Unprofessional Conduct, or Is It?

Running head: Unprofessional Conduct

Unprofessional Conduct, or Is It?
American InterContinental University Online
HCM410-0901A-02: The Ethical and Legal Aspects of Healthcare
March 2, 2009

INTRODUCTION This paper will examine a 1979 Idaho case where a nurse met a woman diagnosed with myelogenous leukemia, a form of cancer. The patient had kept her condition under control for the past twelve years but has had a flare up. The patient was admitted into the hospital, and told by her physician, that any chance of survival would be found in chemotherapy treatment (LSU Law Center, 1998). The patient consented and began treatment. However, after the first dose, she explained to the nurse that she was having second thoughts. At the patient’s request, the nurse returned later that evening, and met with the patient and her family. After two hours of conversation about the alternative methods, as well as the chemotherapy, and both of the risks and side effects, all agreed that the patient would stay and continue the chemotherapy. Prior to the nurse returning to see the patient, the patient’s daughter-in-law had called to inform the doctor of what was going to take place between the nurse, patient, and family. The doctor ordered the chemotherapy stopped until the family made a decision. The patient died two weeks later. Later that month the nurse was reported to the State Board for unprofessional conduct, after a hearing her license was suspended for six months. Was this fair? This paper will review the ethical implications of this case, for instance, did this nurse do anything wrong? Did she move beyond her scope of practice? Could her actions be justified under the patient advocate portion of her job? In addition, should she have been sanctioned?
RIGHT OR WRONG The hearing officer in the case found the nurse guilty of unprofessional conduct. However, in 1976, there were no set standards in place, through either the Board or statutes specifically defining unprofessional conduct. Encarta defines unprofessional conduct as “contrary to the expected standards of a profession”; if there are no definite expectations, how can one do something contrary to what is expected? In this author’s opinion, this nurse was not guilty of unprofessional conduct, if anything, she could have informed the patient’s physician of the information the patient wanted and informed him that she was going to talk to her. In saying that, it was stated in transcripts from LSU Law Center (1998), the student nurse, Candice Freeman, and the patient’s son, both testified that the defendant stated that what she was telling them was “somewhat unethical”. If the defendant thought that, then she should have mentioned it to the patient’s physician. In addition, the International Council of Nurses, in 1973, wrote a Code of Ethics for Nurses that stated, “The nurse, in providing care, promotes an environment in which the values, customs, and spiritual beliefs of the individual are respected”. In reading this, one could interpret that the defendant was only respecting the patient’s spiritual beliefs since she believed that her reliance on her religion and faith was what kept her alive for the previous twelve years.
OUTSIDE SCOPE OF PRACTICE In determining if the defendant practiced outside of her scope of practice, one must know how scope of practice is determined. Each state has developed a Nurse Practice Act that outlines and defines the scope of duties for each level of nursing such as licensed practical nurses (LPN), registered nurses (RN), and others. Prior to 1903, there were no such acts, nurses did what they wanted, and what they thought was right. New York became the first state to enact a mandatory Nurse Practice Act (NPA) that had to be followed by nurses practicing in New York State (Smith, 2008). Each state has some form of a Nurse Practice Act that not only provides definitions of nurses but also what education and examinations need to be taken in order to become a nurse. The NPA may define the establishment of the State Nursing Board and what members will be accepted; as well as defining unprofessional or unlawful conduct, and the consequences of each. Scope of practice is also determined by the level of education of each nurse; all that is known about the defendant is that she is a teaching nurse. In what respect does that mean, is she just a registered nurse who teaches others, or does she have an advanced degree and is more than capable of teaching but has also gained knowledge about alternative treatments and the risks and benefits of such.
According to the New York State Education Department, “The practice of the profession of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential health problems through such services as case finding, health teaching, health counseling, provision of care supportive to or restorative of life and well-being, and executing medical regimens prescribed by a licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner 's regulations. A nursing regimen shall be consistent with and shall not vary any existing medical regimen” (Section 6902 of Article 139…, 2006). If this definition were applied to this case, then the defendant would be guilty of operating outside of her scope of practice. The physician prescribed chemotherapy for this patient. Although the defendant knew of an alternative, it was outside of the existing medical regimen and though the patient opted to continue chemotherapy, what if the conversation with the nurse prompted her to try the alternative method and she died. If she died because of trying the alternative method then the nurse could have been found guilty of possible malpractice and may have incurred a civil suit from the family.
PATIENT ADVOCATE
Nurses have not always advocated on behalf of the patient. Prior to taking on the role of patient advocate, nurses were trained to obey doctors’ instruction and follow the rules and regulations of the hospital. Today, however, nurses’ attention is more patient-focused and they are taught that the patient’s interest, autonomy and safety come first (Beyea, n.d.). In reviewing this case, it seems as if there is a thin line in determining whether the defendant served as the patient advocate or not. A patient advocate is one who speaks on behalf of the patients, who will not or cannot speak up for themselves. The advocate makes sure that what the patient has requested in terms of his or her own health care is conveyed to other healthcare staff members. On one side, it seems as if the defendant’s conduct could be justified as advocating on behalf of the patient. On the other hand, because the defendant did not convey the patient’s interest in alternative medicine to the physician upon the patient’s inquiry it could be construed as the defendant being deceitful towards the physician.
CONCLUSION
This paper reviewed the 1979 case of Tuma v Board of Nursing, Idaho. It was determined through the court transcripts that the defendant, Nurse Tuma, was accused of unprofessional conduct due to her discussion with a patient who was being given chemotherapy but wanted information about alternative treatments, and risks and side effects of such. The nurse was found guilty of unprofessional conduct. However, she appealed the decision by the Board up to the State Supreme Court, because unprofessional conduct had not been defined by the legislatures or the Board. The Supreme Court later overturned the Board’s decision. It was later discovered that each state has a Nurse Practice Act (NPA) that governs the amount of education a certain level of nurse needs, the appropriate examinations, the outline of the scope of duties and the make up of the State Nursing Board, as well as other pertinent matters to be considered a competent nurse. Patient advocacy is something that nurses are paying more attention to these days and are becoming more outspoken for the patient, which also upholds the patient’s autonomy. There is a thin line between advocating for the patient and actually coming between the physician-patient relationship. It was shown that in looking at this definition this author is not quite sure if the defendant crossed the line. Therefore, if this author were to have been a board member during this hearing I would not have sanctioned the nurse without giving her a warning that she was definitely skating on thin ice. It is not fair to punish or sanction someone if they were not aware that they did something morally or ethically wrong. It is our duty as healthcare professionals to protect the patient but just as well to protect the employees. REFERENCES
Bernal, E.W. (1992). The Nurse as Patient Advocate. The Hastings Center Report, 22, p. 18-23. Retrieved March 7, 2009, from http://www.jstor.org/pss/3563018

