Bienial Nursing Leaders’ Conference

16 th
2021
Adherence to Professional Ethics and Patients’
Bill of Right: The Role of Nurse Leaders
by

Aliyu Abdullahi Gusau R. N. (Nig), LL.B, B.L

email: aliyuag63@gmail.com
22nd October, 2021
Nursing and Midwifery Council of Nigeria

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 Presentation Outline
• Abstract
• Introduction
• Ethics
• The Nurse Leader’s Role
• Overview of Patients Bill of Right
• Recommendation
• Conclusion

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 Abstract
Nurse leaders practice in a very complex ecosystem of the healthcare
infrastructure. This complexity sometimes lead to an ethical dilemma which
threatens the caregivers, that is, the staff nurses’ effectiveness in the
organization. To mitigate this, clarity is crucial to shape an environment where
congruence is developed between the moral philosophy of caregivers and the
rights of the patients. Framing this harmony requires nurse/midwife leaders to
uphold the ethical code of their profession within the clinical and administrative
workspace while considering the patient’s Bill of Rights as caregivers. This view
is the primary focus of this paper. Other areas of focus delineated in this paper
are the ethics of the nursing profession, an overview of the patients Bill of
Rights, and a recommended framework to aid the nurse/midwife leaders
mitigate any ambiguity between patients and caregivers.
Keywords: Nurses and Midwives leaders, Nursing, Patients’ Bill of Rights,
Professional Ethics.
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 Introduction
“May I stress the need for courageous, intelligent, and dedicated leadership … Leaders of sound integrity. Leaders not in love
with publicity, but in love with justice. Leaders not in love with money, but in love with humanity. Leaders who can subject
their particular egos to the greatness of the cause” (King, Jr, 1957).
The role of a nurse/midwife leader pivots between the clinical and the administrative office of the healthcare infrastructure.
They are called to act when the rights of staff nurses and patients are violated. nurse/midwife leaders are expected to be
competent, credible, self-confident, motivated, driven, and possess business knowledge (Edmonson, 2010; Gaylord & Grace,
2014). The healthcare infrastructure and professional bodies require that nurse/midwife leaders utilize these elements of
leadership to harmonize the moral philosophy of nurses and the rights of patients (Edmonson, 2010). Failure to uphold this
can negatively impact the healthcare infrastructure. As described in the work of Grossman and Valiga (2009) the leadership
challenge of these leaders is primarily focused on them being morally fit and also creating healthy disorder to challenge
hierarchy, tradition, cultures, and norms that decrease against healthy work environments for the purpose of providing
quality care for patients. It is therefore necessary for nurse leaders to create an environment that strengthens the moral
philosophy of the staff nurse as caregivers in order to properly care for patients. To achieve this, both parties need to have an
ample knowledge of the professional code of nurses and the patients Bill of Rights. Since having one party possessing the
knowledge of one and not both could likely lead to abuse. Although, in all fairness, this responsibility primarily lies with the
nurse/midwife leaders. For according to the core principles which govern nursing practice, nurse/midwife leaders must be
just while respecting one another, and must consider the patients autonomy (Shirey, 2005). Taking these two into
consideration alongside others, which are discussed later in this paper, would further strengthen good practice in the
healthcare workspace, which of course is beneficial to patients. In this paper, the role of the nurse leader in creating an
environment that adheres to the ethical code of nursing practice and enable patient’s to fully grasp and utilize their Bill of
Rights is discussed. Subsequent segments of this paper discusses ethics around the subject of the nursing profession. This is
followed by a compact discussion on the nurse leaders role in both the clinical and administrative workspace. An overview of
the patient’s Bill of Rights is discussed with highlights on the providers responsibility. This paper recommends a future
direction to increase synergy in the healthcare workspace and mitigate any ambiguity between patients and caregivers.
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 LEGAL STATUS OF NURSES IN NIGERIA
• For a Nurse/Midwife to assume the status of a legitimate practitioner
in Nigeria, the nurse/midwife, whether trained in Nigeria or outside
Nigeria must meet or satisfy the requirements set out by the Nursing
and Midwifery Council of Nigeria as follows:
• i.Attended a course or period of instruction in an institution approved
by the council or acceptable to it (if trained outside Nigeria); or
• ii.Sit and pass the council examinations as a preparatory test of
ensuring professional competence in accordance with the standard
acceptable to the council.
• Licensure, authorising or conferring powers to practice as a
nurse/midwife in Nigeria.
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 HOW TO IDENTIFY THE LEGAL DUTIES OF THE
NURSE
The term “duty” may be defined as what is obliged to do by moral, law,
a trade, calling conscience, etc. The literal application of the term does
not suffice in the legal sense. Duty, in the legal sense connotes a
preliminary vital ingredient in establishing the tort/crime of negligence
and breach of contract. In this nexus, duty has further being classified
into two viz:
i.Moral duty; and
ii.Legal duty

