Mrs. Barnum has adult onset diabetes with numerous related complications, which necessitate frequent hospitalizations to the medical floor of the community hospital. Mrs. Barnum weighs 420 pounds. Last year she was hospitalized three times, and her average length of stay was 25 days. When the nurses on the unit learn that she is again in the ED and slotted to be admitted to their unit, a number of them approach the charge nurse and refuse to care for her. Fresh in their memories is a colleague who experienced a work-related back injury while assisting the patient with morning hygiene. “She isn’t helping herself and trying to lose weight — why should we risk our health to help her?” “Besides, she just doesn’t cooperate when we try to help her. Why can’t another unit take her this time around?” Jodi Green, the charge nurse, is wondering how to respond to their refusal to care.
Guidance from the ANA Code of Ethics
Provision 1 of the ANA Code of Ethics for Nurses (2015) obligates every nurse to practice “with compassion and respect for the inherent dignity, worth and unique attributes of every person” (p. 1). Provision 3 obligates nurses to promote, advocate for, and protect “the rights, health and safety of the patient” (p. 9). Complicating matters is Provision 5, which states “the nurse owes the same duties to self as to others, including the responsibility to promote health and safety” (p. 19). Is it reasonable to demand that each nurse on this unit care for Mrs. Barnum? Would asking for volunteers work?
Jodi Green is sympathetic to the nurses who feel they can no longer safely care for Mrs. Barnum. She has several new grads on the unit and believes she can convince them that caring for Mrs. Barnum is an essential part of their orientation. No general care plan is adopted, and each nurse on every time shift is allowed to do as she pleases. Some nurses believe they should make up for the deficiencies of their colleagues and are willing to accept whatever assignments facilitate optimal care of Mrs. Barnum. They express concern to Jodi about the derogatory comments nurses are making about Mrs. Barnum, too often within her hearing range. Others who are willing to take a turn believe allowing some to refuse to care is unfair and want everyone to take a turn.
Jodi Green quickly brings this concern to the hospital practice council and invites the ethics consultant to attend the meeting. The ethics consultant is adamant about Mrs. Barnum receiving respectful, safe, quality care but is equally adamant about not putting staff at risk while providing this care. Jodi realizes her laissez-faire leadership style is endangering both patients and staff. The practice council admits having neglected to research how best to care for patients who are obese and having offered staff few guidelines. The hospital has purchased special beds and lifts but there has been little education about how best to use these devices. Another nurse manager who attended a recent conference where she learned about caring for obese patients offers to accept Mrs. Barnum this admission and to work with her staff to develop a comprehensive plan of care. Everyone agrees the hospital needs a zero tolerance policy for disrespect. The pysch/mental health nurse practitioner will be invited to work with both the staff and Mrs. Barnum to see whether she is open to contracting for some lifestyle changes. Everyone agrees that shaming the patient is counterproductive.