1. Professional Standards
1.1. Responsibility and Accountability: Standard 1; Indicator 5:
1.1.1. "Is accountable and takes responsibility for own nursing actions and professional conduct" (BCCNM, 2024)
1.1.1.1. Maria should have taken responsibility for her lack of formal training in Botox injections and dermal fillers, rather than proceeding with procedures she wasn't qualified to perform. She should have informed Shawna that she's only on third day of orientation and communicated to Shawna that she hasn't been trained for the procedure.
1.2. Competency-Based Practice: Standard 2; Indicator 5
1.2.1. "Collects information on client status and care needs from a variety of sources using assessment skills and a review of pertinent clinical data and maintains competence appropriate to their area of practice" (BCCNM, 2024)
1.2.1.1. Maria did not properly assess the clients she was administering botox and fillers to since Shawna told her to do her assessment quickly. Additionally, these are clients she may not have worked with before so it is important to do a through assessment and check client history prior to adminstering anything.
1.3. Client-Focused Provision of Service: Standard 3; Indicator 1
1.3.1. "Makes the client the primary focus when providing nursing care" (BCCNM, 2024)
1.3.1.1. By continuing with the procedure, Maria did not prioritize the client's safety. She was knew she lack the skills to do the procedure but continued otherwise.
1.4. Ethical Practice: Standard 4; Indicator 1
1.4.1. "Demonstrates honesty and integrity at all times" (BCCNM, 2024)
1.4.1.1. Maria should have communicated to Shawna that it was only her third day and she's still in orientation. She failed to share to Shawna that she lack the skills and can't actually administer botox and fillers since she has not been trained.
1.5. Responsibility and Accountability: Standard 1; Indicator 7
1.5.1. "Takes action to promote safe, competent and ethical care for clients" (BCCNM, 2024)
1.5.1.1. Maria did not prioritized her client's safety when she decided to ahead with the procedure. Continuing the procedure without the proper training puts Maria's clients at risk for infections and possible permanent damages.
2. What Does The Scope Say?
2.1. Administering Botox and Fillers are within the LPN's scope of practice but the LPN must complete additional training to show her knowledge, skills and competency before performing the procedure. ("Medical Aesthetic", BCCNM, 2024)
3. References:
3.1. Medical aesthetics. (n.d.). https://www.bccnm.ca/LPN/learning/aesthetics/Pages/Default.aspx
3.2. Duty to provide care. (n.d.). https://www.bccnm.ca/LPN/PracticeStandards/Pages/dutytoprovidecare.aspx
3.3. BC COLLEGE OF NURSES AND MIDWIVES. (2020). PROFESSIONAL STANDARDS. In BC COLLEGE OF NURSES AND MIDWIVES. https://www.bccnm.ca/Documents/standards_practice/lpn/LPN_ProfessionalStandards.pdf
3.4. Canadian Interprofessional Health Collaborative, Beauchamp, J., Brown, R., Comtois, V., Conti, J. W., Dumenil, A. J., Dunn, S., Giroux, I., Krekoski, C., Langlois, S., Orchard, C., Sinclair, L., Vanier, M.-C., & Wener, P. (2024). CIHC Competency Framework for Advancing Collaboration 2024. https://cihc-cpis.com/wp-content/uploads/2024/06/CIHC-Competency-Framework.pdf
3.5. Medication. (n.d.). https://www.bccnm.ca/LPN/PracticeStandards/Pages/medication.aspx
3.6. Practice standards. (n.d.). https://www.bccnm.ca/LPN/PracticeStandards/Pages/Default.aspx
3.7. Lin, C. J., & Jia, H. (2023). Time pressure affects the risk preference and outcome evaluation. International Journal of Environmental Research and Public Health, 20(4), 3205. https://doi.org/10.3390/ijerph20043205
3.8. Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021, May 11). Supporting the Health and Professional Well-Being of Nurses. The Future of Nursing 2020-2030 - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK573902/
4. Practice Stanards
4.1. Duty to Provide Care: Principle 3
4.1.1. "Nurses do not provide care that is outside their scope of practice except in situations involving imminent risk of death or serious harm that arise unexpectedly and require urgent action. In emergencies, nurses are ethically obligated to provide the best care they can, given the circumstances and their level of competence. Employers and nurses should not rely on the emergency exemption when an activity is considered an expected practice in that setting." (BCCNM, 2024)
4.1.1.1. Maria should have not continued with procedure since she was unsure of her role and needed clarification on what her scope of practice is.