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 HOW TO IDENTIFY THE LEGAL DUTIES OF THE
NURSE (Cont’d)
Moral Duty
This is founded on fairness, sympathy (morals) where a legal duty does not exist. The breach of a moral duty is not actionable. Example, a nurse
who passes by the scene of an accident has only a moral duty to help. In the even that the nurse/midwife decides not to assist, no action can
be instituted against the nurse/midwife since he duty owed in the above circumstance is a moral one.
Legal Duty
This is duty that is defined or recognized by law. If a legal duty is breached, it may be followed by the institution of proceedings (Civil or
Criminal) depending on the nature of the breach. Example of legal duty abounds in the following circumstances:
i.Where a nurse/midwife fails (that is, omits) to discontinue a blood transfusion (to which a patient under nurse’s care is reacting) and serve the
drugs prescribed by the doctor (in contemplation of such reactions) or inform the doctor immediately (as is reasonably possible) may be liable
in breach of a legal duty.
ii.Where a registered midwife in the course of conducting a normal delivery observes cord prolapse around the baby’s neck and refuse to
double - clamp and cut the cord or take any necessary steps (acceptable in practice) to prevent strangulation of the baby, may be guilty of
breach of legal duty.
Therefore, the breach of a moral duty is in-actionable whereas the breach of legal duty may be actionable. Indeed Mbanefo, F. J. (as he then
was) tritely remarked, in the case of Alimi Akanni & Others V.R (1959) that:
“The members of the crowd who stood by and watched the house in which they know an old woman was locked in and being burnt and did
nothing behaved disgracefully, but that does not bring them within the provisions of section 7 of the Criminal code (dealing with principal
offenders) as to be regarded as participants in the act of murder.”

10/22/2021 16th Bienial Nursing Leaders’ Conference

 Provisions of the law on duties of the
nurse/midwife
• By law, the nurse/midwife is not allowed to do whatever he/she wishes. To avoid this the law contained series of provision
which were gradually amended. The final amendment, so far, is contained in ACT NO. 83, 1992 which rested, albeit unclear,
the scope of Nursing and Midwifery duties etc in the following provision;
• “A nurse or midwife registered under this Act shall be entitled to carry out nursing or midwifery care as provided for in the
training curriculum prescribed and approved by the council.”
• Note that irrespective of the content of the curriculum “prescribed and approved by the council,” the Act in its RESTRICTED
EFFECT OR REGISTRATION clause debarred nurses and midwives from taking:
• “... cases of abnormality or disease in or relating to any pregnancy requiring medical attention”
• The above is contained in SECTION 22 of the ACT (as amended) which provides:
• “Registration under this act shall not confer the right to assume any name, title or designation suggesting or implying that
the person registered is by law entitled to take charge of cases of abnormality or disease in or relating to any pregnancy
requiring medical attention.”
• The same Act permitted that a registered nurse or midwife who satisfied certain conditions may establish a nursing or
maternity home(s). one of the conditions, as set out in SECTION 23(1) of the Act is that:
• “He has demonstrated unequivocally that there is prompt access to a participating obstetrician and gynaecologist or and
experienced medical practitioner at all times, WHO HAS THE LEGAL RESPONSIBILITY OF ATTENDING TO EMERGENCIES.”
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 Provisions of the law on duties of the
nurse/midwife (Cont’d)
With the problems created by the legislation came the difficult task of how to identify nursing and or midwifery duties. Two methods have been adopted here:
i.Institutional Approach
ii.Functional approach
Institutional Approach
Under this approach, the nurse/midwife examines the nature of institution that employs him/her as a determinant for the ascertainment of his/her duty. Example:
if the nurse/midwife is employed by a local government and posted to the Rural Health Centre, the nurse/midwife may find himself/herself “wearing the cap of
different roles and offices.” In line with this, the nurse/midwife may fill in for the office of a medical doctor and offer consultancy services without necessary
direction/supervision by a medical doctor, and within the same scenario, the nurse/midwife may fill in for the role of a pharmacist, by dispensing drugs, without
the supervision of resident medical doctor in addition to other nurse/midwife roles.
Note that if the same nurse/midwife leaves the primary health care for a Teaching or Specialist Hospital, the nurse/midwife must cease from prescribing drugs for
any patient.
Merits of the Approach
i.It provides comprehensive care for the patient, community and the nation.
ii.It enables the nurse/midwife to face new tasks which will lead to the application of skill based on the application of nursing process.
iii.It will earn credits for the profession.
Demerits of the Approach
i.It leads to violation of the law.
It exposes the nurse/midwife to risk to committing a criminal offence which will lead to the WITHDRAWAL OF HIS/HER NAME FROM THE REGISTER OF GENERAL
NURSING; DISMISSAL FROM WORK; FINE and or POSSIBLE IMPRISONMENT.
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 Provisions of the law on duties of the
nurse/midwife (Cont’d)
• Functional Approach

