You are the nurse manager on a surgical unit, which has suffered the loss of five seasoned nurses in the past year. Hospital leadership has been slow to replace these nurses and only one new graduate has been added to your team. Morale is at an all time low. Sue Bartlett, one of your more experienced nurses brings you an article she read in JAMA Surgery online. She tells you that the conclusion of this study (Silber et al, 2016) is that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value. Hospitals with better nursing environments and above average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing especially for higher-risk patients. You are not surprised by these findings but are not sure senior leadership will be responsive to your requests for better staffing.
Provision 6.3 of the ANA Code of Ethics for Nurses (2015) holds nurses responsible for contributing to a moral environment that demands respectful interaction among colleagues, mutual peer support, and open identification of difficult issues which includes ongoing professional development of staff in ethical problem solving. “Nurse executives have a particular responsibility to ensure that employees are treated fairly and justly, and that nurses are involved in decisions related to their practice and work conditions. Unsafe or inappropriate activities or practices must not be condoned or allowed to persist” (p. 24).
Consider the following scenarios:
You thank Bartlett for the article and tell her sympathetically that you agree with the researchers’ conclusions. Sadly, you also tell her that you’ve worked in this hospital long enough to know that senior leadership is more concerned with a philosophy of profit than a philosophy of care. You thank her for her continued excellent care and ask if she can pay special attention to the new graduate, who seems to be struggling with her caseload. You also promise her that you will monitor her assignments and nurse-patient ratios. You are surprised when she gives notice the following month that she is transferring to a different hospital. You thought you had affirmed her.
Bartlett’s concerns affirm your sense that the status quo cannot continue. This is probably the biggest leadership challenge you’ve encountered since becoming the surgical charge nurse. You ask Bartlett to share this article at the next nursing meeting and plan to ask for suggestions about how best to respond. The CNO is relatively new to the hospital and you schedule a meeting with her to explore her receptivity to nursing issues and willingness to advocate for your staff. Rereading the Code of Ethics for Nurses, you learn that nurses are expected to address concerns about the healthcare environment through appropriate channels and/or regulatory or accrediting bodies. Moreover, “After repeated efforts to bring about change, nurses have a duty to resign from healthcare facilities, agencies or institutions where there are sustained patterns of violation of patient rights, where nurses are required to compromise standards of practice or personal integrity, or where the administration is unresponsive to nurses’ expression of concern” (American Nurses Association, 2015, p. 24). While you hadn’t planned on leaving this hospital, you believe that it may be an important bargaining chip with senior leadership.
A colleague directs you to the nursing ethics summit website: A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit. There you learn about a group of nurse leaders who met in August 2014 for a summit meeting. The goals of the summit were to “identify the strategic nursing ethics priorities for the profession and create a blueprint for the future that key individuals and professional organizations will adopt and implement to build capacity within nursing; create and support ethically principled, healthy, sustainable work environments; and contribute to the best possible patient, family and community outcomes.” You happily sign the pledge and invite your staff to do the same. Change will take time but everyone seems pleased with the new energy on the unit.