Professional Development - Professional Misconduct & Boundaries (PDF)

Week 10 Professional Development I Module 10: Professional Boundaries/Misconduct & Social Media Use  Land Acknowledgement Mohawk College derives its name from the Mohawk Nation, one of the Six Nations of the Haudenosaunee Confederacy. The Confederacy marks a union of peace and friendship, and M...

Week 10 Professional Development I Module 10: Professional Boundaries/Misconduct & Social Media Use  Land Acknowledgement Mohawk College derives its name from the Mohawk Nation, one of the Six Nations of the Haudenosaunee Confederacy. The Confederacy marks a union of peace and friendship, and Mohawk College honours that union by recognizing the Six Nations of the Grand River and the Mississauga’s of the Credit First Nation. We acknowledge that the territories on which Mohawk College and its campuses are situated are governed by the Between the Lakes Treaty, the Dish with One Spoon Wampum Agreement, and the Upper Canada Treaty Agreement. These agreements are binding to this day and represent our mutual commitment to maintain healthy, reciprocal and respectful relationships with the many Indigenous nations and peoples of this area. We acknowledge this and iterate our dedication to inclusivity, to friendship and to valuing the ongoing contributions of Indigenous peoples and communities. Agenda 01 02 03Professional Housekeeping Learning Boundaries & Outcomes Misconduct 04 05 06 Social Media Coming Up Questions? Use  0 Week 10 1 Housekeeping Questions Week 9?  0 Week 10 Learning 2 Outcomes Learning Outcomes 1 2 3 Explain professional Explain the process the Identify examples of misconduct as CNO follows when reports professional misconduct in defined by the or complaints are made the nursing profession & College of Nurses of discuss how to prevent Ontario professional misconduct 4 5 6 Describe the impact Describe benefits and Identify & apply of social media on risks of using social media professional standards nursing in the nursing profession around the use of social media as a nurse  0 Week 10 3 rofessional Boundaries & Misconduct Small Group Activity Professional Misconduct Time: 5 minutes Think back to Week 7 (CNO: Part 2) What do you remember about misconduct and discipline? (write answers down) Be ready to share in large group CNO Professional Misconduct Nursing is a self-regulating profession This means that the government has delegated to the profession the authority to regulate itself for the purpose of protecting the public In Ontario, under the authority of the Regulated Health Professions Act and the Nursing Act, the College of Nurses of Ontario regulates the practice of nursing to protect the public interest The Professional Misconduct Regulation arises from these acts and defines misconduct for RN’s and RPN’s A nurse’s conduct that is harmful, in any way, or that undermines or detracts from the professional caring relationship with and for the client, is not consistent with expected professional standards It is a nurse’s own responsibility to know what does and does not constitute professional conduct and misconduct (CNO, 2019) CNO Professional Misconduct How does the CNO manage professional misconduct? Acts of professional misconduct may result in an investigation by the CNO, followed by disciplinary proceedings CNO investigates all complaints about nurses that are made by members of the public, other health care professional or employers Review the CNO Code of Conduct (Week 7) (CNO, 2019) CNO Professional Misconduct Nurses are expected to adhere to the standards of practice Standards are reasonable expectations placed on nurses to ensure that appropriate care is provided Professional misconduct occurs when these standards are breached (CNO, 2019) CNO Professional Misconduct There are 11 categories of Professional Misconduct ○ Each category has specific examples (37 listed examples) 1. Failure to Maintain the Standards of Practice 2. Working while Impaired 3. Abusive Conduct 4. Theft 5. Failure to Obtain Client Consent 6. Inadequate Documentation & Record Keeping 7. Misrepresentation 8. Failure to Meet Legal/Professional Obligations 9. Conflict of Interest 10. Inappropriate Business Practices 11. Disgraceful, Dishonourable, and Unprofessional Conduct (CNO, 2019) CNO Professional Misconduct Failure to Maintain the Practice Standards: 1. Failing to meet the standard of practice of the nursing profession 2. Delegating a controlled act set out in the Regulated Health Professions Act 3. Directing a member, student, or health care team member, to perform nursing functions for which they are not adequately competent to perform 4. Failing to inform the member’s employer of the member’s inability to accept specific responsibility in the area where specific training is required or where the member is not competent to function without supervision 5. Discontinuing professional nursing services that are still needed (CNO, 2019) CNO Professional Misconduct Working While Impaired: 6. Practicing the profession while the member’s ability to do so is impaired by any substance (CNO, 2019) CNO Professional Misconduct Abusive Conduct: 7. Abusing a client verbally, physically, or emotionally (CNO, 2019) CNO Professional Misconduct Theft: 8. Misappropriating property from a client or workplace (CNO, 2019) CNO Professional Misconduct