A registered nurse (RN) is a very key individual in the provision of healthcare services.
Often times, patient care is under a registered nurse thus when he or she neglects his or her duty,
the patients’ lives can be in danger. Every single registered nurse is tasked with the responsibility
of promoting health and helping in the prevention of any kind of illness.
RNs are required to adhere to their professional code of conduct and ethical guidelines as
they go about their duties. There are also legal aspects that they must adhere to. Issues such as
cultural safety must be given priority by the practicing registered nurse. According to Nursing
Council of New Zealand (2005) any person delivering nursing services must have a reflection of
his or her cultural identity and get to know how this will impact his or her professional practice-
that which is regarded as unsafe cultural practice is any action which diminishes, demeans or
disempowers the cultural identity and wellbeing of an individual (NCN, 2005).
The responsibilities of RN
RNs have a number of responsibilities in provision of healthcare services. No hospital can
function properly without a registered nurse. This is because the services they provide are very
vital in the entire process of assisting patients to gain good health. Some of the responsibilities of
registered nurses include;
Assessing patients who are admitted in trauma and emergency units. They do this to
determine the severity of the cases presented by the patients. This is referred to us triage.
Undertaking treatment plan. RNs are always charged with the responsibility of
administering medication as prescribed by the medical doctor or medical officer. These
include nutrition by IVs, giving shots etc.
Helping patients with their needs since they are always with patients for a longer time
than any other personnel in the hospital. These may include bathing shaving, toileting,
Monitoring patients’ condition on a regular basis. Some of the conditions monitored by
the RN include body temperature, blood pressure, blood sugar level and blood pressure.
Another vital role of RN is medical documentation. These include treatment administered
and the condition of the patient which is very important in assisting the doctor in treating
Neglect of any of the above responsibilities would put the life of the patient at risk as seen in
the case of Mr. Sheppard. Based on such occurrences, ANMC (2006) has set standards to assess
competence which are also part of the annual renewal of license process, to assess midwives
educated overseas seeking to work in Australia, and to assess midwives returning to work after
breaks in service. These are also used to assess midwives who are involved in professional
From the case study, Mr. Sheppard was placed in the wrong unit after he was operated on
and the analgesia recommended for him by the medical officer after he complained of abdominal
pain and distention was not administered by Ms. Sally Price who was on duty during the night
This goes against the nursing code of ethics according to ANMC (2008) code of ethics which
Nurses value quality nursing care for all people.
Nurses value respect and kindness for self and others.
Nurses value the diversity of people.
Nurses value access to quality nursing and health care for all people.
Nurses value informed decision making.
Nurses value a culture of safety in nursing and health care.
Nurses value ethical management of information.
What is clear in this case study is that priority is not given to management and
documentation of the patient’s records as can be seen by Ms. Price act of not getting to know
what occurred when she was coming in for the night shift. She never documented the
administration of analgesia as recommended by the medical officer and never completed her
notes. Even the verbal communication was not documented. This is a gross negligence on the
part of Ms. Price despite the fact that she had been practicing for five years. It is contrary to the
nursing code of conduct that emphasizes on compassionate patient care (ICN, 2006). According
to ICN (2006), the patients’ focal point should be the focus of nursing work. The four
principle elements in ICN code entails standards related to nurses and people, practice,
profession and coworkers. This is not what we see in the practice of Ms. Price and quality
nursing and healthcare is compromised when a registered nurse fails to take her duties serious.
The negligence is also seen in the day shift RN who did not report that Ms. Price had been
“flat out” all night shift. It is clear evidence that in the hospital in question, RNs were not keen
on details and left out information that are very important in the treatment of patients who were
under their care. According to ANRAC (2008: 9), ethical management of information is given a
priority and documentation and management of the same information which majorly include
health care records and other related documents should be done with professionalism and
integrity. The recorded information should accurate, non-judgemental and should be relevant to
the health, care and treatment of the patient in question. This is not what we see practiced by Ms.
Price and other RN in the hospital under our case study. We rather see lack of professionalism in
the way the records are being handled. ANRAC (2008: 9) state that health documentations
cannot be altered except by addition of information. Any error in documentation can have a
serious or powerful positive or negative on the quality of healthcare received by a patient.
One thing that is worth noting is the way in which patients were mixed in the hospital in our
case study lack of cooperation on Ms. Price side despite the fact that The RN in-charge of the
Post-Anaesthesia Care Unit (PACU) on night-shift reached out to her phone a number of times.
This is a case of laxity on Ms. Price side since if she was overwhelmed by the work that night,
then she was expected to call assistance from the Anaesthesia Care Unit (PACU) according to
Legal registered nursing roles and responsibilities
Legal responsibility of RN becomes so really when questions arise about professional
negligence with regards to dispensing of a registered nurse (RN) duties or any that touches on the
supervision of the care and provision of other medical services to the patient. The knowledge the
legal responsibility expected from NRs is vital in their work and helps them in adhering to the
code of conduct of a RN (Jameton, 1993: 542).
Any act of omission that result to damage to the patient would make RN liable if it is
established that it is as a result of negligence. We see this in our case study where Ms. Price does
not make complete documentation with regards to Mr. Sheppard condition and whether analgesia
was administered or not. According to civil code of the Philippines Art 2176: Whoever by act
or omission causes damage to another, there being fault or negligence, is obliged to pay
for the damage done (Baltron, 2005).
