Choose your words wisely
editors-noteEDITOR'S NOTE: Carol Taylor, PhD, RN, is a senior clinical scholar in the Kennedy Institute of Ethics at Georgetown University in Washington, D.C., 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 lectures internationally and writes on various issues in healthcare ethics and serves as an ethics consultant to systems and professional organizations.
“Nurse Green” wasn’t surprised when a June 2015 Washington Post article featured a story about a patient undergoing a colonoscopy who inadvertently taped inappropriate comments made about him by his anesthesiologist and physician.
ThinkstockPhotos-538010795
The patient, who knew he would be sedated for the procedure, had hit record so he would remember his post-procedure instructions. He did not realize it would tape all the comments during his procedure. When he played the tape on the way home, he learned the surgical team had mocked and insulted him as soon as he fell asleep. Jurors awarded the man $500,000 and the anesthesiologist was quickly fired.

Green knew one of the surgical teams she routinely worked with made jokes about patients once they were asleep and she was becoming increasingly uncomfortable during their procedures. While the surgeon set the tone, residents and her nurse colleagues were quick to participate. Provision 1 of the ANA Code of Ethics for Nurses (2015) clearly holds nurses responsible for practicing “with compassion and respect for the inherent dignity, worth and unique attributes of every person.” Provision 3 states nurses are to promote, advocate for and protect the rights, health, and safety of the patient.

And finally Provision 6.3 holds nurses responsible for contributing to a moral environment that demands respectful interaction among colleagues, mutual peer support and open identification of difficult issues. This includes ongoing professional development of staff in ethical problem solving. It would seem our Code of Ethics not only forbids nurses from taking part in inappropriate conversations about sedated patients but also obligates nurses to change a culture that allows these conversations. It should not take the fear of being recorded to make professional caregivers do the right thing. Consider the following scenarios:
With some trepidation Green makes an appointment to talk with the OR charge nurse, Nurse Waczinski, who has worked in this OR for 20 years. A no-nonsense leader, she runs a tight ship and is a fierce advocate for nurses. She also commands the respect of the surgeons.

Green isn’t sure her charge nurse will be willing to take her concerns seriously and is surprised when Waczinski asks her how willing she is to work on needed culture change. As it turns out there are more nurses feeling uncomfortable about the culture but no one is ready to take leadership to address concerns. Green thinks the Post’s story about the anesthesiologist might provide the perfect opportunity for everyone to reflect on what is becoming a toxic environment.

Waczinski recommends a meeting with the new COO for nursing hired by the CNO. Allegedly he has solid experience in mediation and might be helpful in strategizing how best to build support for a culture change. Assured that her instincts are correct, Green allows herself to start feeling hopeful. She meets with the other nurses who share her concerns and they decide to start small until they meet with the COO.

Remembering Gandhi’s wise adage, “You must be the change you want to see in the world,” they decide at the very least not to participate in insulting language and to try to redirect the comments. One of the nurses suggests contacting the hospital’s clinical ethics consultant. He is delighted to receive the call and affirms Green for recognizing disrespect as an ethical issue.
Scenario 1
Green mentions her discomfort to several colleagues she trusts. Each of them counsels her to not “rock the boat.” The surgeons most responsible for humor at the expense of patients tend to be several of the best revenue generators at the hospital and seem to have the respect of senior leadership. “If you want to be part of the ‘in crowd,’ you’ll learn to make your peace with this behavior,” she is told. “You don’t have to join in.”

One of the reasons Green chose perioperative nursing is because of the close-knit relationships in the operative team. In the past, she felt a sense of family among them, but now finds she feels uncomfortable. She wants to challenge the culture but is afraid of moving outside of her comfort zone. As her dissatisfaction grows she starts looking for openings in other units at the hospital.
Scenario 2
Study patient privacy rules related to social media
Learn Now
quote-mark
It should not take the fear of being recorded to make professional caregivers do the right thing.”
— Carol Taylor, RN
job-board-standard-ad
Advertise with Nurse.com
There's no better time to find the right job, than now.
Nurse-logo
Start searching
With thousands of nursing positions across the country, you'll be sure to find the perfect job.
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
By Carol Taylor, PhD, RN
BACK TO TOP
TOP-ARROW
More inside this guide
bottom-arro
share-dots-shadowleft-arrowright-arrowright-arrow-3
What nurses say about sedated patients does matter
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