Reference no: EM133295120

CASE PATTERN 1: HOME CARE, THE ELDERLY PATIENT AND FINANCIAL OPPORTUNISM
Nurse A
From 1997 to 1998, nurse A, a registered nurse (RN), was employed by a hospital to work as a home healthcare nurse. During the course of her employment, nurse A was responsible for providing care to the patient, an elderly patient who had been diagnosed with congestive heart failure, chronic ulcer disease, hypertension, and diabetes mellitus. During the time that nurse A was providing care for the patient, she disclosed issues regarding her personal life and problems that she was experiencing in her personal life.
Nurse A also led patient 1 to believe that she was not only patient 1's caregiver she was his friend. In addition, nurse A went shopping and out for dinner with the patient and received many items from him, including money, furniture, a television, a cellular phone, and clothing. The value of the items that she received from the patient was in excess of $4500.00. Disciplinary outcome: The Board found that nurse A violated §4723.28 (B) (13), Ohio Revised Code (ORC), which authorizes the Board to discipline a nurse who has obtained or attempted to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice and §4723.28 (B) (19), ORC, for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Nurse A received probation for a minimum
period of 7 years. As a condition of probation, nurse A was required to make restitution to the patient within a 6-month period, participate in individual counseling, complete continuing nursing education (CNE) on professional boundaries, and submit employment reports to the Board. Furthermore, nurse A was permanently restricted from practicing in any home healthcare, agency, or private care setting.

Nurse B
Nurse B, RN, owned and operated a home care agency. In June 2002, nurse B visited an alert and oriented 84-year-old patient for purposes of conducting a posthospitalization assessment. Patient 2 was single, childless, and lived alone. Within 2 weeks of conducting the assessment, nurse B had obtained power of attorney over patient 2's assets. In July 2002, the patient suffered a stroke. Shortly thereafter, nurse B gained control over some $150,000 in patient 2's cash and real estate. Patient 2 died. Criminal charges were filed against nurse B. Nurse B testified that before patient 2's death, the patient's wish was that nurse B convert the patient's property into a nursing home facility and that nurse B take patient 2's cash assets so that her niece could not get the cash. In the criminal case, nurse B pled guilty under an "Alford plea,"a plea enabling the defendant to stipulate that sufficient evidence for a conviction exists, while maintaining a position of innocence. The court found nurse B guilty of theft from an elderly person, a third degree
felony. Disciplinary outcome: The board found that nurse B violated §4723.28 (B) (4), ORC, which authorizes the board to discipline a licensee who has been found guilty of any felony offense. The board did not find credible nurse B's assertions that the patient had asked her to become involved in the patient's financial affairs. Even if the board had believed this testimony, under Rule 4723-4-06 (L), Ohio Administrative Code, for purposes of reviewing a potential boundaries violation, "the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse."The board permanently revoked nurse B's license.

Nurse C
From 1998 to 2000, nurse C, RN, provided care to a diabetic, elderly man who lived alone in a rural area (patient 3). Nurse C met patient 3 after providing home care nursing services to his daughter, who was deceased. Nurse C obtained a power of attorney with respect to patient 3, under which nurse C was to
take care of the patient's medical needs, including making decisions regarding nursing home placement. Nurse C adamantly denied that she was patient 3's "nurse" but rather stated that she was merely his power of attorney. However, in an administrative hearing, nurse C testified that she bought patient 3 food, medication, and medical supplies and checked to make sure he was taking his medication. Nurse C eventually acquired real estate that had belonged to patient 3 and opened bank accounts in her name jointly with him, from which she withdrew cash. Concerned over his well-being, his brothers repeatedly sought assistance from law enforcement. In 2000, deputies arrived at his home to find him frail, extremely thin, without food or medicine, and surrounded by animal feces and filth. Nurse C was convicted, in her fiduciary capacity, of a criminal misdemeanor for failure to provide a functionally impaired person with treatment, care, goods, or services necessary to maintain health or safety. Disciplinary outcome: Without determining that nurse C was actually acting in a professional capacity as a "nurse" to patient 3, the board found that her criminal misdemeanor conviction involved a crime of "gross immorality or moral turpitude" on the basis of the circumstances of the case. Nurse C violated §4723.28 (B) (4), ORC, which authorizes the board to take disciplinary action in any case involving a crime of gross immorality or moral turpitude. The board permanently revoked nurse C's license.

