By now you probably have heard about and seen the video of the Utah nurse who was arrested for protecting a patient's rights. I am sensitive to issues on both sides.
My sister is a police chief and she does a wonderful job connecting and building trust in her community. But incidents like this can shake our trust. Our country has seen plenty of incidents involving the abuse of power and authority. These incidents can lead to animosity and divisiveness between different groups.
"Our country has seen plenty of incidents involving the abuse of power and authority. These incidents can lead to animosity and divisiveness between different groups."
If you haven't heard about what happened, here's a quick play by play: A Salt Lake City police detective requested that a University of Utah Health nurse draw labs on a patient. According to news reports, the patient was involved in a vehicular accident but was not the cause of the accident. The person who supposedly caused the accident died at the scene. The patient was not able to give consent for the labs, was not under arrest and there was no warrant. If this detective or officer came to you with this request, what would you do?
Know your hospital policy
There is a reason hospitals have policies, and this is a great example. While you may not be able to remember every policy off the top of your head, you can always pull up a policy and review it if you need clarity on the details and protocol. If you follow hospital policy and something happens, you will be protected by the hospital in case of a lawsuit -- "protected" in terms that the hospital will defend your actions. If you choose not to follow hospital policy -- say, for instance, you drew the labs on the request of the detective, without a court order or patient consent, and on a patient that wasn't under arrest -- you open yourself up to many potential legal ramifications. These can include a civil lawsuit (battery-no consent), practicing outside of your scope of practice and HIPAA violations. The issue in this case is whether to draw the labs requested from the detective to "save for later" versus drawing labs requested by a provider per an order before the draw. Of course, labs were drawn for other reasons with this patient, although he could not consent. The justification here is the assumption that the reasonable person would not want to be denied necessary medical care because they are too incapacitated to consent. However, there are rules for ordering labs that are in place to protect an individual's rights when he or she cannot consent, and if the labs go beyond the emergency and acute care treatment that person needs.
"If you choose not to follow hospital policy -- say, for instance, you drew the labs on the request of the detective, without a court order or patient consent, and on a patient that wasn't under arrest -- you open yourself up to many potential legal ramifications."
Code of ethics
The American Nurses Association Code of Ethics provides the ethical guide for nurses in these types of situations. Provision 1.4, The Right to Self-Determination, speaks to the respect for autonomy. In this case, the respect for autonomy was at risk. This provision states that patient decisions are to be autonomous, which requires the patient to have adequate and accurate information, and their decision needs to be voluntary. In clinical practice, this is gained through the informed consent process. The emphasis for respect of autonomy, voluntariness and informed consent was in large part a response to the Nazi medical atrocities of World War II (ANA, 2015). During this time, nurses were complicit in these atrocities. If voluntariness cannot be obtained, then a surrogate can be the decision maker. The role of the surrogate is to make decisions that are in the best interests of the patient. The second provision that applies is Provision 2.1, Primacy of the Patient's Interests. Here, the Code of Ethics notes that since the nurse's primary commitment is to the patient, it carries the greatest weight and can lead to conflict (ANA, 2015). The nurse stood up valiantly for her patient when the patient could not speak for himself. Standing up in any situation can be a very uncomfortable, if not scary feeling. Based on the video, I am not sure who was around that could have helped de-escalate the situation and if anyone could have effectively helped. In addition to nurses knowing policy, scope of practice and the Code of Ethics, programs such as TeamSTEPPS can be effective in providing a higher quality safer patient care environment. Having a team of individuals stand with you to support you should be a goal in any organization.
"The nurse stood up valiantly for her patient when the patient could not speak for himself."
TeamSTEPPS
Unfortunately, there are many situations that can occur in our healthcare organizations daily that compromise ethical and legal boundaries. The TeamSTEPPS program is a teamwork system designed for healthcare professionals to improve patient safety and produce highly effective teams. It was developed with more than 20 years of research by the Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality. The training and materials for this program are located on the AHRQ website. At this point unless other details surface, the detective was in the wrong, the nurse was in the right. Hospital policies and protocols exist for a reason, which are always aligned and updated with current laws and regulations. I am thankful the nurse stood up for her unconscious patient's rights. Her actions demonstrate why nurses remain the most trusted profession.
"I am thankful the nurse stood up for her unconscious patient's rights. Her actions demonstrate why nurses remain the most trusted profession."
Courses Related to 'Ethics'
60097: Everyday Ethics for Nurses ( 7.3 contact hrs) This course provides an overview of bioethics as it applies to healthcare and nursing in the U.S. It begins by describing the historical events and forces that brought the bioethics movement into being and explains the concepts, theories and principles that are its underpinnings. It shows how ethics functions within nursing, as well as on a hospitalwide, interdisciplinary ethics committee. The course also explains the elements of ethical decision making as they apply to the care of patients and on ethics committees. The course concludes with a look at the ethical challenges involved in physician-assisted suicide, organ transplantation and genetic testing. CE548: Protect Yourself (1 contact hr) Nurses have an obligation to keep abreast of current issues surrounding the regulation of the practice of nursing, not only in their respective states, but also across the nation, especially when their nursing practice crosses state borders. Because the practice of nursing is a right granted by a state to protect those who need nursing care, nurses have a duty to patients to practice in a safe, competent and responsible manner. This requires a nurse licensee to practice in conformity with their states statute and regulations. This course outlines information about nurse practice acts and how they affect nursing practice.
