PROFESSIONAL MISCONDUCT

Senior nurse who repeatedly slept

while on night duty
are some nurses who go on night duty hoping to catch a Ann continued to take advantage of her auxiliary colleagues and slept
short nap here and there to see them through their shift. Fatigue most ofthe time she was on duty. The nightly visits from her friend, the
caused by working too many hours or sleeping for too few can hospital security guard, also continued.
result in problems for the nurse and can jeopardize patient care. In the Things eventually came to the notice ofthe senior nursing night coor-
following case, Ann, a senior registered nurse working regular nights on dinator when the day sister reported that a patient had not received an
a gerontological ward, had little time for adequate rest and sleep. urgent blood transfusion for her haemoglobin that she had required
Recovery from fatigue and sleep loss can and should occur during off- overnight. The day sister had also noticed that Ann was failing to docu-
duty hours, but Ann filled her non-working hours with too many ment and inform nurses at the morning handover of incidents and
commitments.This left her and her patients very vulnerable. patient care observations that had occurred during the night. Therefore, a
Many industries, particularly airlines and road haulage, have created full investigation was carried out and Ann was dismissed from the trust
strict policies limiting the number of hours an employee can work dur- and also reported to the Nursing and Midwifery Council (NMC).
ing a week as well as the amount of sleep required. It would seem from The NMC carried out further investigations and decided to charge
this following case that nursing is very poor at setting standards of good Ann with the following allegations: (1) That while on a certain period
sleep practice and monitoring the effects of tiredness on patient care. of night duty she slept for long periods of time lasting between 4 and
The first people to note that Ann was tired when she came on duty 6 hours; (2) That she failed to provide appropriate support for staff on
were her work colleagues: two auxiliary nurses. Over a period of duty; (3) That she failed to communicate clinical information regard-
3 months, after joining an acute hospital trust, ing key facts about patients during the night
Ann started to take longer breaks than any- to appropriate nursing staff during shift han-
body else. She would often be found fast dover; (4) That she gave medications to a
asleep in the coffee room with a blanket over BREACH OF THE CODE OF healthcare assistant on several occasions to
her. As the weeks progressed, Ann became PROFESSIONAL CONDUCT administer to patients; (5) That she failed to
more irritable and reluctant to participate in ensure professional nursing care for several
patient care. This reached a crisis point when patients, including a blood transfusion dur-
she turned up for night duty wearing a long In this case, the following clauses
ing night-duty shifts; (6) That she failed to
black sweatshirt and announced she was of the Code are relevant:
inform colleagues appropriately that
'absolutely shattered'. she was leaving the ward and did not
• 1.3. You are personally accountable
When the handover was finished and the for your practice. This means that you hand over the patient care; and (7) That she
two auxiliaries had begun their usual tasks of are answerable for your actions failed to record and document patient care
settling the patients for the night, they and omissions, regardless of advice during night shifts.
noticed that Ann was very short tempered or directions from another professional Ann tried to argue at her professional con-
with some of the patients as she carried out duct hearing that she was tired owing to
the evening drug round. When the auxiliaries • 1.4. You have a duty of care to your social problems at home. The committee
had completed their tasks, Ann told them that patients and clients, who are entitled hearing her case was not convinced by her
she was going for a lie down in the coffee to receive safe and competent care evidence and decided to remover her name
room. That night the auxiliaries were kept • 4.3. You must communicate effectively from the nursing register because she was a
very busy answering buzzers and toileting and share your knowledge, skill risk to patients in the future.
patients. Ann, however, either did not hear or and expertise with other members
chose to ignore the patients' calls. During the of the team as required for the benefit
night, a hospital security guard with whom of patients and clients Note: All the case studies in this series are
Ann was very friendly came to see her and based on actual true cases which were
stayed with her in the coffee room. • 4.4. Healthcare records are a tool reported to the then UKCC (now the Nursing
The following night Ann's behaviour was of communication within the team. You and Midwifery Council) Professional Conduct
the same and one of the auxiliary nurses must ensure that the healthcare record for Department over the past 10 years. In some
had to wake her up to ask for some anal- the patient or client is an accurate account cases the names of those involved and certain
gesics for a patient. The coffee room was of treatment, care planning and delivery details may have been changed to respect
very untidy and there were two lots of anonymity and confidentiality. Compiled by:
• 4.5. When working as a member
chairs grouped together where Ann and the George Castledine, Professor and Consultant
of a team, you remain accountable for your
of General Nursing, University of Central
security guard had slept. The auxiliary nurses professional conduct, any care you provide
England, Birmingham, and Dudley Group
were very angry at the way Ann was behav- and any omission on your part
of Hospitals NHS Trust
ing, but they were unsure to whom they
should report her behaviour. This meant that

160 British Journal of Nursing. 2005, Vol 14, No 3