CASE PATTERN 2: THE VULNERABLE PATIENT AND PERSONAL GAIN
Nurse D
In 2006, nurse D, RN, had been employed as an obstetrical nurse at a hospital for approximately 16 years. Patient 4 was admitted to nurse D's unit when she delivered an infant. Patient 4 was a rape victim and had selected a potential family to adopt her infant. After meeting the potential adoptive family, patient 4 advised nurse D that she did not want to give her infant to the family because of their age and the poor health status of the potential father. Patient 4 and nurse D engaged in a conversation regarding the agency nurse D had used when she adopted her own children and she disclosed the name of the agency to patient 4. During the conversation, patient 4 asked nurse D if she would adopt her baby. Thereafter, nurse D gave the contact information for her adoption agency to a resident physician to give to patient 4. There was a delay in the resident relaying the information so nurse D gave the information to patient 4 directly. Patient 4 was transferred to another unit and nurse D visited her after the nurse had clocked out for the day. Patient 4 had already contacted nurse D's adoption agency. Patient 4 was discharged the following day. Prior to her discharge, social services staff did not have an opportunity to meet with patient 4, which was contrary to hospital policy. Nurse D reported that after she made arrangements to adopt patient 4's infant, she was questioned by hospital administration. Nurse D advised that she would not adopt the infant if she would lose her job. Nurse D was not instructed to stop the adoption process. Nurse D's employer gave her a written corrective action plan to attend a mandatory inservice, to specifically follow the hospital adoption policy, and to contact her manager if unusual situations occur on the unit. During the investigation, information was provided to the board indicating that nurse D had engaged in similar conduct at the same hospital when she adopted her other children. However, there was no record that nurse D was disciplined and/or advised that this conduct was inappropriate or a violation of hospital policy. Disciplinary outcome: In a settlement agreement, nurse D admitted to the board that she understood that her conduct was a violation of nurse/patient boundaries. Nurse D's conduct would have violated professional boundaries whether she made the adoption arrangements independently or through an- other party. Specifically nurse D violated §
4723.28 (B) (31), ORC, for failure to establish and maintain professional boundaries with a patient and Rule 4723-4-06 (L), Ohio Administrative Code (see footnote). Nurse D's license was suspended and subsequently reinstated subject to probationary conditions including permanent practice restrictions on her employment: Nurse D agreed never to practice in unsupervised settings, including agency work or home care or in obstetrical employment, other than in her position with her current employer.

Nurse E
In 2005, nurse E, RN, worked in an obstetrical unit at a local hospital. Patient 5, a young, unwed mother, gave birth in nurse E's unit. Nurse E learned that the patient was interested in placing the baby for adoption.
Rather than following the hospital's adoption policy (entitled Avoiding Conflicts of Interest in Adoption), nurse E contacted a personal acquaintance and told her of an opportunity to adopt the baby. Within 12 hours of birth, nurse E's friend met with patient 5 at the hospital, and 2 weeks later, her baby was discharged from the hospital with nurse E's friend. Disciplinary outcome: In a settlement agreement, nurse E admitted to the board that she understood that her conduct was a violation of nurse/patient boundaries. Nurse E was placed on probation for a period of 2 years, agreed to CNE in Professional Boundaries and Ethics/Professionalism, employer reporting, and permanent practice restrictions: Nurse E agreed never to practice in unsupervised settings, including agency work or home care, unless the position was approved in advance by the board.

Nurse F
Nurse F, LPN, worked as a home care agency nurse. Patient 6, an infant, was born prematurely with multiple medical problems in 2003, including short bowel syndrome and hydrocephalus. Patient 6's mother was young and single (the father was incarcerated) and the mother also had a toddler in the home
to care for. Nurse F was assigned to provide home nursing care to patient 6, who required Broviac care and IV antibiotic administration. Despite the care needs of patient 6, nurse F took on the case without disclosing to patient 6's mother that she was not certified in IV care. In addition to providing nursing care, in an administrative hearing, nurse F testified that she began to babysit both patient 6 and his sibling as a "free and personal service" to patient 6's mother. Nurse F testified that at times, she took patient 6 into her personal residence to babysit him as respite care for the mother, whom nurse F described as being overwhelmed. Nurse F submitted bills for providing 24-hour nursing care to patient 6. In 2004, when patient 6 was hospitalized, nurse F stated on hospital medical forms that she was the patient's "guardian." Nurse F verbally advised hospital staff that she was patient 6's foster parent. In 2005, county children's services ordered that patient 6 be placed in foster care and ordered nurse F not to be present in any home of patient 6 or in his presence. Disciplinary outcome: Nurse F's license to practice was permanently revoked.

Question for Case Pattern 1

Reflect:  1. What surprised you? 

                  2. What considerations will you take away from this for your own future practice?

                  3. How does this relate to ethical nursing practice? 

Question for Case Pattern 2

Reflect:  1. What surprised you? 

                  2. What considerations will you take away from this for your own future practice?

                  3. How does this relate to ethical nursing practice?