Part B Legal and Ethical Scholarly Assignment 1

Part B: Scholarly Written Paper

Student: Sandeep Grewal
Student No: 820 302 743
Date Submitted: March 31, 2015
NURS 217(005): Legal and Ethical Concept
Professor: Kelly Ann Rose
Humber College North

Part B Legal and Ethical Scholarly Assignment 2

It was alleged that Marie C. Aubut, who was a Registered Practical Nurse had committed
acts of professional misconduct as provided by subsection 51(1) of the Health Professions
Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32 , as amended, and defined in
subsection 1(1) of Ontario regulation 799/93, between the period of May 2001 and January
2007, that she did not maintain a level of practice that was in keeping with the expectations of
the College in her relationship with and treatment of client. She was also alleged to have abused
her client emotionally, to have influenced her client to change his will, and had conducted herself
in a manner that would be considered as disgraceful, dishonourable or unprofessional by
members of the nursing profession (Disciplinary Committee Decision, 2009). The Counsel for
the College advised that the College was not going to hear the allegations about abusing her
client or of influencing him to change his will. She was to be charge for failing to meet the
standards of practice with respect to her relationship with and/or treatment of the client.
Qualified as an RPN, but working as a Personal Support Worker at a residential
hospice/supportive housing unit, Aubut was allowed to perform nursing duties such as
administering injections and signing clinical records. She was dismissed from employment on
February 6, 2007. The allegations against Aubut was based on several reports that she had
allowed the client, who had a substance abuse and other medical problems and who had stayed
for short periods of time at the facility, to stay at her house for two days prior to 2006, that she
had pictures of herself and her children which he kept in his room as he had no family, and that
he had put her as Executrix on his will. Besides, from various correspondence, it was evident
that they had an intimate relationship, that Aubut her allowed him to use her address and had
given him a false rent receipt so that he could obtain Ontario disability Benefits. Although client
did not live with her, he spent time in her home. In short, the allegations were that she had

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developed an intimate relationship with the client that constituted a violation of the therapeutic
nurse-client relationship, which was a serious boundary violation (Disciplinary Committee
decision, 2009). Aubut admitted of the professional misconduct. There was no evidence that the
client was experiencing any physical or mental challenge, although he was known to suffer from
ongoing substance abuse. Only this nurse was involved in the allegation of misconduct, and
there was no contributing factors, such as substance abuse or any conditions that affected Aubuts
behaviour. I agree with the decision of the Discipline Committee that Aubut had committed an
act of professional misconduct in her relationship with and treatment of the client.
The ethical values that Aubut contravened were maintaining commitments (CNO, 2009,
p. 4). According to this ethical value of commitment to values, nurses are expected to live up to
expectations with respect to client, self, profession, as well as colleagues, teams and settings. In
this case, Aubut contravened maintaining commitments to clients (CNO, 2009, p. 9) and
maintaining commitments to the nursing profession (CNO, 2009, p. 11). In the first place, Aubut
allowed the client to spend time in her house. While it may appear that at first this might have
been a benevolent act on her part, the many emails that she sent to him appealing to him to come
back and spend time with her, and also telling him to come to live at her home instead of getting
a room, all suggest that she wanted him to be with her as a couple. She also invited him to come
to her home when her children were away, so that they could spend the day together. All of this
suggests that she was having an intimate and sexual relationship with the client. This was totally
unprofessional, because Aubut was looking after her own personal needs as well.
According to commitments to client, nurses are expected promise to look after the best
interests of the client and to provide safe, effective and ethical care (CNO, 2009, p. 9). She was
not supposed to look after her own needs in dispensing this duty to her patients. From the

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allegations and finally the acceptance on the part of Aubut that her actions were unprofessional, I
believe that Aubut had failed in being professional and in meeting the needs of her patient. This
is particularly true when he did not want to stay with her but when she continually wanted him to
do so. It is clear that after a while, Aubut in her relationship with him, was looking after her
interests and not his.
Also, the nurse as a member of the nursing profession is expected to behave in a
respectable and trustful way with clients. As noted, nurses have a duty to uphold the standards
of the profession, conduct themselves in a manner that reflects well on the profession and to
promote the development of the profession (CNO, 2009, p. 11). According to CNA (2008),
nurses are expected to practice according to the values and responsibilities in the Code of ethics
for registered Nurses ad in keeping with the professional standards laws and regulations
supporting ethical practice (p. 18). By becoming intimately involved with the client, Aubut was
showing that she was not acting professionally. Nurses are expected to maintain a therapeutic
relationship with their clients, and this is what the public expect of nurses. To promote the image
of the nurse as a professional, this is the role that the nurse is supposed to carry out. Therefore,
when Aubut started having an intimate relationship with the client, she was acting contrary to
this. From the allegations, on numerous allegations, Aubut was openly affectionate with the
client in public. This was clearly irresponsible and could be damaging to the image of the
profession.
Therefore, I agree with the finding of the Discipline Committee that Aubut was
unprofessional in her actions. She contravened the values of maintaining commitments to clients
as well as to the profession and it is only fitting that should be penalized. It was fitting that she

