Running head: LEGAL ETHICS

Legal Ethics: Analysis of a Case Involving Misconduct by the College of Nurses Ontario
Decision Hearing Committee
Sadiq Adisa Bello
Humber College
Submitted To: Janet Jeffery
Date: 13th November, 2015.

INTRODUCTION

Running head: LEGAL ETHICS

There are many cases of misconduct in the nursing profession

involving nurses getting into a relationship with clients whereby therapeutic
relationship is being jeopardised and it would be seen as the care provider
trying to take advantage of the clients medical condition to deceive and
solicit monetary favours in line of care. However, this particular case
involved a registered practical (Nurse T) who was found guilty of professional
misconduct engaging in an intimate relationship with the spouse of client
while providing care for the client. This happened between the months of July
2011 and February 2012. The nurse was approximated to have collected a
lump sum of $12,000 from the spouse of client during their relationship
(College of Nurses Ontario (CNO): Discipline Decision, 2014, p.2).
The client aged 56 years old was transferred to the unit with multiple
sclerosis, subarachnoid hemorrhage with many other health conditions and
was incapable of movement, non-verbal and non-communicative with
diminished mental health which required her to be fully dependent on care
from the nurse and the clients spouse. The clients condition gave the
opportunity for the relationship to ensue. It was found out that the nurse
would spend more hours attending to client whenever the spouse was
around and the nurse would speak in an unprofessional manner when talking
about the clients conditions to the spouse of client. Other revelations
showed the spouse of client had sexual intercourse with the nurse in
question and they visited each other quite often during this period. All this
was noticed by other nurse staffs in the unit and she was questioned and

Running head: LEGAL ETHICS

advised to stop with the relationship. The decision of discipline committee

was that she is guilty of this dishonorable and unprofessional act. The
penalty was suspending her licence to practice for four months, review
professional standards, expected to complete a course with an expert, and to
notify her employer of the decision hearing for a period of 12 month prior to
accepting any employment which is acceptable because she admitted to
committing this dishonourable act and she took responsibility for her actions
(C.N.O. Discipline Decision: 2014, p.4). The ethical values the nurse
contravened are client well-being, client choice, respect for life, and
maintaining commitment.
BODY
This professional misconduct and unacceptable behavior speaks to a
great deal of insensitivity the nurse could be to clients well-being in having
to go into a relationship with the client spouse at the expense of her
condition and knowing fully well that she is married. Engaging in a
relationship with the clients spouse does not contribute to the client wellbeing because nurses are responsible for providing safe ethical care and
always having to deal with client holistically in order to provide sensitive
care. However, deceit is the order of this scenario as it is evident that the
clients spouse action showed a great deal of disloyalty and dishonour to the
marriage. Its disrespectful to the client considering her condition. The
clients condition alone should be a bell ringer for both parties not to have

Running head: LEGAL ETHICS

started the relationship as they both showed a great deal of infidelity and
insensitivity to the client well-being promoting client well-being means
facilitating the clients health and welfare, and preventing or removing
harm(C.N.O. Practice Guidelines: Ethics, 2009 p.5).
The nurse breached therapeutic relationship and crossed the boundary
of professionalism as evident by getting to spend much time on the phone
with clients spouse, speaking in an un-professional manner by speaking in a
hush tone with spouse of client when discussing matters relating to clients
condition. Client choice will definitely be violated because the client is
incapable of making informed decision and the spouse of client who is
supposed to be responsible for making decision is already spending intimate
time with nurse. Although decision made by both parties in this relationship
may be beneficial to the client, sometimes it could be biased and based on
personal judgement when a client is incompetent, nurses need to ensure
that a therapeutic relationship is maintained within the limits possible for the
client and with the substitute decision-maker (C.N.O. Practice Guidelines:
Ethics, 2009 p.6).
The nurse accepting monetary gift from spouse of client indicates she
crossed her professional boundary because nurses are not to solicit gift from
client or family members of client as this will jeopardise therapeutic
relationship. Nurse T did not maintain commitment to the nursing profession
or herself. Nurses are supposed to uphold the profession in public interest,

Running head: LEGAL ETHICS

this act being portrayed by the nurse showed a great deal of disloyalty and
disrespect to the nursing profession Being a member of the profession
brings with it the respect and trust of the public. To continue to deserve this
respect, nurses have a duty to uphold the standards of the profession,
conduct themselves in a manner that reflects well on the profession, and to
participate in and promote the growth of the profession (C.N.O. Practice
Guidelines: Ethics, 2009, p.11)
The nurse did not show any respect for life to the client and she did not
self-reflect on her actions before spending intimate time with the clients
spouse and eventually sleeping with him. The nurse action to the client
shows no empathy and depicts insensitivity to the clients condition. Respect
for life in this case would be, basically honoring the marriage of the client
and resisting any intimate relationship with the spouse of the client Respect
for life also includes considerations of the quality of life. It is sometimes difficult to
identify what is human life and what society wants, values and protects in relation
to human life (C.N.O. Practice Guidelines: Ethics, 2009, p.8).