• The nurse/midwife may identify duties be characterizing the duties into:

• Independent Functions:

• Refers to any functions(s) which the house/midwife can undertake without direction and or supervision by anybody. Example include: bed bath, oral toilet, offering of bed pans, bed-making, record of
vital signs, care of pressure areas, etc.

• Interdependent Functions:

• It involves the simultaneous execution of certain services or joint care which run the same jointly undertaken by the nurse/midwife and doctor or the nurse/midwife and any other member of the health
team. Example: in an operating theatre, during the course of a major operation, the functions of the anaesthetist, theatre nurse/midwife and the surgeon are interdependent functions. This is because
non can operate without the other.

• Dependent Functions:

• Involves nursing duties that are entirely dependent on the directives/order or supervision of a doctor or therapist as the case may be. Here the exclusive right of execution of such duty is not rested in the
nurse/midwife as is the case in independent function. Example: administration of drugs without prescription, admission of DDA drugs (narcotics) without prescription, administration of intravenous fluids
or blood transfusion, etc.

• Merit of the Approach

• i.It is in compliance with the law.

• ii.It gives protection to the nurse and midwife

• Demerits of the Approach

• i.It is not helpful to the patient and community particularly where doctors are not available.

• It prevents the nurse/midwife from implementing the knowledge acquired from the school.

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 Views of contemporary writers/authorities on
nursing/midwifery duties
The views of contemporary writers and authorities on nursing and midwifery duties is essential towards the identification
of the duties of the nurse/midwife in Nigeria.
Mr. E. Olu Adelowo (Nurse, Lawyer and Lecturer)
He observed, in his article that (Adelowo, 1985):
“Early legislation(s) on nursing and the present day nurses act have failed to define in law the specific duties and
responsibilities of nurses of which an ordinary man can easily identify with certainty.”
Cafferty and Sugarman (Nurses, Educationists)
They commented in their book as follows (Cafferty & Sugarman, 1971):
“Nurses have no more right to take medication without medical supervision than any other citizen. Only a physician can
diagnose and prescribe and only a pharmacist can dispense drugs. It is illegal for a nurse to prescribe drugs for herself or
others.”
Milton and Bernice (Nurses, Lawyer and Educationist) commented thus (Milton & Bernice, 1947):
“Many functions commonly practiced by nurses are remedial in nature and are certainly acts within the purview of the
practice of medicine. Such function as administering an anaesthetic, suturing of wounds, administering of turpentine
enemas, and many others are remedial in nature and involve act which are prohibited unless performed by a licensed
physicians … by what legal sanction does the nurse act? What is her responsibility? Fundamentally, the practice of such
functions by the nurse is prohibited by law. This is not an independent function of nursing.”