Failure to Obtain Informed Consent and Breach of Confidentiality: 9. Doing anything to a client for a therapeutic, presentative, palliative, diagnostic, cosmetic or health related purpose in a situation in which consent is required by law, without such consent 10. Giving information about a client to a person other than the client or their authorized representative except with the consent of the client or their authorized representative as required or allowed by law 11. Failing to reveal the exact nature of a secret remedy or treatment used by the member following a client’s request to do so 12. Failing to advise the client to obtain services from another health professional when a member knows, or ought to know, that a client has a condition that is outside the member’s scope of practice, or within the member’s scope of practice but outside the member’s competence to treat (CNO, 2019) CNO Professional Misconduct Inadequate Documentation & Record Keeping: 13. Failing to keep records as required 14. Falsifying a record relating to the member’s practice 15. Signing or issuing, in the member’s professional capacity, a document that the member knows, or ought to know, contains a false or misleading statement (CNO, 2019) CNO Professional Misconduct Misrepresentation: 16. Inappropriately using term, title or designation in respect of the member’s practice 17. Using a name other than the member’s name as set out in the register, in the course of providing or offering to provide services within the scope of practice of the profession, except where the use of another name is necessary for personal safety and provided the employer and the College have been made aware of the pseudonym and the pseudonym is distinctive (CNO, 2019) CNO Professional Misconduct Failure to Meet Legal/Professional Obligations: 18. Contravening a term, condition or limitation on the member’s Certificate of Registration 19. Contravening a provision of the Nursing Act, the Regulated Health Professions Act, or the regulations under either of those 20. Failing to appear before a Panel of the Complaints Committee to be cautioned 21. Failing to comply with an order of a Panel of the Discipline Committee or an order of a Panel of the Fitness to Practice Committee 22. Failing to cooperate in a College investigation (CNO, 2019) CNO Professional Misconduct Failure to Meet Legal/Professional Obligations: 23. Failing to take reasonable steps to ensure that the requested information is provided in a complete and accurate manner when a member is required to provide information to the College pursuant to the regulations under the Act 24. Failing to: ○ Abide by a written undertaking given by the member to the College ○ Carry out an agreement entered into with the College 25. Failing to report an incident of unsafe practice or unethical conduct of a health care provider (CNO, 2019) CNO Professional Misconduct Conflict of Interest: 26. Practicing the profession while the member is in a conflict of interest 27. Influencing a client to change thewir will or other testamentary instrument (CNO, 2019) CNO Professional Misconduct Inappropriate Business Practices: 28. Submitting an account or charge for services that the member knos is false or misleading 29. Failing to fulfill the term of an agreement for professional services 30. Charging a fee that is excessive in relation to the services for which it is charged 31. Charging a block fee. A block fee is a fee for uninsured services that is the same regardless of how many services are preformed 32. Charging a fee for an undertaking not to charge for a service or class of services (CNO, 2019) CNO Professional Misconduct Inappropriate Business Practices: 33. Charging a fee for an undertaking to be available to provide services to the client 34. Offering or giving a reduction for prompt payment of an account 35. Failing to itemize an account for professional services: ○ If requested to do so by the client or the person or agency who is to pay, in whole or in part, for the services ○ If the account includes a commercial laboratory fee 36. Selling or assigning any debt owed to the member for professional(CNO, services 2019) CNO Professional Misconduct Disgraceful, Dishonourable, and Unprofessional Conduct: 37. Engaging in conduct or performing an act relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable, or unprofessional (CNO, 2019) CNO Professional Misconduct Other Ground for Professional Misconduct: Criminal convictions Finding of professional misconduct in another jurisdiction Sexual abuse Failure to report sexual abuse committed by another member (CNO, 2019) Professional Misconduct Examples Failure to assess and respond to changes in a patient’s health condition during her shift Failure to assess a patient that suffered an injury, failure to complete an incident report Medication error, failure to complete transfer of accountability Failure to assess a post-op patient and complete transfer of accountability Failure to complete a specified continuing education course as ordered by the College Raised her voice, made disrespectful comments about co-workers, failed to communicate with family Accessed her own health information and that of clients not in her care (CNO, 2019) Professional Misconduct Examples Inappropriately touching a co-worker Using a restraint to obtain a blood sample without consent