Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff

Abstract

Background: Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or actually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of professional misconduct can be distinguished: misconduct associated with incompetence and that associated with impairment. This study aimed to (1) quantify home-care nursing staff's experiences with actual or possible professional misconduct; (2) provide insight into the difficulty home-care nursing staff experience in reporting suspicions of professional misconduct within the organisation and whether this is related to the individual characteristics of nursing staff; and (3) show which aspects of professional practice home-care nursing staff consider important in preventing professional misconduct. Methods: A questionnaire survey was held among registered nurses and certified nursing assistants employed in Dutch home-care organisations in 2014. The 259 respondents (60 % response rate; mean age of 51; 95 % female) were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings. Results: Forty-two percent of the nursing staff in home care noticed or suspected professional misconduct by another healthcare worker during the previous year, predominantly a nursing colleague. Twenty to 52 % of the nursing staff experience difficulty in reporting suspicions of different forms of incompetence or impairment. This is related to educational level (in the case of incompetence), and managerial tasks (both in the case of incompetence and of impairment). Nursing staff consider a positive team climate (75 %), discussing incidents (67 %) and good communication between healthcare workers (57 %) most important in preventing professional misconduct among nursing staff. Conclusions: Suspicions of professional misconduct by colleagues occur quite frequently among nursing staff. However, many nursing staff members experience difficulty in reporting suspicions of professional misconduct, especially in the case of suspected impairment. Home-care employers and professional associations should eliminate the barriers that nursing staff may encounter when they attempt to raise an issue. Furthermore, advocating a positive team climate within nursing teams, encouraging nursing staff to discuss incidents and facilitating this, and promoting good communication between healthcare workers may be appropriate strategies that help reduce professional misconduct by nursing staff.

Integrative review of studies about nurses who have been disciplined by their professional regulatory bodies

“…Many factors can influence harmful or unprofessional conduct in nursing practice (Beardwood & Kainer, ; Donaldson, Corrigan, & Kohn, ). Violating or failing to meet nursing standards or relevant legislation (Johnstone & Kanitsaki, ; Maurits, Veer, Groenewegen, & Francke, ; Pugh, ) may be a result of a nurse's lack of skills or knowledge, negligence, inattention, fatigue or bad behaviour (Benner et al, ; Johnstone & Kanitsaki, ; Reason, ).…”

Home Visiting Nurses’ Job Stress and Error Incidents

“…For many staff nurses, it is difficult to report suspicion of wrongdoing within specialized contexts, but the promotion of discussions about incidents, and good communication among those who serve in the medical field, is an appropriate strategy for reducing such errors. 24 It is necessary for the entire sector, and not just individuals, to engage with improvement to convert HVNs' incident experiences into preventive safety. Home visiting nursing agencies need to establish workplace systems rooted in a culture of safety, in which HVNs can share information and hold discussions.…”

Wrongdoing and whistleblowing in health care

“…They can be targeted at patients, or HCPs (Orbe & King, ). Wrongdoings have been studied among nurses (Jackson et al., ; Maurits, de Veer, Groenewegen, & Francke, ; Moore & McAuliffe, ; Ohnishi et al., ; Orbe & King, ; Rabold & Goergen, ), certified nurse assistants (Maurits et al., ) and HCPs (Pohjanoksa et al., ).…”

“…Poor care was observed more by nurses working in acute hospital care (Moore & McAuliffe, ) than those working in homecare (Rabold & Goergen, ) or with older care recipients. The most observed wrongdoings targeted at patients were substandard (Maurits et al., ) or poor care (Moore & McAuliffe, ), inappropriate treatment (Pohjanoksa et al., ), and verbal abuse (Rabold & Goergen, ). Moreover, neglect and physical abuse of patients (Pohjanoksa et al., ; Rabold & Goergen, ) such as beating a tied patient in an acute stage of mental illness were observed in health care (Ohnishi et al., ).…”

“…Wrongdoings observed in health care were also targeted at HCPs as a form of workplace bullying (Pohjanoksa et al., ). Moreover substance (Maurits et al., ) and alcohol abuse by HCPs (Orbe & King, ) and stealing substances from patients and the workplace were observed (Pohjanoksa et al., ). In addition HCPs observed, HCMs hiring incompetent personnel which was accepted in the organization (Moore & McAuliffe, ; Pohjanoksa et al., ).…”