A complaint was made to the Council about an experienced Registered Nurse and Midwife who had recently transferred her scope of practice from an acute setting to a community based setting. As part of her role, the practitioner was required to administer vaccines and other medications. She was also required to supervise nursing students on placements.

It was alleged that the practitioner was involved in eight separate medication incidents and a number of near misses in relation to medication handling and administration whilst employed as a Practice Nurse at a Medical centre. Notably, the majority of these incidents were related to the administration of vaccines.

Following notification of the events involving errors of medication administration, the Council decided a hearing was appropriate to decide whether immediate interim action (i.e. conditions or suspension on registration) was required for the safety of the public, whilst the notification was further assessed and dealt with.

Specific allegations included;

• Four patients being given an incorrect drug which had not been prescribed
• The nurse failing to appropriately supervise a student nurse who incorrectly administered two incorrect medications
• A patient being given an incorrect dose of medication and subsequently requiring transfer to hospital
• Allegation that she deliberately changed medication records when an error was found
• Evidence of a privacy breach

Throughout the hearing, the committee heard that despite a long career in nursing and midwifery, this was the practitioner’s first role in a GP practice and she did not have previous  experience with immunisation’ and vaccine administration. The RN declared her lack of training and knowledge of immunisation during the interview process and advised that the Practice had offered training and support at the interview.

Consequently the committee found that;

• The practitioner had not identified the gaps in her knowledge and skills required in her new role. She did not develop a learning plan or complete education to ensure safe practice prior to changing roles
• In the new position she received little or no induction or training and was expected to 'learn on the job'. Often she was the only nurse on the shift and received minimal supervision and support
• The practitioner did not demonstrate understanding that her scope of practice is a personal, professional responsibility
• An audit of the Practice software found that much of the document inconsistencies were due to the inadequacy of the software
• Some data inconsistencies had been errors made in early days of employment at the Practice when she had been inexperienced in using the technology
• Some medication errors had been attributed by the practitioner to the pressure of the work
• The practitioner accepted responsibility for the errors and had notified her employer, doing all she could to correct them

In conclusion the hearing committee decided that no conditions on registration were necessary as;

• The RN recognised and took responsibility for the medication administration errors and the explanations for the documentation errors were acknowledged
• It was recognised that many of the difficulties arose due to a lack of adequate workplace systems and the practitioner did not appear to lack nursing knowledge
• The practitioner declared that she would undertake training in areas where gaps of knowledge and skill were identified

The committee did however advise that the RN actively seek to continue professional development around the requirements of;

• Proactive learning - taking accountability for her own continued professional development relevant to her current context of practice – a registration standard
• Accurate and adequate documentation of the provision of care - particularly when digitally recorded
• Education on dealing and managing people in stressful situations
• The need for clear communication - a skill that needs constant review and practice
• How verbal orders need to be documented
• Her professional responsibility to maintain good health so that she is safe and fit to practise
• Her professional responsibility in relation to delegation and the support and supervision of students

Practice points

• Be proactive in seeking ongoing professional development. If you have a knowledge gap, ensure you prioritise up skilling in this practice area
• Document your learning needs, actions and reflections as per the National registration standard of CPD
• Be aware that CPD is a personal and professional responsibility
• Demonstrate professional responsibility by acknowledging to employers/managers any knowledge gaps
• Raise and discuss lack of induction, training, knowledge gaps or inadequate systems with your manager or management as soon as you are aware of the gaps
• Seek supervision and feedback from a relevant health practitioner when needed
• Seek a professional mentor external to the workplace
• Understand the responsibilities of a practitioner to provide an appropriate level of delegation, oversight, support and guidance according to the knowledge, skills, experience and level of education of the individual being supervised including students.
• Do not agree to supervise if you do not have the appropriate level of knowledge and skills in the context of practice.