Nurse receives no punishment in professional conduct investigation

A nurse facing charges of professional misconduct will receive no penalty after an investigation found her actions weren't serious enough to face punishment. Photo / Getty Images

A registered nurse facing a charge of professional misconduct for two instances of sedating children will receive no disciplinary punishment.

The nurse, who has permanent name suppression, was brought before the New Zealand Health Practitioners Disciplinary Tribunal facing one charge of professional misconduct with 10 particulars relating to two incidents of sedation.

After an investigation in Auckland in mid-August this year, the nurse was found to have insufficiently provided documentation of two sedation procedures, but the harm to the patients was not sufficient to warrant disciplinary action, a decision released today said.

The investigation, which followed a complaint by the DHB, was opened after the nurse let slip to a colleague that she had administered intravenous propofol to paediatric patients in the ED where she interned.

Administration of this drug, used among others for sedation so that patients can tolerate "unpleasant" procedures, is out of the scope of an intern or registered nurse and can only happen after a verbal order and supervision, following protocols and guidelines.

She resigned from the DHB she worked in after an investigative meeting in 2017.

The Tribunal looked into two separate instances of child sedation at the Emergency Department.

Firstly, a 15-year-old boy admitted to hospital with fractured and
displaced left distal tibia and fibula who the nurse intravenously gave ketamine, propofol and fentanyl.

The second instance involved an 11-year-old girl with a fractured left ankle who was given propofol.

Both sedations took place before an orthopaedic procedure at a children's emergency department in 2017.

During the four-day hearing, the Tribunal heard that the use of propofol in the children's ED is considered "very rare".

The Clinical Nurse Specialist the practitioner in question worked with had never administered the drug and a doctor in the ED described only administering the drug twice in the previous 12 months.

The nurse under investigation worked as an intern in the children's ED at the unnamed hospital from 2016-2018 after a graduate stint at Starship Children's Hospital.

She was interning as a Clinical Nurse Specialist, employed on a training programme at the DHB for nurses wanting to become a Clinical Nurse Specialist in Paediatrics.

But she described her interning experience as "poor," saying she often did not have enough support and faced a heavy workload, with pre-procedure sedations making up a large part of her role.

In her role, she managed her own patients and had to manage the children's ED on her own at times.

Ultimately, the Tribunal found that the nurse's documentation for the two sedated patients in question was "unsatisfactory," but that the patient's safety was not compromised.

The Tribunal imposed no disciplinary action on the nurse and said that to do so would be a "disproportionate response" to the behaviour in question, as neither patient was caused harm by her actions.

"We are not satisfied that the gravity of the conduct in the circumstances of this case warrants disciplinary sanction for the purposes of protection of the public and monitoring professional standards."

The nurse accepted that aspects of her practise were "below professional standards" and said that she was disappointed with her inadequate documentation.