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Ethically speaking: Does management get it?

Hypothetical Case

The nurse manager on the cardiology ICU unit and the staff are angry when they learn that one of intensivists complained to the chief nursing officer about two of the night nurses. Both were recently hired new grads. The one senior nurse working with them that evening was on break when a patient went into crisis. The nurses called a code but the patient died. The physician claimed she should have been alerted earlier and the nurses were slow with meds during the code.

The nurse manager is upset because she said the managers have been complaining for months about leadership’s decision to hire new grads because they can hire three new nurses for the price of two experienced nurses. Ever since a national chain bought the hospital, retention has been a problem. On this particular unit there is only one senior nurse who remains on the night shift and she is responsible for working charge, taking care of her patients and orienting the new staff. Many nurses are disgruntled by leadership’s priority of achieving safe, quality care with less. They are also sad that the physician with the complaint went to the CNO before talking with them as they might have enlisted her as an ally if she heard them out first.

The ANA Code of Ethics

The Code of Ethics for Nurses offers detailed guidance to address these challenges. Provision 5 states that the nurse “owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.” The Code is clear that if nurses are to preserve their integrity when placed in circumstances that exceed moral standards, “they must express to the appropriate authority their conscientious objection to participating in these situations.” Provision 2.3 specifically addresses collaboration. “The complexity of healthcare requires collaborative effort that has the strong support and active participation of all health professions. Nurses should foster collaborative planning to provide safe, high quality, patient-centered care.” And finally, Provision 6: “The nurse, through individual and collective effort, establishes, maintains and improves the ethical environment of the work setting and conditions of employments that are conducive to safe, quality healthcare.” While the guidance our Code offers about nursing responsibilities is clear, strategic thinking about how best to address these challenges is needed.

Scenario 1:

Fed up with leadership’s failure to listen to the voice of nursing and to rethink staffing decisions, the nurse manager decides to join her colleagues who are leaving. She knows that with her experience it won’t be difficult to get another position. While she loved her 20 years at this hospital until recently, she feels sad but she doubts leadership truly values safe and high quality care. She writes an angry and detailed email to the CNO and the physician who reported her nurses. She knows it will be read as reactive and defensive but she honestly doesn’t care. It’s time to move on. While she may preserve her integrity with this move, she definitely is abandoning her nurses and patients.

Scenario 2:

The nurse manager takes a deep breath after hearing from the CNO. She schedules a time to meet with the CNO, which will give her time to talk with her nurses and the intensivist who complained. She also talks with a respected colleague, who she knows shares her concerns about recent changes at the hospital. Together they decide to bring this issue to the next nursing leadership/management meeting. Some of the managers believe that the CNO could become a strong ally for nurses and, of course, patients, if she would just be open to hearing the nurses’ experiences. Four of the managers offer to work together to identify the content to be shared with the CNO. Included in the content are the number of experienced nurses who have left that hospital since its sale and the number currently thinking of leaving. When the nurse manager meets with the intensivist, she apologizes for going to the CNO. “I was just frustrated that we lost this patient; it shouldn’t have happened,” she said. “How can I help you make your case for better preparation of nurses?”

Source: American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: Author.

Editor’s note: Carol Taylor, PhD, RN, offers a special thanks to Georgetown University graduate students in nursing for providing the above scenario: Christina Bleakley, Debra Gunning, Kathrine Krupnik and Katie Leone.

By | 2020-04-15T16:20:45-04:00 November 18th, 2015|Categories: Blogs, Nursing careers and jobs, Nursing news|1 Comment

About the Author:

Carol Taylor
Carol Taylor, PhD, RN, is a senior clinical scholar in the Kennedy Institute of Ethics at Georgetown University, a professor of nursing and the former director of the university's Center for Clinical Bioethics. Taylor directs an innovative ethics curriculum grounded in a rich notion of moral agency for advanced practice nurses. She teaches in the undergraduate nursing curriculum, directs a practicum in clinical ethics for graduate students in the philosophy program, conducts ethics rounds and ethics case presentations, and develops professional seminars in clinical ethics for healthcare professionals and the public. Her research interests include clinical and professional ethics, and organizational integrity. She lectures internationally and writes on various issues in healthcare ethics and serves as an ethics consultant to systems and professional organizations. She is the author of "Lippincott, Williams & Wilkins Fundamentals of Nursing: The Art and Science of Nursing Care," which is in its 8th edition, and co-editor of "Health and Human Flourishing: Religion, Medicine and Moral Anthropology" and the 4th edition of "Case Studies in Nursing Ethics."

One Comment

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    Linda Scheetz, BSN, RN, CLNC December 6, 2015 at 9:25 pm - Reply

    When I was a new grad, the hospital I went to work for had a mandatory 6 week in hospital training program and then to work in ICU/CCU, another intensive 6 week training program. After the 6 weeks training, we were given a seasoned, highly skilled preceptor nurse who further followed and teamed with each “new grad”. We were still had our own case load, but also a skilled nurse to guide us into reality from books to bedside.
    Where was the “seasoned nurse” who went on break when the code was called? Where was the “code response team” that most hospitals have now? How many times in the cardiac unit were drills for codes and certification for same? We need to nurture our new grads, not hinder or block their growth Provide the education and training. If they do not measure up then, place them in a less stressful unit until they have more time, grade, and experience. Thank you from a seasoned nurse.

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