have supervised his/her stay in the said medical facility. The second element implies that the claimant has to prove that the medical practitioner that attended to him/her have failed to comply with the appropriate standard of care required of the doctor. This is normally labeled as the Bola Test. ( Hospital Management Committee)


 


The test states that the standard of care obligatory of a RN is that of the customarily trained RN exercising and professing to have that skill. He requires not possessing the uppermost professional skill. Nonetheless, it is adequate if he practices the common skill of a common proficient RN exercising that particular discipline. Moreover, it also denotes that an RN who had acted in conformity with a practice established at the time as appropriate by an accountable body of medical opinion accomplished in the particular type of treatment under consideration was not responsible of negligence simply because in attendance was a body of competent professional opinion which might espouse a dissimilar method. On the other hand, the last element should also be satisfied. This means that the claimant should establish that the cause of the current injury is triggered by the negligence of the medical practitioner involved. (Hospital Management Committee) Another determinant of negligence among medical practitioners is when a blunder of judgment may possibly, or may possibly not, be deemed negligent; it depends on the characteristics of the blunder. If it is one that would not have been made by a convincingly knowledgeable professional acknowledging to have the degree and category of dexterity that the defendant held himself out as having, and performing with average care, then it is negligent. If, conversely, it is an inaccuracy that a man, performing with average care, may perhaps have made, then it is not negligent. ( [1981] 1 All ER 267)


 


 


 


 


Conclusion


 


The role of the registered nurse has been thoroughly discussed in the body of the paper. This is to present the responsibilities and important duties that the RNs have to contend with in his/her line of work. In presenting the kind of work they assume, it is apparent that they are similarly in charge of the life of the patient once they are going under the knife. Their technical skills are required to keep the medical team’s performance without glitches and thus ensuring the safety of the patient.


 


In this context, the study has also presented that with the RNs extended function, they are also subject to concepts like duty of care and accountability. Along with this kind of responsibilities are the sanctions of medical negligence that they could be charged once they have not performed at par with what is required of them by the medical institutions. These are the dilemmas that a regular RNs face in his/her line of work. These are the problems in which the safety of the patient is still the central component.


 


In looking into the discussions above, the presence of an RN in the medical team has apparently provided a positive impact on the outcomes of the medical operations. In this manner, the patient makes the most of the extended function that these registered nurses are willing to undertake. Nevertheless, the continuous vigilance of these nurses to constantly upgrade the skills and educate themselves persistently regarding the advancements in medical technology is still necessary and indispensable.



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