Sandra Lewis 9022112
Allegations and Plea
The College alleged that the Member inappropriately confined a client to her room and applied a five-point restraint, failed to monitor the client, failed to respond when the client became agitated, communicated in an angry or intimidating or demeaning manner with the client, failed to ensure that the client was not left exposed after she disrobed, used profanity when talking to colleagues about client care, and falsified documentation of client care. The College alleged that this conduct would be regarded as disgraceful, dishonourable or unprofessional, and that the communication and restraints issues constituted abuse. In addition, the College alleged further conduct that would be regarded as disgraceful, dishonourable or unprofessional: the Member used the nursing station computer for personal use to an extent that negatively impacted her performance of her nursing duties, and refused to open the door when a parent came to speak about care of her child but compelled the parent to speak through a closed door.
The Member was neither present nor represented by counsel at the hearing. The hearing proceeded on the basis that the Member denied the allegations.
Five witnesses, including one expert, testified. The Panel also accepted seven notarized affidavits from colleagues, and a surveillance video. The Member did not object when advised before the hearing that the College would be submitting affidavit evidence.
The Member worked in the psychiatric unit at two different facilities. The allegations related to her employment at both facilities.
Most of the allegations related to the Member’s treatment of Client A during a night shift at Facility A. Client A suffered from periods of psychosis and on occasion needed to be secluded. According to documentation, video coverage, affidavits, and testimony, at 1924 hrs, Client A slammed her door and took off her gown. The Member had a High Risk Officer (HRO) lock the door, following which Client A sat quietly on her bed. The Member entered at 1953 hrs with a cup of medications. The medication sheet signed by the Member also indicates that ointment was applied, but this was not done.
At 2033 hrs, the Member and five other staff members put Client A into five-point restraints. Client A voluntarily went to bed and was calm and cooperative at this time and throughout the night. The Member entered the room four times between 1953 hrs and 0424 hrs. Restraints were removed to allow Client A to go to the bathroom, but they were reapplied. Video showed that Client A was totally exposed, with her gown over her shoulders and her sheets saturated with urine. The Member made no attempts to cover Client A. At 0332 hrs, the waist restraint had risen to the upper chest and Client A’s gown was on the floor. The Member made no intervention other than to cover Client A with a sheet. The Member made no attempt to re-adjust the waist restraint.
At 0409 hrs, the video showed that Client A was restless and frustrated, banging on the bedrails, exposed, and struggling with the waist belt at her breast. She showed no signs of aggression or agitation.
At 0420 hrs, staff ran into the room in response to a loud noise. Client A had fallen off the side of the bed with both ankles and left wrist restrained, and her back severely twisted. The Member did not assist with removing the restraints until 0427 hrs, when she removed one ankle restraint. Client A was helped to the bathroom, visually limping, calm and cooperative. She was returned to five-point restraints until 0700 hrs.
Several witnesses testified that the restraints were not required. The usual practice would be to try to deescalate the situation using PRN medications before considering restraints. The unit’s least restraints policy required visual checks for clients in five-point restraints. The video clearly showed that the Member did not check Client A. Several colleagues saw that the Member sat at the nursing station and used the computer for personal shopping and watching DVDs.
The Member’s charting of the incident did not fit with the video or other evidence. The Member charted that Client A was unable to follow staff re-direction, that she tried to push away from staff, that she had to be physically re-directed, that she was encouraged to settle but to no avail, and that she was parading around exposed.
Staff overheard the Member say to the client, “If you don’t settle down, I will cancel your visit with your father tomorrow.” One colleague testified that the Member provoked clients, resulting in their seclusion. It was the Member’s pattern to seclude, restrain or sedate her clients. Another colleague testified that Client A complained that the restraints hurt her, but that the Member wanted the ankle restraints to be made tighter, tying them together.
With regard to the Member’s communication, colleagues described her as showing no empathy, compassion or concern for Client A’s safety or care. They described her as harsh, threatening, demanding, abusive, disrespectful and nasty.
The expert testified that the Member contravened the Professional Standards and the Therapeutic Nurse-Client Relationship standard; provided a non-caring environment; withheld care; abused the client; used a tone of contempt; used offensive language. The use of five-point restraints when not warranted was abusive. The Member denied the client care by not meeting her basic needs, not properly monitoring her while she was restrained, and minimizing communication with her. All these incidents amounted to verbal and emotional abuse including neglect.
At Facility B, the Member used offensive language while helping colleagues to restrain a client: “What the fuck are you doing?”; “Just give him a fucking needle.” The parent of another client observed this and was concerned that her child would be treated in the same manner as the boy who had been restrained.
The parent also wanted to speak to the Member about her son’s care, but the Member would not open the door. Instead, they spoke through a closed door. When a colleague confronted the Member about this, the Member replied, “Who the fuck does she think she is that she needs to be so close?”
The expert testified that the Member contravened standards. She violated the requirement to foster collegial relationships, and her use of profanity was unprofessional and modelled aggressive behaviour which conflicts with the goal of calming the client.
The Panel found that the evidence supported findings of professional misconduct as alleged. She failed to maintain standards of practice, abused a client, falsified a record, and engaged in conduct that would be regarded as disgraceful, dishonourable and unprofessional.
Oral evidence was corroborated and supported by other evidence. The Panel found that the Member’s disregard for her professional obligations as a nurse was a serious matter. Her conduct had elements of moral failing. She should have known that her conduct was seriously wrong.
Submissions on Order
The College submitted that, since the Member resigned her certificate of registration before the hearing, it could not be revoked, suspended or made subject to terms, conditions and limitations. The College asked the Panel to indicate that the appropriate order in this case would have been revocation.
The Panel accepted the College’s submission. In light of the serious nature of the findings, the appropriate order would be revocation if the Member had had an active certificate of registration. The Member was in a position of authority and abused her position while caring for clients.