Charge

On 27 April 2022 by audio visual link the Health Practitioner’s Disciplinary Tribunal heard a charge of professional misconduct laid by the Professional Conduct Committee appointed by the Nursing Council of New Zealand against Ms Elisabeth Buckley, a registered nurse of Auckland (the nurse).

The charge alleged that:

1. While employed as a registered nurse, in the capacity of Facility Manager, at Briargate Dementia Care, Bayview, (“Briargate”), the nurse either directed a healthcare assistant to administer medication that was not clinically indicated to residents, or, in the alternative, administered the medication herself.  In particular:

1. 1. That on 11 January 2020, the nurse instructed a healthcare assistant, to administer unprescribed medication (PRN Lorazepam), that was not clinically indicated to two residents [Ms G] and [Ms S];

Or, in the alternative

1. 2. That on 11 January 2020 the nurse administered the prescribed Lorazepam medication to Ms Y herself.

2. While employed as a registered nurse, in the capacity of Facility Manager, at Briargate, the nurse falsified a document. In particular:
   1. That on or around a date unknown but between 6 January 2020 and 16 March 2020, the nurse falsified the signature of another registered nurse, when updating a dietary profile for a resident, Mr R.

The conduct alleged in Charges 1.0 and 2.0 amounts to professional misconduct pursuant to section 100(1)(a) and/or (b) of the Act and particulars 1.1, 1.2 and 2.1, either separately or cumulatively, are particulars of that professional misconduct.

Background

The nurse was employed as Facility Manager at Briargate Rest Home, a facility for residents with dementia, from January 2020 until her resignation in March 2020.

The doctor visited Briargate every Friday to conduct routine medical reviews of the residents. The doctor did not recall any concerns from the nurse related to possible “sundowning” behaviours of Ms S and Ms G. Residents Ms S and Ms G had previously been treated for such behaviours with Risperidone and Quetiapine. These behaviours can occur in people with dementia, where they become more confused, restless, or insecure in the late afternoon or early evening. The doctor had not previously prescribed Lorazepam, for either Ms G or Ms S, and would not usually have done so.

The nurse approached team leader Healthcare Assistant (the assistant) and asked her to administer Lorazepam to Ms Y, Ms S, and Ms G. Ms Y was prescribed Lorazepam, although the assistant did not consider her agitated and therefore it was not clinically indicated at the time. The assistant saw that neither Ms S nor Ms G had been prescribed Lorazepam by a doctor. The Assistant pointed this out to the nurse, but despite this the nurse handed her a medication pack which included Lorazepam misappropriated from another resident’s pack. The practitioner again instructed the assistant to administer Lorazepam to Ms G and Ms S.

The assistant did as instructed, and then called the registered nurse (RN) to report the incident. The nurse personally administered prescribed Lorazepam to Ms Y, and now accepts that it was not clinically indicated. When the nurse became aware that the RN had made notes to this effect, she asked her to change them, stating that the doctor had told her to give Ms S and Ms G Lorazepam. The RN did not do so.

The nurse later contacted the doctor and asked her to prescribe Ms S and G, citing sun-downing concerns. The doctor contacted the RN about the request, who informed her of the preceding events. A meeting took place with the nurse, the RN, and Briargate management to discuss the matter. The nurse initially denied giving medication without the doctor’s knowledge and claimed that the doctor had forgotten to chart it. She later admitted and apologised for the incident.

In early March of 2020, the RN reported that her signature had been falsified on a dietary profile of a resident, Mr R. While updating an outdated dietary profile form, the nurse had copied information completed by the RN to the new, correct form. She included the RN’s name and signature on the new form. The nurse could not specifically remember falsifying the RN’s signature, however she accepts that she most likely did so.

Finding

The Tribunal found the charge established.  Particulars 1.1, 1.2 and 2.1 both cumulatively and separately amounted to professional misconduct and were serious enough to warrant disciplinary sanction. 

Penalty

The Tribunal ordered the nurse be:

• Censured
• Conditions of registration
• Recommendation of apology to affected co-workers
• Pay $7,925 amounting to 35% of the investigation, prosecution and hearing costs

The Tribunal directed publication of the decision and a summary.