Misappropriating narcotics for personal use Misappropriating narcotics, falsifying records, accessing patient information, failure to notify the College of charges under the Criminal Code Attempting to force a client to eat, pushing a client, making rude comments to a client, throwing water at a client Failure to ensure that hourly rounds were completed Sexual abuse, maintained a personal relationship with a client (CNO, 2019) Professional Misconduct Examples Failure to identify an abnormal fetal heartbeat Failure to implement a bowel protocol for a client Making racial slurs Spoke to a patient loudly and aggressively Posted info on Facebook/Instagram/Snapchat/other about a patient Sexual harassment of nursing students Sexual abuse toward a client (CNO, 2019) Professional Misconduct Examples Engaged in a personal and sexual relationship with a patient Failure to notify the College of charges in Florida, resisting arrest, driving under the influence Threatening a co-worker Using profanity (CNO, 2019) Disciplinary Proceedings https://registry.cno.org/ Disciplinary Proceedings Discipline Process 1. Pre-hearing Conference ○ Purpose is to narrow the issues for the hearing, to identify legal and procedural issues for the panel, and to provide the parties with the opportunity to receive a candid assessment of the case to assist with resolution 2. Disciplinary Hearing ○ Composed of 3-5 people (at least 2 members are College Council and remaining are nurses) ○ Panel considers allegations, hears evidence, determines if evidence proves allegations ○ Determines whether the member has committed an act 3. Hearing Outcomes ○ If the member is found guilty a penalty will be assigned (CNO, 2018) Addressing Complaints Who can complain to the College of Nurses of Ontario? (CNO, 2023) Addressing Complaints What kind of complaints can the College address? Must address all complaints about any aspect of nursing care ○ Inaccurate medication administration ○ Unsafe care, theft, physical inappropriateness with clients The College does not address a complaint if the complaint… ○ Is about problems where the nurse works, ie. Not about the nurse (facility practices) ○ Is made in bad faith (a personal dispute) ○ Is unsigned and the College cannot get further information (anonymous) (CNO, 2023) Addressing Complaints What happens when someone wants to make a complaint? The College must receive the complaint in some permanent form, written or recorded and must include the name and contact information of the person making the complaint The College then writes to the complainant to acknowledge receipt of the complaint and explains the complaint process The College encourages the complainant to bring the problem to the attention of the facility where the nurse works first to resolve the complaint quickly (CNO, 2023) Addressing Complaints Alternative Dispute Resolution: The College writes to the nurse named in the complaint informing them of the complaint Ontario law allows the College to resolve certain types of complaints using an alternative dispute resolution process Alternative dispute resolution is only possible if everyone involved agrees to it A trained facilitator from the College talks separately with the complainant and the nurse They discuss the complaint and exchange ideas for resolving it The facilitator then drafts a resolution agreement which is signed by both parties Everything in a dispute resolution process stays confidential and is not published in the Colleges public record (CNO, 2023) Addressing Complaints Investigating a Complaint: When a complaint cannot be dealt with through alternative dispute resolution, it goes through the investigation process The College investigator will interview the complainant and witnesses and compile documents such as health records Once the information is gathered the nurse receives a copy of any documents gathered that could help her with her response The nurse has 30 days to provide a written response Once received, the investigator does any further investigation needed and provides the results to the nurse involved The nurse then has another opportunity to respond (CNO, 2023) Addressing Complaints Reviewing the Complaint: The matter is then scheduled for review by a panel of the Inquiries, Complaints and Reports Committee (ICRC) All the information the investigator has gathered is carefully reviewed by the ICRC If the information gathered during the investigation does not support the complaint, the ICRC will take no action If the information supports the complaint, the ICRC will consider the seriousness of the issues raised Depending on the seriousness of the review outcome, the ICRC can: issue advice to the nurse about the standards, require the nurse to appear before them for a caution, require the nurse to compete a remedial program or refer some or all of the issues to the Discipline Committee (CNO, 2023) Addressing Complaints Discipline Review: If the complaint has been referred to the Discipline Committee the committee holds a public hearing Complainants may be asked to testify at the hearing Nurses usually attend with a lawyer (CNO, 2023) Addressing Complaints Hearing Outcomes: Pay a fine to the Ontario Government (not the College or the complainant) Appear in person for a reprimand delivered by the panel Complete remedial education Place conditions on the nurse’s practice Suspend the nurse from working for a set period In the most serious cases (especially sexual abuse) revoke the nurse’s ability to practice. (CNO, 2023) Small Group Activity Discipline Hearings Time: 10 minutes Choose one of the summarized discipline decisions found in the link below https://www.cno.org/en/learn-about-standards-guidelines/magazines-newsletters/the-standard/summarized-decisions/Links to an external site. Answer the following: 1. What was the complaint? 