10/22/2021 16th Bienial Nursing Leaders’ Conference

 Views of contemporary writers/authorities on
nursing/midwifery duties (Cont’d)
• Medical and Dental Council of Nigeria (Statutory Professional Body)
• Commented on the legal implication of the law (particularly Section 22 - restricted effect of resignation) as follows (Medical and Dental Counsel of
Nigeria):
• “It is normal for medical practitioners to accept patients who have obstetric abnormalities and are referred to them by midwives. A nurse or midwife
must not be shielded if she tries to assume the name, title or any designation implying she is a doctor. She must be protected if she tries to undertake
responsibilities for the care of patient with obstetric abnormalities, on action which contravenes the law. Male nurses are to be particularly watched for
passing themselves off as doctors.”
• The Nigerian Nurse (An Educative Nurses/Midwives (NANNM) Journal)
• Commented on the legal duties of the nurse/midwife in its editorial as follows (NANNM):
• “... Nurses have been agitating for the amendment of nurses and midwives act of make public the legal responsibilities and scope of practice of
registered nurses for the benefit and protection of the general public (their client) … the law still forbade the nurses the right to participate overtty in
diagnosis and treatment.”
• Adelowo E. Olw (Mr) (Nurse, Lawyer and Educationist)
• Commenting further on nursing duties involving the use of standing order observed Adelowo, 1985:
• “For cases yet to be diagnosed and never seen by the physician which is the common practice in primary health care centers and hospitals in rural areas,
primary health clinics and industrial areas - such orders are invalid because the physician has no power to delegate the authority to diagnose, treat or
prescribe. For example, a standing order for the treatment of ulcer, headache, malaria fever or diarrhoea is illegal because it presuppose a prescription
based on diagnosis. Therefore, Nurses who actually practice Medicine in reliance on standing orders … (whether in Clinics, Hospitals, Primary Health Care
and industrial areas) are ill advised because they are wide open to a criminal charge which may lead to the withdrawal of their names from the register
for nurses and loss of their certificate and possible imprisonment.”
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• It should be mentioned that the views expressed by writers BienialisNursing
16thabove Leaders’ Conference
in consonance with UDUTH circular which has been incorporated in UDUTH13annual
report.
 ETHICS
• "Ethics, also called moral philosophy, is the discipline concerned with what is morally good and bad and morally right and wrong" (Singer,
2021).
• The terms ethics and morality are closely related, although, they slightly vary. Ethics refer to publicly stated and formal set of rules and
values, while morals are values or principles to which one is personally committed. Several professions have their respective ethical code,
however, the profession do not make ethical decision, individuals do. For a professional nurse/midwife, both the publicly stated and formal
set of rules as well as the principles to which the nurse/midwife is committed all interact to form the nurse/midwives moral philosophy
(Singer, 2021; Nwonu et al., 2013). In turn, this philosophy enables professional nurse/midwife to provide efficient and effective patient care.
• Nursing Code of Ethics
• Nursing code of ethics is a formal statement of the ideals and values of nursing and ethical principles that serve as standards for
nurse/midwife actions. It concerns the behaviour that is normally right for a nurse/midwife in professional situations. The need for an
ethical code of practice for nursing was perceived in the 19th century. Some religious communities prepared code of practice for their nurse
in consonance with the “religious orders” rule of life. Among the earliest evidence of that perceived need in the secular world was the
Florence Nightingales pledge formulated by a group of nurse in 1893. It was based on the Hippocratic Oath and contained all the
expectations from a nurse/midwife in that era. Although the pledge was formulated based on the subservient nature of nursing at the time.
Because it no longer has social relevance to the 21st century context of nursing, it was replaced by what is now known as the “Nurses
Pledge” which is recited by students of most schools of nursing either at the beginning or at the completion of their training (Nwonu et al.,
2013). However, the pledge in this case does not make ethical decision, the nurse/midwife are the ones required to make such decisions.

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 Ethics
• Ethical Leadership among Nurse/Midwife Leaders
• I n t h i s p a p e r, n u rs e / m i d w i fe l e a d e rs i n d i c a t e re g i st e re d
nurse/midwife in various leadership roles who provide support to
frontline nurse/midwife. The leadership roles could be managerial,
supervisory, administrative, etc. The expectation for ethical leadership
is that these nurse leaders take responsibility to engage in ethical
behaviour and provide leadership in building a moral community, that
is, a workplace where values are made clear and are shared, where
these values direct ethical actions, and where individuals feel safe to
be heard (Storch et al., 2013).

