Call out unsafe practices
editors-note
EDITOR'S NOTE: Nancy J. Brent, MS, JD, RN, Nurse.com's legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist.
A reader asked about an ethical dilemma in nursing that may be an all-too-familiar experience in your everyday practice. A new nurse who is the only RN in a small community ED (two other inpatient RNs are available for assistance) has observed troubling conduct on the part of an ED physician.
The physician orders inappropriate dosages of medications, contradicts himself in his documentation of patient care and gives narcotic pain medications to almost every patient for any complaint.
The new RN has voiced her concerns with management but there has been no change in the physician’s conduct. The RN is concerned about her patients, especially since she is new in this area of practice and is not seasoned enough to know what might be acceptable practices and what are not. She also is concerned about her own potential liability if she makes a mistake because she is unfamiliar with ED nursing.
There is no question the ED nurse needs to be concerned about her practice setting as it now exists. First and foremost, her duty is to protect patients’ safety and well-being. Several aspects of her practice setting are not conducive to fulfilling that legal and ethical duty.
Being the only RN in an ED — however small — is not acceptable staffing. The two RNs who assist in the ED may not be able to leave their inpatient positions because of the critical nature of the patients they are caring for. As a result, any injury to or death of a patient will most certainly result in the ED nurse being named in a suit alleging professional negligence for care not provided, or if provided, in a negligent manner.
The RN’s obligations under the state nurse practice act and rules also must be considered. With the RN’s factual knowledge of the physician’s conduct and the staffing issue, the state nurse practice act may require additional action on her part to protect both the patients’ safety and her own license, even though she has voiced her concerns to management. It appears administration is not interested in these occurrences nor has it initiated an investigation into them.
Despite being a new nurse in ED practice, the RN has fittingly experienced internal moral distress with her work circumstances. And internal moral distress occurs when a nurse feels faced with interpersonal value conflicts. It is manifested as feelings of frustration, anxiety, anger and an inability to act as one sees fit because of many factors, one being the constraints of the organization.
Find more stories and tips
Read More
GettyImages-487312820quote-mark
Despite being a new nurse in ED practice, the RN has fittingly experienced internal moral distress with her work circumstances.”
— Nancy Brent, RN
The nurse seems to be the only one observing this behavior and administrators are seemingly ignoring her worries, which raises an affirmation problem. With whom can she share her concerns and gain feedback? Who can help her decide what she can do about the physician’s conduct? Her isolation results in self-doubt about her observations and feelings.
Although this nurse decided to demonstrate moral courage and speak up about the physician and his consistent practices in the ED, a resolution seems far from being established. If not resolved, further internal conflict for this RN may grow, resulting in frustration with her work, anger, missing critical patient signs and symptoms that need intervention, or simply leaving the job.
Although not easy, it is a nurse’s obligation to advocate for patients when unethical, illegal or unsafe practices occur.
Advertise with Nurse.com
desktop-teachers-college-2
The Executive Program for Nurses at Teachers College, Columbia University is now accepting full-time and part-time Masters Students for Autumn 2017. Learn more about our programs by joining us at our Open House on February 17th, March 24th or April 14th. To RSVP, please call (212) 678-3812.
teachers_college_logo
Join a Legacy of Nurse Leaders
Earn a Masters Degree in Nursing Administration Studies or Nursing Professional Studies in four full-time semesters with no summer classes. Full-time and part-time students are encouraged to apply now for admission for Autumn 2017. Learn more about our programs by joining us at our Open House on one of the following dates: February 17th, March 24th, or April 14th. For more information and to RSVP, please call 212-678-3812.
Ranking-Award
For more information
How to address the unethical conduct of healthcare colleagues
article-down-arrow
© 2017 OnCourse Learning Corp. All rights reserved
facebooktwitterLinkedinyoutube
Contact Nurse.com
20225 Water Tower Blvd. Brookfield, WI 53045
Advertise with Nurse.com
google-pluspinterest
BACK TO TOP
TOP-ARROW
More inside this guide
bottom-arro
By Nancy J. Brent, MS, JD, RN
share-dots-shadowleft-arrowright-arrowright-arrow-3
hamburguer-icon-shadow
MENU
toc-image-nurse-1X
Contents
HOME
arrow-TOC
arrow-TOC
Helm an ethics team
ThinkstockPhotos-200253002-001
RNs can successfully lead interprofessional ethics committees with the right tools.
ThinkstockPhotos-73772520
Address your moral distress
Liaisons help nurses feel supported in voicing and discussing ethical concerns.
arrow-TOC
ThinkstockPhotos-514630172
When the end of life is near
Nurses must see to patients’ both physical and psychological needs during this difficult time.
arrow-TOC
GettyImages-476613252
Call out unsafe practices
Speaking out if a colleague is not operating by ethical standards can be intimidating, but is necessary.
arrow-TOC
ThinkstockPhotos-638754448
8 key assumptions
Nurse leaders draft a blueprint for a healthcare culture that is more supportive of nursing ethics.
arrow-TOC
ThinkstockPhotos-504457820
Who's your go-to person?
RNs share whom they turn to for support when faced with an ethical dilemma at work.
arrow-TOC
ThinkstockPhotos-529580279
How to make ethical decisions
What a patient wants should be of paramount importance when a decision needs to be made.
arrow-TOC
GettyImages-519860340
Make every day count
A nurse helps a dying patient spend as much time as possible with his young daughter.
arrow-TOC
ThinkstockPhotos-517989376
Know the code
Being familiar with the Code of Ethics can help nurses prepare for tough ethical dilemmas that are bound to happen.
arrow-TOC
ThinkstockPhotos-509476848
Choose your words wisely
A patient tapes his medical employees making inappropriate comments about him while he is sedated.
arrow-TOC
GettyImages-598948640
Live by the code
Base your practice on strong moral principles.
arrow-TOC
ThinkstockPhotos-498189922
LGBTQ CE series debuts
Learn about the health needs of the LGBTQ community with a new series of courses.
arrow-TOC
ThinkstockPhotos-525970104
6 key ethical principles
Discover how fidelity, beneficence, autonomy and other principles come into play in ethics.
arrow-TOC
ThinkstockPhotos-495774324
Are you an ethics champion?
Operate within three core responsibilities to make a critical difference in patients’ lives.
arrow-TOC
image7
CE catalog
From bioethics to palliative care, several education modules provide important ethics lessons for nurses.
arrow-TOC
COVER_ThinkstockPhotos-534028837
Detect human trafficking
The first steps in patient care for potential victims is identification and assessment.
arrow-TOC
legal-small
Keep it confidential
Nurses who work in the community are obligated to follow confidentiality and privacy policies.
arrow-TOC
ThinkstockPhotos-170083531
Protect whistleblowers
The ANA Code of Ethics says nurses have a responsibility to assist whistleblowers.
arrow-TOC
GettyImages-531055006
A beautiful death
Nurse learns valuable lessons about end-of-life care and experiencing a beautiful death.
arrow-TOC
Nurse-logo
You're subscribed!
To join Unlimited CE, enter your email address
Enjoy
x