The nurse did not maintain commitment to her client as demonstrated

by her actions in having sex with the clients spouse at that time. NURSE T
did not follow the principle of beneficence to the client and she vitiated trust
and compassion to the client (Zook, 2001 p.40). The principles of
beneficence involve 3 components: do or promote good, prevent harm,
remove evil and harm. Respect and honor is what would be expected of care
givers to reflect and offer good therapeutic care for anyone whose condition

Running head: LEGAL ETHICS

has deteriorated because of their illnesses. Nurse need to know they are
moral agent and need exemplify good behaviors to who they are taking
care of (Canadian Nurse Association (CNA): Code of Ethics, 2008, p.5).
Strategies to prevent this misconduct from happening again is through
strengthening organizational policy and education of staff as a reminder to
reflect on whether they are maintaining or crossing boundaries during
therapeutic relationship with client. Strengthening organizational policy in
this case might involve having to sign a disclosure form before attending to
clients and if a case of sexual misconduct is sensed it should be reported
immediately. Staff assignment could be changed when a case of crossing
boundaries is self-reported by the nurse and allowing a third party nurse to
take on the care of client involved. Exploitation index developed by Simon &
Epstein in the 1990 can be used to improve self-awareness and self-reflection
on boundary crossing. It involves rating ones feelings and behavior on a five
point scale which includes questions such as (do you take pleasure in
romantic daydreams about a patient, do you seek social contact with client
outside of clinically scheduled times, and so on) could help to provide
awareness on issues relating to crossing of boundaries (Gallop, 1998, p.44).
This self-assessment tool should be made mandatory for nurses before and
after the therapeutic relationship is terminated.
Also, in house service on boundary crossing or violation should be done
at the institution on quarterly basis to provide education and awareness on

Running head: LEGAL ETHICS

misconduct such as this. The education aspect would involve inviting nurses
who have been found guilty of the sexual misconduct to provide the
situational background and conditions that lead to such act. The idea of
making an offender an advocate for change would greatly impact the
awareness about boundary crossing and serve as deterrence for other nurses
to always maintain boundary during therapeutic relationships. To emphasis
more, tools such as the boundary formula can be used as a learning course
to determine how and when boundary is violated. This tool measures the
violation potential and the underlying factors or instance that promotes
boundary crossing. Accountability groups are also recommended to help
nurses practice self-reflection on boundary crossing and to improve boundary
protection (Karen & Stephen, 2007, p.28).
In conclusion, sexual misconduct and boundary crossing should be
given detailed attention as it is often under looked. Therapeutic relationship
should be maintained at all times when caring for a patient as going beyond
this result in misappropriation of power and trust in which ethical principles
and values are violated. This leads to misconduct and dishonorable acts
such as seen in this case which ends up with serious sanctions. Some of the
ethical values violated are clients well-being, client choice, respect for life
and maintaining commitment which transpired when Nurse T crossed her
professional boundary by; having intimate relationship and collecting
monetary gift from spouse of client. Strategies for preventing this from
happening are strengthening organizational policy, education and awareness

Running head: LEGAL ETHICS

on matters entailing boundary crossing. Also, psychological tool and

questionnaire such as those developed by Simon & Epstein can be
incorporated in institutional policy for promoting self-reflection on boundary
crossing. Nurses have to follow ethical principles with emphasis on fidelity,
beneficence and veracity. They also need to conduct themselves in
honorable ways in order to command the respect the nursing profession
upholds.

REFERENCES
College of Nurses of Ontario. (CNO). (2009). Practice Standard: Ethics.

Running head: LEGAL ETHICS

Retrieved from www.cno.org

Canadian Nurses Association. (CNA). (current edition). Code of Ethics for
Registered Nurses. Retrieved from www.cna-aiic.ca
College of Nurses of Ontario. (2014).Discipline committee of the nurses of
Ontario, Toronto:.
Retrieved from http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2014/Tamara
%20Beauparlant,%20JE01148,%20June%2011,%202014.pdf
Gallop, R. (1998). Abuse of power in the nurse client relationship. Nursing
Standard, 12(37), 43- 7. Retrieved from
http://search.proquest.com/docview/219837194?accountid=11530
Karen,V. & Stephen J. (2007). Watch Your Step: Nursing and Professional
Boundaries. Journal of Nursing Management vol. 38(2), 24-29. Retrieved
from https://www.nursingcenter.com/CEArticle?an=00006247-20070200000009&Journal_ID=54013&Issue_ID=696076
Zook, Ruth,R.N.C., M.Ed. (2001). Sexual misconduct by health care
providers. Journal of
Psychosocial Nursing & Mental Health
Services, 39(6), 40-7. Retrieved from
http://search.proquest.com/docview/225537137?accountid=11530