Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE

Norma Hearty: Professional Misconduct Case

Humber ITAL: NURS 217
Sylvia Wojtalik
820668499
Kristin M Carter
November 7, 2014

Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE

In the case of Norma Hearty a Registered Practical Nurse for many years, who
resides specifically within Ontario. Norma worked with a community based nursing
facility for several years, working with various clients within their homes. One client in
particular, a 61-year-old male, who was a client of Normas over a span of four years.
Norma was not the only nurse involved in providing care to the client over the four-year
span, the client received regular visits from a Registered Nurse from the same facility.
The client lived on his own, estranged form his family, living with a condition called
paraplegia. In combination with his paraplegia he also suffers from several pressure
ulcers, incontinency and a non-compliant attitude towards various treatments. This
particular client had records that were short of having been complete; care
plans/documentation, treatments administered, wound care flow sheets (WCFS) as well
as failure to document wound progression. Due to poor documentation and record
keeping it made it difficult to differentiate between which location care and treatments
were given to, as well as the overall procedure administered. The total number of wounds
the patient had presented and the status of the client throughout stages of treatment were
neglected throughout the four-year period within the documentation. Leaving the patients
state in a constant decline with numerous trips in and out of the hospital for adverse
treatments. During the college hearing Norma stated that she was guilty of professional
misconduct by being unprofessional and unsuccessful in completing necessary
documentation about protocols and clients condition. Leading Norma to the decision of
resigning towards the end of the hearing. Reading over this case I do agree with the
College of Nurses that good thorough documentation is crucial in order to communicate
with other staff effectively in order to decrease errors. If Norma continued to work in the
heath care environment it could increase the possibility of other clients being neglected
due to poor documentation and put the patients at a risk of error. Nursing is a selfregulated profession that requires nursing to constantly reflect and improve their scope of
practice. Norma neglected reflection and practice updating throughout her time nursing
within the community, leading to flaws within her care. Resulting in me believing that
Norma made the right decision for herself and the safety and well being of the public.

Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE

Ethical values that were breached and lead to concern are maintaining
commitment to the nursing profession, health care colleagues, as well as to the patients.
Norma did not maintain commitment to the nursing profession as Norma disobeyed
multiple professional standards, in conjunction with accountability (CNO, 2002). As a
Practical Nurse, Norma has the accountability and responsibility to document all that had
been observed, treatments preformed, assessments and reassessments done to patients,
this documentation was neglected and never transcribed. Norma violated the professional
standards as well as she showed visible signs of unprofessionalism (CNO, 2009).
Exposing the patient to medical hazards and risking their safety as well as putting the
public at risk. These are the commitments nurses pledge to abide by within the
profession, which was hindered by Norma. In conjunction, maintaining commitments to
colleagues, which is immensely important when working with a team in order to care for
patient. Nurses collaborate with other health-care providersto maximize health
benefits to persons receiving care(CNA, 2008). Stating why it is relevant for nurses to
document and communicate well as a team in order to provide efficient care. Norma
disregarded this value by not relaying the deterioration of the clients status and
progression of ulcers and continued to document same for the health status updates
(CNO, 2013). Proper documentation could aid fellow HCPs in an appropriate course of
treatment along with accurate wound timelines. Another instance is when Norma failed to
maintain commitment by not recording a time, date and signature on client records. Client
well-being includes inhibiting the patient from harm while, promoting health (CNO,
2009). This can be established by honoring all informed, voluntary decisions of the
clientare respected (CNO, 2009), as well as being noted on file. Although appropriate
care may have been dispensed there is no proof to support treatment was giving, leaving
the client at risk. Poor communication could result in dual treatment that may be
ineffective, which later on could potentially lead to further complications. Overall,
increasing risk to patients current overall state and health (CNO, 2009). Hence, thorough
documentation is necessary because it, demonstrates the nurses commitment to
providing safe, effective and ethical care(CNO, 2008) for clients.

Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE

Several strategies can be implemented by the nursing profession to prevent
reoccurrence of an incident such as having an in service sessions on documentation
(Mathias, 2002) along with regular screenings of client documentation. This could result
in a decrease of documentation errors by implementing progressive teaching on
appropriate documentation, organizing relevant and irrelevant information, which should
be recorded in the clients chart. The teaching seminars should shed light on the priority
of documenting which may incorporate all documents, care plans, wound flow sheets
have been time/date stamped followed with a signature and placed with patient records
visible for other HCPs to view. Making it easy to be review areas requiring improvement
in the planning of care, time management and developing approach as well as the
reassessment of clients current status. The community-based facility should apply
seminars to review patient charts regularly in order to monitor care the client is receiving,
improvements, interventions and any arising areas that stimulate concern. Therefore
restricting the nurse from overlooking documentation, highlighting the nurses
understanding and importance and essentialism of timely documentation to prevent
hazards towards the client. These seminars should be mandatory for all staff who are
obligated to document, bringing the health care team closer as well as allowing staff to
gain further knowledge on importance of roles and documentation. Secondly, underlining
the relevance of focus note method of documentation (Blair & Smith, 2012), that can
grant nurses to plan the primary focus of care, meanwhile integrating proper assessments,
interventions and evaluations. This may be crucial as this approach can assist, what
should be done, what has been done and the outcomes of that care (Blair & Smith,
2012), over creating long care plans as well as nursing diagnoses. Using this approach it
can help the nurse to prioritize time effectively by reducing the amount of paper work at
the end of each task. This can be relevant for the community-based nurses as it may be a
convenient simple approach to documenting multiple problems all at once.
In conclusion, documenting is a mandatory responsibility of nurses that highlights
important documents such as care plans, progress notes, wound assessment flow sheets as
well as statements made by the patient and/or family as well as HCPs. Normas case
showcased bewilderment in regards to documenting important client changes and

Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE

exhibiting professional misconduct as a whole. Norma lacked growth in her scope of
practice as well as he moral and ethical values. Norma took full accountability towards
her actions, which resulted in her resignation from the nursing profession. Ethical values
that were breached were an obligation to the nursing profession by showcasing
unprofessionalism and failure to oblige by the professional standards primarily
accountability. Responsibility to the health care team inhibits the patient from acquiring
the utmost care, as the nurse fails to pass on important information to involved HCPs.
Clients well being encompasses more evidence in regards to hazards than benefits to
health promotion. On going seminars and focus methods signify the relevance of
documentation and how it is apart of the daily protocols as a Registered Nurse. Nurses
should be constantly allowing growth into their scopes of practice as well as moral and
ethical values that are important towards providing optimal care to each member of the
public.

Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE

References
College of Nurses of Ontario. (CNO). (2009). Practice Standard: Ethics. Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario. (CNO). (2002). Practice Standards: Professional
Standards. Retrieved from
http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf
Canadian Nurses Association. (CNA). (2008). Code of Ethics for Registered Nurses.
Retrieved from
http://www2.cnaaiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_
e.pdf
College of Nurses of Ontario. (CNO). (2008). Practice Standard: Documentation, revised
2008. Retrieved from
http://www.cno.org/Global/docs/prac/41001_documentation.pdf
Mathias, J. M. (2002). Review these common documentation errors. OR Manager,
18(10), 40-2. Retrieved from http://search.proquest.com/docview/213063356?
accountid=11530
Blair, W., & Smith, B. (2012). Nursing documentation: Frameworks and barriers.
Contemporary Nurse : A Journal for the Australian Nursing Profession, 41(2),
160-8. Retrieved from http://search.proquest.com/docview/1040777017?
accountid=11530

Running Head: NORMA HEARTY: PROFESSIONAL MISCONDUCT CASE