Registered nurses, enrolled nurses, and midwives are

Registered nurses, enrolled nurses, and midwives are responsible for making professional judgments about when an activity is within their scope of practice and, when it is not, for initiating consultation and collaboration with, or referral to, other healthcare team members. Differentiate and critically discuss the ethical, legal and clinical issues that is associated with the Ms Smith? Identify and integrate the relevant Codes of practice and the Australian Registered Nurses’ Standards of Practice that aims to prevent these events throughout the discussion. The Case Study – Jun 2022 A tribunal has ordered the cancellation of a registered nurse’s registration after she failed to conduct necessary observations of a patient and made false amendments to the patient’s medical records. 26 May 2019, Ms Christina Smithfield was given a directive to monitor a patient who had taken a fall in an aged care facility (the facility) for signs of injury to the brain. Ms Smithfield failed to conduct any neurological observations and recorded in progress notes that the patient had settled throughout the night with no behavioural issue of concern. The patient then deteriorated and spent time in the hospital, only to return to the facility for palliative care. On 5 June 2019 the patient died. Out of concern for professional and personal ramifications, Ms Smithfield made amendments to the progress notes and recorded false neurological observations. When questioned, Ms Smithfield denied making any changes, but when confronted with time stamps, alleged that her observations were written on a piece of tissue at the time and she forgot to transfer the details into the progress notes that night. Ms Smithfield’ employment was terminated on June 2019, and a notification was made by the facility to the Australian Health Practitioner Regulation Agency (Ahpra), and the Nursing and Midwifery Board of Australia (NMBA). The NMBA initially proposed immediate action in the form of suspension, as at this time Ms Smithfield maintained that she had made the necessary observations. The NMBA imposed conditions on her registration which, among other things, required her to be supervised by another registered nurse when practising. March 2020, the NMBA referred Ms Smithfield to the NSW Civil and Administrative Tribunal (the tribunal). Ms Smithfield formally admitted to falsifying the patient’s progress notes and that she failed to conduct the necessary observations of the patient. The tribunal found that Ms Smithfield had engaged in professional misconduct and ordered that she: be reprimanded have her registration cancelled, and be disqualified from applying for registration until 1 May 2023. The tribunal agreed with the NMBA that a fundamental assumption made by patients, clients, colleagues, employers and the community in general is that nurses will faithfully record true observations in clinical records and said that Ms Smithfield’ conduct ‘amounted to behaviour that was inconsistent with her being a fit and proper person to hold registration in the profession’. SCIENCE HEALTH SCIENCE NURSING HSNS 273

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