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.
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.
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.