10 Mandatory Reporting
GOALS AND ISSUES IN MANDATORY REPORTING
This chapter focuses on illegal and irresponsible activities that fall outside the boundaries of professional practice. Such illegal actions require reporting the incident to the State Board of Nursing, and the profession is responsible for “policing” such activities, preventing them, and ensuring a due course of legal action when these professional practice boundaries of good practice are crossed. This is where Marx (2001) cautionary notes on a “blame-free” culture are particularly well taken and appropriate. According to Marx (2001), “blame free” can never mean “responsibility free,” and some acts fall outside ethical comportment altogether or are egregious and blameworthy. It is one thing to govern and engage in self-improving practices within the bounds of commitment of the practitioners to uphold the standards and notions of good internal to the practice (MacIntyre, 1984), and quite another when practitioners willfully violate the notions of good practice. Some people, within every discipline for whatever reasons, do not choose to uphold the standards of their practice and fall outside ethical practice. Papadkkis (2008), at the University of California San Francisco, found that medical students who had problems with “professional behavior issues” were more likely to be reported to the state board of medicine. This is a cautionary tale for nurse educators as well. Sometimes people may intellectually assent to the standards and boundaries of good practice but not accurately discern in practical situations where these standards are salient and relevant. Others blatantly choose to ignore or violate the professional standards, and therefore do not engage in the essential commitments and formative skills related to good practice. Sometimes, however, extenuating circumstances call for choosing to repair a crisis situation in the only way possible under the circumstances. The patient falling off the operating table had already experienced a serious practice breakdown, and there was no safer choice than to continue the operation under compromised conditions and offer the patient full disclosure of the error. Sometimes in an emergency a contaminated piece of emergency equipment may be used, and when time is essential for saving the patient’s life, the safer choice is to use the contaminated instrument to establish the airway or inject an emergency resuscitative medication. Repair of a breakdown situation is the best that can be achieved. Full disclosure to the patient is warranted, and redesign strategies to prevent such future problems are in order. But here we turn to criminal and egregious acts that fall outside of professional practice.
2. Physical/verbal abuse, sexual abuse, or exploitation
3. Falsification of documents, cover-ups
4. Repeated medication errors that show a pattern of incompetence or negligence
6. Patient neglect (such as failing to properly assess, treat, monitor, notify, or intervene)
HISTORICAL CASE STUDY #1: The Charles Cullen Case
The prosecutor’s office reviewed pertinent medical records and on December 8, 2003, alerted the New Jersey Board of Nursing of an impending arrest. On December 12, 2003, Mr. Cullen was arrested and charged with one count of murder and one count of attempted murder.* On request made by the New Jersey Board of Nursing that very day, Mr. Cullen signed an interim order of voluntary surrender pending the completion of the criminal case. On April 29, 2004, after Mr. Cullen pleaded guilty to multiple counts of murder and attempted murder in County Superior Court, he signed a consent order with the New Jersey Board of Nursing agreeing to permanently surrender his license to be deemed a license revocation. His license was also revoked in Pennsylvania.

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