2. What was found ? 3. What standards of practice does this fail to maintain? 4. What was decided in the end by the panel? 5. Are you in agreement – do you have any questions that you would like to ask the member and the panel? Break Time… Please enjoy a 5-minute break  0 Week 10 4 Social Media Small Group Activity Social Media Time: 5 minutes Discuss the benefits and risks of using social media in the nursing profession Be ready to share in large group Social Media Use Nurses are facing increased requests from patients to connect on professional social media accounts and on their personal accounts Never accept a patient’s friend request on your personal social media accounts By connecting or corresponding over your personal social media account, you are crossing the boundary where the professional therapeutic nurse-client relationship changes into unprofessional and personal When using a professional media account, you must ensure you are not violating patient privacy and confidentiality The International Nurse Regulator Collaborative, which the CNO is a member of, has released a position statement on the use of social media by nurses (INRC, 2016) Social Media Use The International Nurse Regulator Collaborative (INRC) defines Social Media as… “Social media” describes the online and mobile tools that people use to share opinions, information and experiences, images and video or audio clips, and includes websites and applications used for social networking. Common sources of social media include but are not limited to social networking sites such as Facebook and LinkedIn; personal, professional and anonymous blogs; WOMO, True Local and microblogs such as Twitter; content-sharing websites such as YouTube and Instagram, and discussion forums and message boards. (INRC, 2016) Social Media Use Common Expectations for Nurses: Benefits & Risks Know the risks of social media and build your competence Know the technology and have the skills and judgement to use it appropriately and ethically Be aware of social media’s evolving culture and changing technology Reflect on the intent and possible consequences of your online behaviour (INRC, 2016) Social Media Use Personal Image: Use the same level of professionalism in your online interactions as you do face-to-face Keep your personal and professional lives separate. Use different accounts for personal and professional activities Confidentiality: Do not share any client information on social media sites Leaving out details when you post information or images does not protect client confidentiality Report confidentiality breaches to the right person, immediately (INRC, 2016) Social Media Use Privacy: Set and maintain your privacy settings to limit access to your personal information Be aware of your privacy settings and know that even if you use the highest privacy settings, others can copy and share your information without your knowledge or permission Boundaries: Maintain professional boundaries Just as with face-to-face relationships, you must set and communicate these boundaries with clients online End your professional relationships appropriately and don’t accept client “friend” requests on your personal social media accounts If you use social media with clients, use a professional account separate from your personal one (INRC, 2016) Social Media Use Expectations: Use caution if you identify yourself as a nurse online If you do so, others may ask for advice, which could lead to a nurse-client relationship Using a name that hides your identity does not release you from this expectation Know this and practise accordingly (INRC, 2016) Social Media Use Integrity: Protect yours and the profession’s integrity Use proper communication channels to discuss, report and resolve workplace issues — not social media Refer to colleagues or clients online with the same level of respect as you would in the workplace Before you blog, tweet or share information about your practice, reflect on your intentions and the possible consequences Understand that “liking” someone’s disrespectful comments is not much different than making them yourself (INRC, 2016) Social Media Use Employer Policies: Know and follow employer policies on using social media, photography, computers and mobile devices, including personal, at work If you communicate with clients via social media, work with your employer to develop policies (INRC, 2016) Social Media Use Accountability: Make sure you can answer for your actions Reflect on why, how and when you use social media and help others do the same Know that personal use of social media while working could be viewed as client abandonment If you are unable to discuss your online behaviour with others, consider this a red flag Use professional judgment to keep your obligations to clients, colleagues and employers front and center. (INRC, 2016) Social Media Use (INRC, 2016) CNO & Social Media Use Refer to the CNO: Therapeutic Nurse-Client Relationships Professional Standards Confidentiality & Privacy Ethics Code of Conduct We are representing our profession and are held to the professional standards outlined by the CNO Use can be beneficial in the right circumstances, with appropriate safeguards in place (CNO, 2022) CNO & Social Media Use (CNO, 2022) Social Media Use Mitigating Risk: What are some strategies to reduce or eliminate the potential risks in using social media as a nursing professional? CNO & Social Media Use (CNO, 2022) Small Group Activity Group Scenarios Time: 10 minutes Read the scenario assigned to your group & answer the questions Be ready to share in large group Scenario #1 Confidentiality You are invited to “friend” Ravneet, a Registered Nurse who has recently graduated and is new to the small town where you live. She has just started working with you at the hospital and is anxious to make friends (real and virtual). When you visit her Facebook site, you see she has posted a great deal of information about the unit where you both work, including specific details about a patient recently admitted with an unusual and interesting diagnosis—though no names are used, or pictures posted. Questions: 1. What are the concerns in this scenario? Use CNO standards to support your statements. 2. How would you handle this situation? 3. How will you prevent this situation in your own professional/personal lives? Scenario #2 Professional Boundaries Diane, a home care nurse, has been seeing Jin daily for complicated dressing changes and has developed a trusting nurse-patient relationship. Jin has recently suffered the loss of many people in his life, including his beloved mother (and main caregiver). He is feeling isolated and lonely. Diane has cared for Jin off and on for several years and has always enjoyed seeing him and his family. Today, Jin asks Diane to be his Facebook ‘friend’. Questions: 1. What are the concerns in this scenario? Use CNO standards to support your statements. 2. How would you handle this situation? 3. How will you prevent this situation in your own professional/personal lives? Scenario #3 Professionalism You were recently out celebrating a friend’s birthday. It was a great time! You post some fun pictures on social media of the evening at the bar with you and your friends, some of whom are also nursing colleagues at the same hospital where you work. Your colleague sees the pictures shortly after you post them and is not at all happy with you. Questions: 1. What are the concerns in this scenario? Use CNO standards to support your statements. 2. How would you handle this situation? 3. How will you prevent this situation in your own professional/personal lives? Scenario #4 Student Perspective You are in your final clinical placement. You have enjoyed this placement so much and have made such a good impression on the team and unit manager that you have secured a full-time position after graduation. A fellow student, John, is also nearing the end of his last semester and is looking for his first RPN job. John has heard about the wonderful experience you are having in your clinical placement and has asked you to put in a good word for him with the unit manager so he can try to get a job there. You are Facebook ‘friends’ with John and have seen many posts where he highlights some of the challenges he observed in his most recent clinical placement. Many of his comments relate to his placement unit being short staffed or lacking sufficient resources to provide ‘high quality’ nursing care. He has also said that ‘the staff are not teaching him the way they should and insinuating that they are not knowledgeable. Questions: 1. What are the concerns in this scenario? Use CNO standards to support your statements. 2. How would you handle this situation? 3. How will you prevent this situation in your own professional/personal lives? References College of Nurses of Ontario. (2023). Addressing complaints: process guide. https://www.cno.org/globalassets/docs/ih/42017_resolvingcomplaints.pdf College of Nurses of Ontario (2022). Discussing clients with colleagues online. Retrieved from: https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/discussing- clients-with-colleagues-online/ College of Nurses of Ontario (2018). Professional Conduct: Disciplinary Proceedings. https://www.cno.org/globalassets/docs/ih/42010_fsdiscproceed.pdf College of Nurses of Ontario. (2019). Professional conduct/professional misconduct. Retrieved from https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf College of Nurses of Ontario. (2011). Preventing client abuse. https://www.cno.org/globalassets/docs/ih/47008_fspreventabuse.pdf International Nurse Regulator Collaborative (2016). Social media: Common expectations for nurses (position statement). Retrieved from: https://www.cno.org/globalassets/docs/prac/incr-social-media- use-common- expectations-for-nurses.pdf  0 Week 10 5 Coming Up… Coming up… Ensure you have completed 1 hour of asynchronous work for Module 10 Prepare for Module 11 (Week 11) ○ Review module objectives ○ Begin required readings and activities and come prepared to engage in lecture Part C Assignment: Group Presentation (Thinking Ahead) ○ Refer to Canvas for Assignment Instructions ○ Due: Week 13 (Will discuss further Week 11)  0 Week 10 6 Questions