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 The Nurse Leader’s Role
• Nurse leaders play a vital role in balancing the diverse and complex interests of patients, families, physicians,
employees and organization while upholding the ethical code of their profession. The role of the nurse
l e a d e r d i ffe rs f ro m o t h e r h e a l t h ca re l e a d e rs i n t h at t h ey p i vo t b e t we e n t h e c l i n i ca l a n d
administrative/organizational domains of the healthcare infrastructure (Edmonson, 2010). Since most of the
healthcare infrastructures have formal written codes of ethics that advocate caring missions, nurse leaders
must ensure that the professional code of the nursing practice translate into caring work environment.
Failure to create this breeds an undesirable environment that undermines ethical principles in the healthcare
infrastructure (Shirey, 2005).
• For nurse leadership and ethical decision making to work concurrently, nurse leaders should review what
kind of ethical challenges their staff typically encounter and determine the best ways to resolve the
difficulties. Researchers in the Journal of Medical Ethics and History of Medicine said nurses who practice
ethical leadership in their daily actions advance positive behaviors in healthcare (Duquesne University School
of Nursing, 2020).
• Ethical leaders must strive to model and support ethical performance and at the same time be sensitive to
moral issues and enhance nurse’s performance by fostering respect for human dignity; thus, they can play an
important role in promoting patient safety, increase the capacity to discuss and act upon ethics in daily
activities and support the ethical competence of nurses (Barkhordari-Sharifabad et al., 2017)

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 The Nurse Leader’s Rolw
• Ensuring Congruence with Ethical Principles
• Before nurse leaders can adapt and implement ethical standards, they must understand the components of ethical decision-making as they
apply to the field (Duquesne University School of Nursing, 2020). The ethical behaviour within the nurse leader roles includes six basic
principles as a baseline for ethical nursing practice. These are: beneficence, fidelity, justice, non-maleficence, patients autonomy, and
veracity (Shirey, 2005).
• beneficence: is the obligation to do good. To this end, nurse leaders have a duty to create practice settings in which nurses must be
committed to helping patients and seeking out the best possible healthcare outcomes for them. Within this framework, the patient is
central to the foundation of care.
• Fidelity: this is the obligation to remain faithful to one’s commitment. Nurses must be committed to helping patients and seeking out the
best possible healthcare outcomes for them.
• Justice: refers to the fair and equitable distribution benefits and burdens in society. In managerial behavior, the concept of justice
incorporates both truthfulness and respect for others.
• Non-maleficence: is the obligation to avoid doing harm. Nurses must make sure they are not purposely harming patients in their care. While
medical treatments or procedures can have negative impacts on patients, nurses should not cause intentional harm.
• Patients Autonomy: Patients are entitled to know about all of their treatment options and have the right to make decisions about their
healthcare based on their personal beliefs. Patients have the right to refuse treatment or medication. If a patient does not have the capacity
to understand the information, the patient’s healthcare power of attorney should be consulted (Duquesne University School of Nursing,
2020).
• Veracity represents the obligation to tell the truth and not to lie or deceive others. Truthfulness is viewed as fundamental to ethical
relationships, is an expected part of the respect owed to persons, and constitutes an element of clear, consistent communication. Nurse
leaders have a duty to tell the truth regardless of whether others want to hear the truth or not. The pervasive and troubling practice of
‘‘white lies’’ constitutes dishonesty and interferes with the ability to be a caring leader.

