By Catherine Ngo Content writer, presenter and podcaster
In a recent case overseen by the Civil and Administrative Tribunal of New South Wales, a registered nurse engaged in inappropriate relationships with vulnerable mental health patients.
The case highlighted the significance of upholding professional boundaries for healthcare professionals, especially when working with at-risk individuals. The Tribunal stressed the consequences faced by healthcare practitioners who violate these boundaries, even amid personal challenges.
Background
A registered nurse was employed in the hospital's Adult Mental Health Unit and Psychiatric Emergency Care Centre. With experience in acute mental health settings, she commenced her nursing career in 2010.
The nurse faced allegations of failing to uphold appropriate professional and personal boundaries with two patients. These allegations included engaging in a sexual relationship with one patient and forming a friendship with another.
The Health Care Complaints Commission approached the Tribunal seeking disciplinary findings and orders against the nurse under the Health Practitioner Regulation National Law (NSW). The Mental Health Drug & Alcohol Services lodged the initial complaint in September 2021.
Allegations against the healthcare worker
There were four primary allegations raised against the nurse:
- Professional misconduct due to engaging in actions significantly below the expected standard for a practitioner with comparable training and experience.
- Improper and unethical behaviour.
- Professional misconduct of sufficient gravity to warrant the suspension or revocation of nursing registration.
- Impairment that adversely affects the nurse's ability to practice nursing.
The nurse acknowledged all the allegations and details outlined in the Commission's application.
Nurse's inappropriate conduct with patients
The nurse engaged in misconduct that directly affected two patients (Patient A and Patient B). Both patients were highly vulnerable and had complex mental health needs.
Patient A, a 28-year-old female, had a history of post-traumatic stress disorder, borderline personality disorder, and anorexia. Due to her considerable risk of suicide or self-harm, she was considered a high-risk inpatient and required one-on-one care.
The nurse first met Patient A in December 2020, when she was admitted as an inpatient. The nurse engaged in a sexual relationship shortly after Patient A's discharge from the hospital in August 2021. She also made inappropriate comments and communicated extensively outside of professional boundaries.
Patient B, a 47-year-old female with bipolar affective disorder, had a history of acute relapses of mania. After the patient's discharge, the nurse established an inappropriate friendship with Patient B, including social visits and group messaging.
In response to the nurse's conduct, the Tribunal noted that the nurse had significantly deviated from the standards expected of a practitioner with similar education and expertise. The Tribunal specifically highlighted the nurse's failure to maintain appropriate professional boundaries by engaging in excessive social communication with Patient B.
Professional misconduct and misleading evidence
The Tribunal concluded that the nurse's actions constituted professional misconduct, considering the gravity of the boundary violations and the vulnerability of the patients involved.
During the initial investigations, the nurse provided inaccurate evidence to her employer and the Nursing and Midwifery Council. She initially denied any personal relationship with Patient A outside of their professional nurse-patient interactions. The nurse denied or downplayed her interactions with Patient A in several interviews.
The Tribunal emphasised the critical importance of honesty in disciplinary proceedings, stressing that engaging with one's professional regulator and participating in disciplinary enquiries with due diligence and complete honesty are fundamental requirements for any professional.
Mental health considerations
The nurse was diagnosed with Major Depressive Disorder, which is recognised as an impairment by the Tribunal. However, the Tribunal found inadequate evidence to establish the impairment during misconduct. The disciplinary proceedings considered the nurse's mental health struggles but did not absolve her of professional misconduct.
The Finding
The decision was made by the Tribunal to withdraw the nurse's registration with a non-review period of two years.
This decision was based on multiple considerations:
- The severity of the boundary violations committed against vulnerable patients.
- The nurse's initial dishonesty during the investigation process.
- Concerns regarding the nurse's understanding and acknowledgment of the harm caused to patients.
- The paramount need to protect the public and uphold professional standards within the nursing profession.
Read the decision
Health Care Complaints Commission v GGI [2024] NSWCATOD 125 (15 August 2024)
