RUNNING HEAD: Scholarly Assignment Ethics

Ethics final paper
Shakira Wynter
Student No: N01044497
Professor: Nadine Janes
Humber College ITAL

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Ethics can be defined as the study of morality, connecting ideas and theoretical
justifications that are involved in applying a realistic approach to practice and/or
reasoning that is meant to govern an individual’s behavior (Fisher, 2009). The definition
of ethics extends to the ethics of care, biomedical ethics, morality and meta-ethics. It is
important to understand that ethics is not something that is stagnant it can be changed and
applied to different areas and to different fields of practice (Fisher, 2009). This paper will
look an ethical issue of professional misconduct that occur in the nursing practice with
respect to a practical nurse (Kauling) that resulted in an investigation by the Disciplinary
Committee of the College of Nurses of Ontario.
In 2013 Kauling was brought before the panel of the Disciplinary Committee for
failure to maintain the standards of practice, practicing the profession while in a conflict
of interest thereby breaching the ethical values of client well-being, maintaining
commitments, and truthfulness (CNO, 2009; CNO, 2013 & CNO, 2014). In 2008 at
Facility A Kauling borrowing money from Client C ($2000) and in 2009 attempted to
borrow money from Client A, B and C ranging from approximately $850-$900. Kauling
sited financial hardship when she borrowed money in 2008 and attempted to borrow
more money in 2009. In 2009 Kauling failed to administer medication on two separate
occasions to Client D and E (February 23rd and on May 31st, 2009). Additionally,
Kauling falsely charted the administration of medication including narcotics scheduled
for bedtime. In 2010 at Facility B and C Kauling worked as an RPN while her certificate
was suspended from March 2011 to February 2013 and as a result breached the controlled
acts that are reserved for members of the college (CNO, 2013). These controlled acts
included “administration of medications, nutrition and maintenance procedures with

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respect to the G-tube for Client F” and IM injections for Vitamin B12 for Client G and H
(CNO, p.2, 2013).
Kauling’s actions can be seen as professional misconduct and a conflict of interest
as she went through a facility orientation at Facility A on their policy of “gifts” and an
“abuse-free environment”. Therefore she was fully aware of the policies of the facility
that strictly prohibits accepting gifts from clients. Consequently, she committed financial
abuse as she solicited the gift of money from sick or disabled clients. Kauling was the
only member of staff involved in the ethical case presented and there was no indication
that she had any mental deficiencies or issues of substance abuse. The clients involved
ranges in age 75 -94 years old. The client’s diagnosis or mental state of mind where not
noted. In regards to Kauling’s membership with the college, emails were sent reminding
her of her upcoming renewal. On December 31st she attempted to renew her certificate;
however it was rejected as the form was incomplete. She was also informed on January 8,
2010 about the incomplete forms and the need to resubmit. Subsequently, when Kauling
attempted to renew her membership on the 22nd of January 2010 it was rejected once
more, as the form was still incomplete. As a result her membership was suspended on
March 11, 2010 for non-payment of fees and in light of allegations against her (CNO,
2013).
The disciplinary committee found that Kauling had committed acts of
professional misconduct that could be classified as disgraceful, dishonorable and
unprofessional in nature (CNO, 2013). The committee suspended the member’s
certificate of registration for six months and made impositions and limitations of the
member’s certificate for a period of 24 months. They also stated that the member ought to

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be reprimanded in three months. Therefore, Kauling also needed to have two meetings
with a nursing expert within six months, complete learning modules online and for 24
months after being reinstated she needs to notify her employer about all decisions and
limitations placed on her by the committee (CNO, 2013). Overall I agree with the
decision of the committee I still believe that her suspension should have been for a longer
period of time as information was falsified and client’s lives were placed at risk.
Though nurses encounter ethical conflicts, uncertainty and distress on a daily
basis it is up to them to use good judgment to identify when an ethical dilemma occurs
and to appropriately react to those situations (CNO, 2009; CNO, 2011 and CNO, 2014).
Nurses may also experience ethical dilemmas when they know what is ethically correct
but multiple factors cause then to do the opposite (CNO, 2009). In the case of Kauling,
she sited financial hardship as the reason for her actions (CNO, 2013).
Nurses are trusted to maintain their commitments whether it is to the client, to
himself or herself and to nursing profession (CNO, 2009). Kauling did not maintain her
commitments to her clients and to the nursing profession, as she did not provide safe,
effective and ethical care as she performed acts that are regulated under the college when
her license was suspended. She failed to act with respect and within the guidelines of
codes of ethics that she signed upon being an RPN (CNO, 2011; CNO, 2014). By doing
this she showed a complete disregard for the college and for the client. She did not see
the necessity of maintaining her license nor did she see the danger in performing acts that
are designated to members of the college. She also breached commitment to client “Nurse
and the people” by requesting to borrow money on multiple occasions from different
clients and by taking a financial “gift” from Client C in the sum of $2000. Kauling did

