College of Licensed Practical Nurses of Alberta v Lai (LPN#44820) (June 9, 2021) is a new case in which a Licensed Practical Nurse (“LPN”) was found guilty of unprofessional conduct when she used inappropriate physical force and communicated in an inappropriate manner with a dementia patient.
This case is unique, and there are very few like it. The cases serves to reaffirm that there are important professional standards which LPN’s and other nurses must follow at all times, despite that dealing with dementia patients is extremely difficult.
Facts
The relevant conduct in this case was summarized at paragraph 8:
Ms. Lal admitted that on or about September 9, 2020, she did one or more of the following when providing care to client MET:
a) Used inappropriate and excessive physical force, particulars of which include one or more of the following:
a. Forcibly grabbing MET’s wrists;
b. Leaning her body weight onto MET; and
c. Shoving MET’s arms into MET’s chest and face.
b) Communicated in an inappropriate manner, particulars of which include one or more of the following:
a. Saying “Shut up” or “Be quiet” or words to that effect in an aggressive manner;
b. Saying “Oh yah, I’m the one with a few screws loose” or words to that effect in a sarcastic manner;
c. Instructing MET to “Stop screaming” or words to that effect; and
d. Advising, in MET’s presence, that MET was the most difficult patient to work with due to her dementia.
[…]
Ms. Lal admitted that on or about September 9, 2020, she struck the arm of a female patient residing in Room 9 with her hand in retaliation to the patient hitting her.
The context of these incidents was an elderly patient with dementia who was making things very difficult for the LPN and kept trying to resist the care the LPN was trying to provide and who was screaming at the LPN through the interaction. The patient was known to be very difficult. The LPN was using force to restrain the patient, but had not first actually explained to the patient what she was trying to do and why, which is the proper procedure, and had not stopped using force despite the patient saying she was hurt.
The College of Licensed Practical Nurses of Alberta (“CLPNA”) Tribunal found that the LPN had been hostile to the patient during this interaction.
Analysis
The LPN admitted to all of the allegations against her, and the CLPNA Tribunal found that it was unprofessional conduct.
The CLPNA Tribunal noted that there were no similar cases to this one by which they could judge the appropriate penalty. The penalty against the LPN was as follows:
- The LPN to pay 25% of the cost of investigation and hearing;
- The LPN to have 200 hours of supervised practice by someone who has been provided a copy of the discipline decision;
- The LPN to review a series of CLPNA practice documents on nursing, client abuse, professional responsibility, judgment, ethics, cognitive care and dementia care;
- The LPN to take several different training courses regarding ethics, elder abuse, and anger and conflict.
My Take
This case is genuinely interesting, but also sad. I cannot imagine how difficult and stressful it is to work with dementia patients, and reading between the lines I suspect this LPN had a seriously rough day and went way over the line. This behavior by the LPN clearly needed to be disciplined, and I think the penalty would have been more severe had the LPN not taken responsibility for her actions in this particular case.
A link to CLPNA v Lai (June 9, 2021) can be found here: https://www.clpna.com/wp-content/uploads/2021/06/doc_CLPNA_HT_Decision_Angelika_Lal_44820_2021_06.pdf