Another issue worth noting in our case study is the bit of cultural sensitivity. Culture
could be defined as “Integrated patterns of human behavior that language, thoughts, beliefs,
action, communication, customs values and/or institutions of ethnic, racial, religious and/or
social groups (Lipson and Dibble, 2005). The nursing profession must recognize the universal
human rights of people and the moral responsibility to safeguard the inherent dignity and equal
worth of everyone. That is inclusive of rights to a particular religion (ANRAC, 2008).
It is imperative that RN value the diversity of people and in a special way seek to meet to
the need of each and every patient for the purpose good services and satisfaction on the patient’s
side. There people from cultures who believe that touching and medical attention can only be
administered by a medical personnel of the same gender to the patient. Anything short of this
will be regarded as an infringement (Wolf, 1989: 57). In this case study, the female patient
admitted to the same unit was not pleased of being placed together with the male patients. This
was because of her religious affiliation. Despite the fact the she was promised that a change
would be made to this arrangement, nothing was done. This was to be the responsibility of the
registered nurse (RN).
Ethical Issues in Nursing
Some of the key ethical principles that any registered nurse (RN) must follow include the
principle of autonomy, principle of beneficence, principle of nonmaleficence, principle of
fidelity, principle of justice and the principle of paternalism. These principles are very important
in delivery of health care services by any hospital staff or individuals in the medical field (Guido,
According to Beauchamp and Childress (2009), the principle of autonomy entails
agreement to respect another’s right to self-determine a course of action; support of independent
decision making. Thus NRs must respect the patient’s autonomy in any kind of clinical situation.
Any action that is contrary to this principle is considered as a violation of the patient’s right and
it goes against the code of ethics of valuing informed decision-making according to ANMC
(2008). In our case study, there is no evidence that the patients or the people close to them were
engaged at level when the treatment was being administered. What we see in the case study is
procedures being done on the patients to correct complications. In Mr. Sheppard case, it is not
clear whether he was involved in making the decision to carryout laparoscopic cholecystectomy
on him. This can only be speculated. The patients should always be involved and be given the
freedom to choose the kind treatment to be administered on him or her (Jones & Cayard, 1982:
The principle of beneficence entails compassion which is positive action to help others;
desire to do good and is the core principle of our patient advocacy (Beauchamp and Childress,
2009). Nursing profession is all about having compassion on the patients and this is the driving
force of the job. Any RN that is not driven by compassion as she or he dispenses the nursing
services may not measure up to the challenges of nursing profession. This principle demands that
the RN provide pain medication as soon as possible in a case where a patient goes through pain
as an act of beneficence (Schröck, 1995). This should happen without waiting for doctor’s
instructions or coercion. In the case study, there is a case of two of the male patients admitted in
the same unit as Mr. Sheppard (Extended Day Only Unit) who were distressed; one was
continuously vomiting post-appendectomy and the other was experiencing urinary retention
following a Transurethral Resection of the Prostate (TURP) and there is no indication that the
NR responded to their situation. This was also evident in Mr. Sheppard case who although
complained of abdominal pain and distension, nothing was done by the RN on duty to relieve
him of the pain. Thus it is clear from the case study Ms. Price violated this ethical principle. The
code of ethics which calls on RNs to value a culture of safety in nursing and health care is not
adhered to in our case study (ANMC 2008).
Nonmaleficence principle deals with avoidance of harm or hurt and it is a very important
or core of medical oath and nursing ethics (Romano, 1987). Any medication administered which
result to any kind of hurt or harm or failure to administer a medication that would otherwise help
the patient should be regarded as non-compliance to this principle. In our case study, Ms. Price
failure to administer analgesia to Mr. Sheppard as documented by the medical officer should be
construed as abuse of the principle of nonmaleficence. Mr. Sheppard develops a complication
which could have been sorted if the RN had taken her duties seriously. This is also against the
code of ethics according to ANMC (2008; 1) which states that Nurses value ethical management
of information and quality nursing care for all people. The beneficence of providing the
medication quickly must always be balanced with the possible maleficence of obtaining consent
when the patient does not have the capacity to make the decision for any kind of treatment
procedure (Beauchamp and Childress, 2009).
Another instance that raises ethical questions in our in the case study is the placing of
female patient and male patients in the same ward. It was expected that the female patient to be
placed in different ward for the purpose of privacy (Ellis & Hartley, 1998). It goes against the
principle of autonomy since the decision to have the female patient in the same place as the male
patients was not done with the consultation. The female patient was just assigned the ward and
that is the reason as to why she raised concerns with regard to the ward where she was placed.
This is in contravinance to the nursing code of ethics according to ANMC (2008; 1) which states
that nurses value respect and kindness for self and others and the diversity of people.
Other ethical principles such as fidelity which is about loyalty, fairness, truthfulness,
advocacy, and dedication to patients are not covered in the case study, but it is very vital medical
profession and any medical practitioner is expected to adhere to this principle (ERC, 2009).
Other principles such justice which entails equal and fair distribution of resources and
paternalism where healthcare professionals make decisions about diagnosis, therapy, and
prognosis for the patient are also key ethical principles to be adhered to (Butts and Rich, 2008).
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