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 OVERVIEW OF THE PATIENTS’ BILL OF RIGHTs
• A patient’s Bill of Rights is a list of guarantees for those receiving medical care. The patients Bill of Rights (often
referred to as PBoR) was launched on the 31st of July 2018 in Abuja, Nigeria. This act was spearheaded by the
Consumer Protection Council (CPC), and the Federal Ministry of Health (FMH). The aim of the PBoR is to protect
Nigerian patients and ease access to quality healthcare services (Nigerian Health Watch, 2018).
• The PBoR, although newly launched is not a new concept, it is merely a collection of Patients’ Rights by the CPC
which are enclosed in the constitution, and covered by the Consumer Protection Council Act, Freedom of
Information Act, National Health Act, the Hippocratic Oath among others. Before the launch of the PBoR, existing
regulations under the constitution, Consumer Protection Act, Child Rights Act, Freedom of Information Act,
National Health Act, the Hippocratic Oath, etc., had been present to meet the need of consumer, which are
Nigerians. However, the launch of the PBoR comprised of an amalgamation of patient rights that existed in the
preceding regulations listed. The CPC and other stakeholders developed the PBoRs for the protection of consumers
(Nigerian Health Watch, 2018).
• The development of the PBoR considered 11 key considerations. These considerations are discussed under the
patient rights, the patient responsibility, and the providers responsibilities to eliminate ambiguity with the entities
involved (FCCAC, 2018). Entities in this paper represent the caregiver and the patients. This paper discuss the
patient rights and providers responsibility of which the latter is the focus of this paper. A summary of both
considerations are delineated in Table 1:

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 OVERVIEW OF THE PATIENTS’ BILL OF RIGHTs
Key Consideration Patient Rights Providers responsibilities

Access to Information To make available all relevant information a patients To inform patients about services that are available at
requests in a language the patient understands. This healthcare facilities and eligibility for treatment.To inform
includes diagnosis, treatment, prognosis, and other patients whether proposed treatment is experimental or part
procedures and possible outcomes.Right to participate in of an on-going research.To answer questions and provide
decisions about the scope and intensity of the patient’s information to the treatment/procedure. It is necessary to
treatment plan and make decisions based on their needs. state any potential risks, alternativeTo provide patients
records or patient’s medical records in accordance with the
law.

Patients Related Information Right to access records in order to obtain the details on the Conspicuously display scope of practice and available
scope of services available.Right to obtain details of the services; and customer care phone numbers, email
medical personnel published by the health authorities. addresses and other contact Information.Communicate
clearly with patient , including, providing translation in the
case of language barrier, or adaptation in the case of other
disabilities.Ensure patient demonstrates sufficient
understanding of information provided.Provide sufficient
identification when on duty, including displayed rosters and
apparel with visible identity tags.

Free Related Information Full rights to transparent billing as regards to recommended In the event of an emergency, provide immediate and
treatment plan and items. sufficient intervention and care,prioritizing such
neededattention over other factorsincluding cost and
payment.Care providers have a rightto fees and therefore
shoulduse legal means to recoverfees owed.

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 OVERVIEW OF THE PATIENTS’ BILL OF RIGHTs
Key Consideration Patient Rights Providers responsibilities

Confidentiality Right to privacy and confidentiality of medical records. Respect and maintain patient's personalrecords, except
disclosure byoperation oflaw or in the interest of
publichealth.
Quality of Care Right to clean, safe, and secure healthcare Maintain records of personnel’s current certificates and/or
environments.Access to fair quality of care and medical licenses to practice.Maintain a current Certificate of
personnel, irrespective of disability. Standards as evidence of authorization to operate within its
approved scope of practice.Deliver care that minimizes risk
and harm to patients, including preventable injury and
errors.Adopt clinical governance standards and provide the
best care while protecting patients form harm, or abuse.

Patient’s Dignity Right to be treated with respect, irrespective of allegation of Treat patients, human remainsand tissue samples with
crimes, disability, ethnicity, or socio-economic care,consideration and dignitywithout prejudice to
circumstances.Prior wishes of the patient or in the absence gender,religion, race, ethnicity,allegations of crimes
of same, of the legal next of kin are fully respected. geographical location, physicalability and
socioeconomiccircumstances.Ensure comprehensive
information, guidance andsupport to bereaved
relatives.Prepare remains for viewing atthe mortuary/rest
room byrelatives in compliance withguidelines for last
offices unlessharmful to public health, and tothe extent
consistent with extantlaws, including coroners law.Counsel
and encouragepatients on the disclosure ofdisease of public
healthimportance (deadly, infectiousor non-infectious
disease) tospouse or close relatives inaccordance with
public healthLaws.

Access to emergency care Right to receive urgent and sufficient intervention and care Immediately evaluate patients with medical emergencies,
in the event of an emergency. including prioritization where necessary.Maintain a
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sufficiently responsive and efficient 24-hour uninterrupted
emergency unit in the facility.
 OVERVIEW OF THE PATIENTS’ BILL OF RIGHTs
Key Consideration Patient Rights Providers responsibilities

Visitation Right of a patient to receive visitors. Although, the visitors Inform patients and relatives of visitation rules upon
must adhere to the rules and regulations of the facility. admission and any subsequent modification.Conspicuously
display visitation rules/schedule of the facility.

