Four mental health nurses have been deregistered after an indigenous patient with a history of self-harm killed himself on their night shift at a large Sydney hospital.
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Staff were required to take observations every 30 minutes, but a coroner found the patient could have been dead from between two and eight hours before he was found at 7.30 am on May 27, 2017.
Days earlier the patient told a psychiatric registrar he needed to make a will because he would "not be here in a week" and he "had nothing left".
The Health Care Complaints Commission took disciplinary action against the five nurses on duty that night, contending they failed to provide proper observations and make appropriate records for the patient in the acute mental health unit.
The NSW Civil and Administrative Tribunal on Tuesday found four guilty of professional misconduct but dismissed the case against the fifth nurse, Phoebe Chikuku.
Emma Kate Brown was deregistered for two years, Mehul Mukundray Dudhela and Jill Louise Watkins for 18 months, and Florence Egbufor for 12 months.
The 49-year-old involuntary patient, who had a recent history of suicide attempts and depression, was admitted to the hospital on May 22.
A psychiatric registrar noted the patient's worsening depression with suicidality in the past few weeks, precipitated by separation from his partner and inability to contact his children.
"Reference was also made to his living conditions, being homeless and living in his car, lack of social support and upcoming court case," the tribunal said.
The registrar directed level 3 observations, which required nursing staff to take observations every 20 minutes during the day shift and every 30 minutes during the night shift.
The tribunal found the nurses made records indicating that observations had taken place when they knew they had not.
Some made entries on the observation sheet without personally assessing whether the patient was alive.
One nurse made a progress note suggesting that the patient was asleep during all rounds in circumstances where the nurse had last sighted the patient almost seven hours previously.
One failed to record significant information about the patient's behaviour relevant to his mental state.
They involved the patient allegedly coming out of his room to abuse another patient and later allegedly being agitated and verbally aggressive.
"This conduct posed a direct risk to the safety of a vulnerable involuntary mental health patient.
"It was ultimately realised."
The tribunal deemed their conduct to be serious.
They all "demonstrated an absence of care, propriety, honesty and integrity relating to the practice of nursing".
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Australian Associated Press