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had limitations and conditions placed on her annual payment card. In this way, Aubut would
learn the lesson of what constitutes professional nursing behaviour.
Two strategies that would be suggested to prevent a situation like this from occurring
again are education and policy. Nurses should continue to be reminded of their relationship with
their clients. They are expected to provide care to their clients, and must be aware that there is
difference in power between nurses and their clients. It is because of this that nurses are expected
to be very careful to provide ethical care to their clients and not to become emotionally and
intimately involved with them. To promote education so that nurses know the importance of the
nurse-patient relationship, all nurses should be required to do a short review of the publication,
Therapeutic nurse-client relationship, revised 2006. The reason for this is to keep nurses always
aware of the everyday situations and interaction with patients that could be seen as problematic.
In this publication, one of the statements that is clearly identified is Maintaining boundaries:
Giving and accepting gifts (CNO, 2013, p. 13). One of the indicators listed in this publication
highlights for the nurse that there should be not share personal information with clients, except it
helps the client. Other indicators were that the nurse should continue to clarify his or her role in
the therapeutic relationship, especially in situations in which the client may became unclear
about the boundaries and limits of the relationship, and that the nurse should be abstaining
from engaging in financial transactions unrelated to the provision of care and services with the
client or the clients family/significant other (CNO, 2013, p. 7).
In terms of policy, all healthcare facilities should have a policy that states specifically that
violation of the nurse-patient or the healthcare worker-patient is not allowed, and could be
subject to disciplinary action including dismissal. The reason that policy would work is that this
would be stressed when a nurse is hired, so that the nurse is not placed in an ethical dilemma

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from time to time. The reason that this is a good idea is that nurses are frequently being placed
in difficult situations on an ongoing basis. According to Peternelj-Taylor and Yonge (2003),
nurses are expected to do the right thing, even when it is not always clear what doing the right
thing might look like (p. 56). If there is policy in place that says certain things cannot be done,
then this removes the issue of trying to decide what the right thing is. Besides, having a policy in
place could help make a nurse conscious of her behaviour and her relationship with her patients.
As Rasheed (2015) points out, self-awareness is considered as the therapeutic tool for nurse
client relationship (p. 211). Having a policy in place will keep a nurse ever conscious of that
relationship, especially if any misconduct could mean the end of her or his employment.
In conclusion, I agree with the decision. As pointed out, The panel concluded that the
Members actions were unprofessional as they represented a serious and persistent disregard for
professional obligations in respect of this client, but did not represent dishonest behaviour and
members of the profession would not consider them to be disgraceful in this situation.
(Disciplinary Committee Decision, 2009). The penalty was to suspend Aubuts certificate of
registration for 3 months, to have conditions and limitations placed on her annual Payment Card,
and require her to take counselling and education with respect to the nurse-client relationship and
ethics. I believe that this is a fitting penalty for the misconduct. It is clear that Aubut did not
intend to defraud or be dishonest. She had met her client, and had become intimately involved
with her. On reflecting on this case, I think that it is possible that Aubut may not have considered
herself bound by the patient-client relationship because she was working as a personal support
worker (PSW). She may have thought that this relationship did not cover her in the role of PSW.
But the fact that she was carrying out the duties of an RPN and that she was also signing as RPN,
should have suggested to her that she was working in that capacity. She should have known

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better. Whether Aubut thought of herself as a RPN in the role of a PSW, or whether she
disregarded the ethics of her position, what was clear was that Aubut had violated the boundary
that is expected to govern a nurse-patient relationship. Therefore, Aubut was wrong in allowing
this relationship to have developed. The penalty that was imposed and the conditions to do
counselling and complete an online program dealing with the therapeutic relationships between
nurses and clients are relevant, because they would teach her what her relationships should be
with her clients. Aubut would be able to learn of the proper relationship and boundary that
should exist between nurses and patients.

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References
Canadian Nurses Association (CNA) (2008). Code of ethics for Registered Nurses. Retrieved
from
http://www.cna-aiic.ca/~/media/cna/page-content/pdf-fr/code-of-ethics-for-registerednurses.pdf?la=en
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 (2013). Practice Standard. Therapeutic nurse-client
relationship, revised 2006. Retrieved from
http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
Disciplinary Committees Decision regarding hearing between College of Nurses of Ontario and
Annette Aubut, Registration No. 1A11022. Heard February 9, 2009. Retrieved from
http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2011/Annette%20Aubit,
%20IA11022,%20Feb.9.2009.pdf

Peternelj-Taylor, C.A. & Yonge, O. (2003). Exploring Boundaries in the nurse-client

relationship: Professional roles and responsibilities. Perspectives in Psychiatric Care,
39(2), 55-66
Rasheed, S.P. (2015). Self-awareness as a therapeutic tool for nurse client relationship.
International Journal of Caring Sciences,8(1), 211-216