Patient’s Refusal of Care Patients always retain the control of their person and must Recognize that minors are under the care of parents or
be informed of their power/rights to decline care upon full guardians whose consent must be secured in clinical
disclosure of the consequences of their decisions.Right to management and procedures to the extent permitted by
consent or decline participation in medical procedures. law.All medical research experimental procedures or
clinical trials must comply with approved ethical
procedures.Provider may detain patient in the interest of
public health.

Interruption of Service by Provider Right to be informed about impending interruption or Reschedule patients’ appointments in the event of
disengagement of services of primary/attending inevitable service interruption.Render sufficient
professional.Methodical and practical transition of intervention to in-patients and emergency cases in the event
treatment for patients safety and continuity of care. of inevitable service interruption.

Complaints Right to express discontent regarding services received. Encourage patients to ask questions about the
services.Maintain records of complaints and redress
procedure of the facility and address complaints in
accordance with procedure.Inform patient at onset of the
redress mechanism provided by the facility and regulatory
bodies, with timelines for action on complaints.

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 Nurse Professional Code and Patients’ Bill of
Rights
• The professional code of caregivers and the patients Bill of Rights are crucial
to the harmony of the healthcare infrastructure. It is relevant that nurse
leaders are equipped with the knowledge of the both, as this influences the
services provided to patients. Nursing is a profession that is centered on doing
what is right for patients that are in poor or struggling health situations. The
introduction of the patient ’s Bill of Rights expands the scope that
nurse/midwife leaders use to develop and execute instructions.
• Table 1 depicts a summary of the patients Bill of Rights. The fundamental flow
of the patients rights is centered around “asking”, while the fundamental flow
concerning the providers, is centered around “fidelity ”. From an
administrative perceptive, it is crucial for health leaders to instill assurance for
the service provided and offered by the healthcare infrastructure.

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 RECOMMENDATIONS
• Although, it would be difficult to account for every scenario that could negatively impact the nurse leaders role. It is
necessary for nurse leaders to develop an environment that is suitable for nursing practice. On this premise, it is necessary
for nurse leaders to take into consideration the legal aspect, which builds part of the foundation for the ethics of nursing
practice. Discussed below are additional recommendations that can be adopted by the nurse leaders.
• i.Protection of Staff Nurse/Midwife: the National Association of Nigeria Nurses and Midwives provide legal protection for
her members. Therefore in order to avoid professional offense, it is expedient for nurse leaders and staff nurses to have an
indepth understanding of these laws. This would guide the actions of the nurse leaders and registered nurse/midwife
when interacting with patients, since the fundamental objective of these laws is to ensure a healthful environment for
practice.
• Trust Model: patients are required to provide their information in order to receive treatment, but in some cases, this
information, which is meant to be private is found in the hands of malicious individuals. This affects the trust of patients. In
order to ensure confidentiality, nurse/midwife leaders could take a cue from the Digital-based Contact Tracing (DCT)
solutions designed to curb the spread of the Coronavirus 2019 disease (also referred to as COVID-19). At the start of the
pandemic, initial roll-outs of these solutions prioritized usage over privacy. This lead to a low adoption rate of the solution
among the masses. To address the ethical concerns around this, subsequent designs worked with a trust model, which
utilized both a centralized and decentralized architecture to increase users trust. Implementing this framework could
further increase synergy in the healthcare workspace and mitigate any ambiguity between patients and caregivers.

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 CONCLUSION
• Creating an environment that is suitable for nursing practice in the
healthcare workspace is the nurse leader’s responsibility. The ability
of a nurse leader to implement a framework that harmonizes staff
nurses between the organizations missions and caring work
environments is assertion to the nurse leader’s effectiveness. And at
its core, this creates an environment where the ethical code of the
profession is upheld in consideration of the patients rights and the
success of the healthcare infrastructure.

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 References
• Adelowo, E. O. (1985). The registered Nigerian Nurse in the arms to the law. The Nigerian Nurse, 17(1) , 3.

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