The photograph and the infusion pump

This is a privacy breach, not a communication shortcut. A photograph of a wound on a personal device is personal health information. The Health Information Privacy Code requires the information to be collected lawfully and with the person's knowledge where practicable, held securely, and disclosed only for the purpose it was collected. Sending it to fifteen people via a consumer messaging app fails all three.

Immediate actions:

1. Raise it with Sue at the time, privately and directly: 'Did that patient agree to their wound being photographed and sent to that group? I don't think we can do that.' Being new does not remove the obligation to speak - but the reply should be a question about the standard, not an accusation of the person.
2. Tell the patient that a photograph was taken and shared on a personal device, and that it will be deleted. Patients have a right to know what happened to their information and a right to complain.
3. Ask for the image and the message to be deleted: from Sue's phone, and from the group by requesting the group members delete it. Deletion is not certain and must not be assumed - record what was requested and what was confirmed.
4. Escalate to the charge nurse manager or privacy officer so the organisation can assess whether it is a notifiable privacy breach. Notification to the Privacy Commissioner is the agency's decision, not Hemi's - but the agency can only make it if it is told.
5. Document factually: what was seen, when, what was said, who was informed. Keep the record about the event.

Do not photograph the record of the photograph, forward it, or handle it further. Hemi's concern is protecting the patient's information, not building a case.

The line is scope and competence, and it is not negotiable because someone is busy. An HCA is not a regulated health practitioner and does not hold a scope of practice permitting medication administration. Adjusting a rate on an infusion pump is administering a prescribed medicine. The HCA has no competency for it, so the task cannot be delegated to them, whatever the workload.

Immediate clinical action:

• Check the pump - what rate is set, what rate is prescribed, and has any dose been delivered at the wrong rate? If yes, this is a medication error requiring clinical review of the patient, observation, and reporting through the incident system.
• Restore the prescribed rate if it is wrong, or complete the adjustment himself if he is competent and it is within his own scope.

Professional action:

• Speak to Sue directly and concretely: 'The HCA isn't competent to change a pump. I'll do it, or we need to find an RN who can.' Frame it around the risk to the patient and to the HCA, who is exposed too.
• Remember that the delegating RN retains accountability for the delegation. The Code requires a nurse to be accountable for decisions about what is delegated and to whom - and to make sure the person is competent and supervised.
• If Sue repeats it, or if the HCA is placed in that position again, escalate to the charge nurse manager. This is a patient safety issue and also a conduct issue.
• Raise the underlying system problem: if a busy RN feels an HCA is the only available option at that moment, the roster and skill mix need examining, and the answer is not to loosen scope.

Name the conflict honestly, then act anyway. The risk of a poor assessment is real, but the greater risk to Hemi's registration is being a witness who says nothing. Silence here is not neutral: it looks like agreement, and it is the kind of thing that surfaces later, when the wound photo has reached a wider audience and the question becomes 'who knew?'

Practical approach:

• Use the least escalated route that will work, first: direct, private, specific, standard-focused conversations with Sue as above. Most experienced nurses will adjust when the standard is stated plainly; very few are deliberately unsafe.
• If it does not change, use the reporting structures rather than informal circuits: charge nurse manager, and the clinical or professional leader, with facts and dates. A written record created contemporaneously is far stronger than recollection weeks later.
• Tell someone independent in the organisation about the assessor relationship - the new graduate programme coordinator or the nurse educator - so his final assessment can be handled fairly and by someone not implicated in the concerns. This is a legitimate request, not disloyalty.
• Use the supports available: new graduate programme support person, professional indemnity insurer's advisory service, and the Nursing Council's guidance on raising concerns about a colleague's practice.

The professional framing to hold onto: accountability for patient safety does not have a probation period attached to it. A newly registered nurse is a registered nurse, and the Code applies from the first shift, regardless of contract length or assessment status.