4.2. Duty to Provide Care: Principle 5
4.2.1. "Nurses may withdraw from care provision or refuse to provide care if they believe that providing care would place them or their clients at an unacceptable level of risk. Nurses consider relevant factors" (BCCNM, 2024)
4.2.1.1. Maria should have refused Shawna and explained why she is unable to help her with administering fillers and botox.
4.3. Medication: Principle 1
4.3.1. "Nurses perform only those medication-related activities as allowed by: Relevant provincial or federal legislation or regulations,BCCNM standards, limits, and conditions, Organizational/employer policies and processes, the nurse’s individual competence." (BCCNM, 2024)
4.3.1.1. As an LPN, Maria is required to successfully complete additional education in order to perform any medical aesthetic procedure. Since Maria lack the formal training it is against BCCNM regualtion.
4.4. Medication: Principle 6
4.4.1. "Nurses assess the appropriateness of the medication for the client before administering, dispensing, or prescribing a medication." (BCCNM, 2024)
4.4.1.1. Due to a busy environment, Maria could have skipped steps on checks and assessments before administering the fillersa nd botox. Since it indicated that the clinic's waiting room was filling up, her mental state might have been altered as well and clinic sound could have been a distraction.
5. Why did Maria do it?
5.1. Lack of Immediate Supervision
5.1.1. With Joanne absent and Shawna being a new and unfamiliar supervisor, Maria might have felt pressured to proceed without proper guidance to avoid appearing incompetent or uncooperative.
5.1.1.1. Rationalization: Employees often feel compelled to follow instructions from authority figures, even when they are uncomfortable with the tasks.
5.2. Desire to Make a Good Impression
5.2.1. Maria is new to her position and likely wants to demonstrate her competence and reliability to her colleagues and supervisors. This desire to make a good impression can lead to taking on tasks even when she feels unprepared.
5.2.1.1. Rationalization: "Placing pressure on yourself may be a way to seek validation and prove your worth to yourself or others. You might believe that achieving certain goals or meeting certain standards will make you feel more valuable or accepted." (Lmft, 2024)
5.3. High Workload and Time Pressure
5.3.1. The clinic’s waiting room was filled with clients, creating a high-pressure environment. Maria might have felt that she had no choice but to proceed quickly to manage the workload.
5.3.1.1. Time Pressure: High workload and time constraints can lead to rushed decisions and actions. (Lin & Jia, 2023)
5.4. Lack of Access to Support
5.4.1. Maria wanted to ask a physician about her role but couldn’t locate one, leaving her without the necessary support and guidance.
5.4.1.1. Support Systems: " To care responsibly for people ... nurses need to feel healthy, well, and supported. The systems that educate and employ nurses have a duty to fully support them as they take on new roles to advance health equity." (Flaubert et al., 2021)
6. Preventative Steps:
6.1. Role Clarification
6.1.1. Maria should have clarified her role and responsibilities, especially regarding procedures she was not formally trained to perform.
6.1.2. Understanding Scope of Practice: Ensuring she only performed tasks within her scope of practice would have prevented her from undertaking procedures she was not qualified for. (CIHC, 2024)
6.2. Team Functioning
6.2.1. Maria could have engaged more effectively with her team to ensure proper support and supervision.
6.2.2. Effective Team Communication: By communicating her concerns and limitations to Shawna or other team members, Maria could have ensured she received the necessary guidance. (CIHC, 2024)
6.3. Interprofessional Communication
6.3.1. Maria should have communicated her lack of training and discomfort with the procedures to Shawna or sought out another healthcare professional for advice.
6.3.2. Clear Communication: Openly discussing her training needs and seeking clarification would have helped prevent errors. (CIHC, 2024)
6.4. Patient-Centered Care
6.4.1. Maria should have prioritized the safety and well-being of her patients by refusing to perform procedures she was not trained for.
6.4.2. Patient Safety: Ensuring that patient care is safe and effective by adhering to best practices and guidelines. (CIHC, 2024)
6.5. Collaborative Leadership
6.5.1. Maria could have demonstrated leadership by advocating for proper training and supervision before performing any procedures.
6.5.2. Advocacy for Training: Taking initiative to ensure she was adequately prepared for her role. (CIHC, 2024)
6.6. Conflict Resolution
6.6.1. Maria should have addressed any conflicts or uncertainties about her role and responsibilities with her supervisors or colleagues.
6.6.2. Resolving Uncertainties: Addressing conflicts and uncertainties proactively to ensure clarity and safety in her practice. (CIHC, 2024)