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Director of Proceedings v Ward

Health Practitioners Disciplinary Tribunal, 679/Nur14/286D

(28 January 2015)

The Director of Proceedings laid a charge against Enrolled Nurse, Raewyn Ward, in the Health Practitioners Disciplinary Tribunal concerning the care provided to an elderly dementia patient who was resident at Killarney Rest Home for just over a month.

At the time of the hearing, Ms Ward was no longer practising as a nurse. The charge against Ms Ward related to a failure to maintain adequate standards of care planning and falls risk assessment, failure to ensure a plan for the resident after three falls, failure to notify the resident's family of two falls or to ensure they were notified, and failure to seek appropriate clinical assessment of the resident following a third fall where she fractured her hip and it went undiagnosed for six days.

The Tribunal found that the charge of professional misconduct had been made out in certain respects and imposed conditions on Ms Ward's practice should she ever seek to resume practice, and imposed costs.

Ms Ward was employed by Killarney Rest Rome as its Manager and as an Enrolled Nurse. Questions arose as to the role of the Enrolled Nurse (EN) as opposed to the Registered Nurse (RN) employed at the Rest Home, and as to the EN scope of practice within a management role. On the evidence, the Tribunal accepted that exercising clinical judgment was a fundamental part of Ms Ward's role as Manager.

Ms Ward had quite a significant professional role in respect of the residents, in addition to her responsibilities as Manager. Her prime concern as Manager was the health and wellbeing of residents which required her to exercise professional skills and judgment. Ms Ward also had clinical responsibilities as the Manager in the context of her being an EN with core competencies that applied to her at the time.

Initially the resident was admitted to Killarney Rest Home for short term respite care, then subsequently on a permanent basis. She was identified as a high falls risk due to her advanced dementia and tendency to wander.

On the evidence, the Tribunal found there were significant inadequacies in the care planning forms and documentation for both the resident's respite and permanent admissions, and that ultimately it was Ms Ward's responsibility as the Manager to ensure these were done properly and comprehensively. During her stay, the resident had three falls.

The Tribunal accepted independent expert advice that Ms Ward, as Manager, should have followed up on the falls and ensured the RN had completed a falls risk assessment. It was her responsibility as Manager to ensure there was a plan implemented to minimise or prevent future falls.

The Tribunal also accepted that Ms Ward's failure to seek appropriate clinical assessment for the resident, as both an EN and the Manager, during the four days after the resident's third fall was a severe departure from accepted standards of practice.

The Tribunal's decision can be found at: http://www.hpdt.org.nz/portals/0/nur14286ddecisionanon.pdf