Beyea, S.C. (n.d.). Patient advocacy—nurses keeping patients safe. Retrieved March 7, 2009, from http://findarticles.com/p/articles/mi_m0FSL/is_5_81/ai_n13793213

Encarta Dictionary. (2009). Retrieved March 4, 2009, from http://encarta.msn.com/dictionary_/ unprofessional.html International Council of Nurses. (1973). Ethical Concepts Applied to Nursing. Retrieved March 5, 2009, from http://ethics.iit.edu/codes/coe/int.council.nurses.1973.html

LSU: Medical and Public Health Site. (1998). Nurse Disciplined for Telling Patient about Alternative Treatments (court reverses) - Tuma v. Board of Nursing, 100 Idaho 74, 593 P.2d 711 (Idaho Apr 17, 1979). Retrieved March 2, 2009, from http://biotech.law.lsu.edu/ cases/pro_lic/Tuma_v_Board_of_Nursing.htm New York State Education Department. (2006). The Differentiated Scope of Practice of Licensed Practical Nurses (LPNs) and Registered Professional Nurses (RNs). Retrieved March 7, 2009, from http://www.op.nysed.gov/nurse-scope-lpn-rn.htm.
Smith, M. (2008). Legal Basics for Professional Nursing: Nurse Practice Acts. Retrieved March 6, 2009, from http://www.nursingworld.org/mods/mod995/canlegalnrsfull.htm

References: Bernal, E.W. (1992). The Nurse as Patient Advocate. The Hastings Center Report, 22, p. 18-23. Retrieved March 7, 2009, from http://www.jstor.org/pss/3563018 Beyea, S.C. (n.d.). Patient advocacy—nurses keeping patients safe. Retrieved March 7, 2009, from http://findarticles.com/p/articles/mi_m0FSL/is_5_81/ai_n13793213 Encarta Dictionary. (2009). Retrieved March 4, 2009, from http://encarta.msn.com/dictionary_/ unprofessional.html International Council of Nurses. (1973). Ethical Concepts Applied to Nursing. Retrieved March 5, 2009, from http://ethics.iit.edu/codes/coe/int.council.nurses.1973.html LSU: Medical and Public Health Site. (1998). Nurse Disciplined for Telling Patient about Alternative Treatments (court reverses) - Tuma v. Board of Nursing, 100 Idaho 74, 593 P.2d 711 (Idaho Apr 17, 1979). Retrieved March 2, 2009, from http://biotech.law.lsu.edu/ cases/pro_lic/Tuma_v_Board_of_Nursing.htm New York State Education Department. (2006). The Differentiated Scope of Practice of Licensed Practical Nurses (LPNs) and Registered Professional Nurses (RNs). Retrieved March 7, 2009, from http://www.op.nysed.gov/nurse-scope-lpn-rn.htm. Smith, M. (2008). Legal Basics for Professional Nursing: Nurse Practice Acts. Retrieved March 6, 2009, from http://www.nursingworld.org/mods/mod995/canlegalnrsfull.htm