Unprofessional conduct by nurses: A document analysis of disciplinary decisions

Abstract

Background: A small minority of nurses are investigated when they fail to meet the required professional standards. Unprofessional conduct does not just affect the nurse but also patients, colleagues and managers. However, it has not been clearly defined. Objective: The objective was to identify unprofessional conduct by registered nurses by examining disciplinary decisions by a national regulator. Design: A retrospective document analysis. Data and research context: Disciplinary decisions delivered to 204 registered nurses by the Finnish national regulatory authority from 2007 to 2016. The data were analysed with quantitative statistics. Ethical consideration: The study received permission from the Finnish National Supervisory Authority for Welfare and Health and used confidential documents that were supplied on the basis of complete anonymity and confidentiality. Findings: The mean age of the registered nurses who were disciplined was 44 years and 81% were female. Two-thirds had worked for their employer for 5 years or less, 53% had two or more employers and 18% had a criminal history. All the decisions included a primary reason for why the nurses were investigated, but there were also 479 coexisting reasons. In most cases, unprofessional conduct was connected to substance abuse (96%). In addition, stealing of medicine, a decreased ability to work and neglect of nursing guidelines were reported. Discussion: We found that the nurses were investigated for unprofessional conduct for complex combinations of primary and coexisting reasons. Our study highlighted that more attention needs to be paid to the key markers for unprofessional conduct. Conclusion: Unprofessional conduct is a complex phenomenon that is connected to nurses’ individual and working backgrounds and has an impact on their work performance. More research is needed to identify how nursing communities can detect, manage and limit the serious effects and consequences of unprofessional conduct.

Developing a Feasible and Credible Method for Analyzing Healthcare Documents as Written Data

“…Information or access may be unavailable before the data collection if highly confidential or sensitive data are involved. This means that the research questions are exploratory during this phase and can only be specified after an overview of the entire data has been obtained ( Häggman-Laitila et al, 2019 , 2020 ; Kangasniemi et al, 2022 ; Papinaho et al, 2021 , 2022 ; Toivonen et al, 2020 ). Determining the research questions and data can be based on previous studies and by consulting responsible authorities ( Appleton & Cowley, 1997 ) who hold relevant data or experts and practitioners engaged in the study topic.…”

“…This phase includes providing reasons to justify the use of selected documents in the analysis, by identifying available and potentially suitable documents and any bias they may have (see phase 6). Justifying the use of documents is also crucial when using highly protected or sensitive data, such as complaints from clients and patients or official investigations ( Bowen, 2009 ; Häggman-Laitila et al, 2019 , 2020 ; Kangasniemi et al, 2022 ; Papinaho et al, 2021 , 2022 ; Toivonen et al, 2020 ).…”

“…Document analysis can have different focuses , depending on the study purpose ( Atkinson & Coffey, 2010 ; Coffey, 2014 ; Finnegan, 2011 ; Gorichanaz & Latham, 2016 ). First, it can be used to understand documents and their content in a specific context, such as an analysis of healthcare steering documents ( Papinaho et al, 2021 , 2022 ). For example, the analysis can focus on how the documents relate to real-life practical healthcare ( Häggman-Laitila, 2003 ; Häggman-Laitila et al, 2010 , 2019 , 2020 ; Toivonen et al, 2020 ).…”

“…A deductive development strategy can be used to develop an extraction matrix that is based on previous knowledge, using either a systematic review method or systematic literature searches. If previous knowledge is limited, or unavailable, experts in the field can be consulted as part of the development process ( Häggman-Laitila et al, 2019 , 2020 ; Hipp et al, 2020 , 2021 ; Papinaho et al, 2021 , 2022 ; Toivonen et al, 2020 ). For example, we consulted relevant authorities when we developed an extraction matrix to study administrative decisions related to unprofessional conduct.…”

“…In addition, we used our experience of carrying out 14 studies using document analysis to examine the feasibility and credibility of the method. These document analyses employed qualitative and quantitative methods and used documents such as patient records or plans ( Häggman-Laitila, 2003 ; Häggman-Laitila et al, 2010 , 2019 , 2020 ; Hipp et al, 2020 , 2021 ; Puustinen et al, 2021 ; Toivonen et al, 2020 ; Turjamaa et al, 2015 ), healthcare steering documents ( Kallio et al, 2018 , 2020 ), clients’ complaints ( Kangasniemi et al, 2022 ), and administrative healthcare decisions ( Papinaho et al, 2021 , 2022 ).…”