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not put the interest of the client before her own as her need for financial stability overrode
the need for commitment to the client. She did not maintain professionalism,
trustworthiness or her integrity in this case presented thus breaching nurse and people.
She also failed to maintain commitment and breached client well being when she did not
administer prescribed medications to her patients and falsified documentation in the
MAR (CNO, 2015). Thus, breaching the nurse and practice as she failed to maintain
professional conduct in keeping with the image of nursing and confidence of society. The
mismanagement of these medications could have caused the patient suffering and even
their lives. To knowingly falsify documentation to reflect compliance with medication
administration is not moral and is a gross violation of practice standards and therapeutic
nurse client relationship (CNO, 2009; CNO, 2011; CNO, 2014 and CNO, 2015).
Kauling failed to maintain commitments to self, as she should have used selfreflection and good judgment to recognize when her personal needs conflicted with her
clients needs. Kauling recognized that she required financial assistance and as such
should have sought out the assistance of professional assistance such as a government
agency or a regulatory body to meet her needs. She failed to maintain commitment to the
nursing profession and breached truthfulness when she kept practicing as a registered
practical nurse knowing that her license was suspended for non-payment (CNO, 2009).
Additionally, she further breached commitment to the nursing profession by conducting
her practice in a manner that she later stated could be deemed to be disgraceful,
dishonorable and unprofessional in nature (CNO, 2013). Kauling also failed to maintain
client well-being by practicing without a license and performing controlled acts such as
“administration of medications, nutrition and maintenance procedures with respect to the

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G-tube for Client F” and IM injections for Vitamin B12 for Client G and H (CNO, p.2,
2013 and CNO, 2014). Kauling practicing without a license means that she is practicing
as an unregulated professional and as such performed controlled act are outside of her
scope of practice. Thus, breaching nurse and practice as all nurses should do continuing
education and keep up with new scientific changes within the profession. This behavior
could have had detrimental consequences for not only her and her clients that are under
her care but her employer.
While Kauling breached ethical values and failed to “facilitate the client’s-health
and welfare and preventing and removing harm” strategies can be put in place by the
facilities or by the college to reduce breaches (CNO, p.5, 2009). Two strategies that can
be employed to prevent situations like this from occurring in the future are to review the
practice standards on ethics and professional conduct: professional misconduct and
therapeutic nurse-client relationship once every six months to ensure that each nurse is
aware and knowledgeable about the possibilities of professional misconduct. This would
include online modules, scenarios and questionnaires that would be mandatory to
complete. Another strategy would be to have a complete check of medications at the
beginning and at the end of each shift similar to what occurs when narcotics are doublechecked. Medication checks can also be complete in groups of two’s where nurses cosign
that medications are administered to the patient following the six rights of medication
administration (CNO, 2015) This would cut down on medication errors as nurses become
more accountable for their actions as they are also checking their cosigner’s actions.
In conclusion the decisions made by the committee are in keeping with ethical
standards, ethical values and professional conduct. As stated by the CNO (p.3, 2014),

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“standards of practice are set and enforced in which nurses must adhere in order to
provide the public with safe, effective and ethical nursing care. Professional misconduct
is an act or omission that is in breach of these accepted ethical and professional standards
of conduct”. Though the CNO provides guidelines and interactive online modules it is up
to each member to use good judgment to determine whether their actions are ethical and
professional (CNO, 2011; CNO, 2014). It is the personal interpretations of the guidelines
that can cause ethical dilemmas and conflicts to occur. The strategies mentioned above
would help to alleviate the occurrence of professional misconduct and would be a
constant reminder or what is acceptable and what is not. It would force individuals to
perform self-reflection and understand that her are consequences to their actions. It would
be a good forum for individuals to perform self- reflection and aid them in recognizing
when their actions are leading towards professional misconduct or whether they are in
direct violation of the code of ethics.

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Reference:

College of Nursing. (2009). Practice Standard: Ethics retrieved from
http://www.cno.org/Global/docs/prac/41034_ Ethics.pdf

College of Nursing. (2011). Professional Conduct: Disciplinary Proceedings Retrieved
from https://www.cno.org/Global/docs/ih/42010_fsDiscProceed.pdf

College of Nursing (2015). Practice Standard: Medication. Retrieved from
http://www.cno.org/Global/docs/prac/41007_Medication.pdf

College of Nursing (2013). Disciplinary Decision: Monique Kauling vs College of
Nurses. Retrieved from http://www.cno.org/en/protect-public/disciplinedecisions/

College of Nursing. (2014). Practice Standard: Professional Misconduct Retrieved from
http://www.cno.org/Global/docs/ih/42007_misconduct.pdf

Fisher J. (Ed.). (2009). Biomedical Ethics: A Canadian Focus. Ontario: Oxford
University Press