Advice to Nurses on Reporting Ethical Dilemmas
Learning how to deal with ethical problems nurses have to confront today is difficult enough on a personal level; the matter becomes even more complicated and painful when it comes to handling and possibly having to report problems on a professional level.
Telling nurses that they need to comply with ethical breach laws and regulations sounds easy enough, but in the real world, ethical dilemmas nursing compliance is fill with complications and personal risks.
Nurses who report on ethical dilemmas nursing problems, especially those having to do with fellow healthcare professional’s negligence, incompetence, or malfeasance can easily lead to being ostracized, labeled as a “rat” by peers, and even retribution by administrators and supervisors.
One of the problems with ethical dilemmas nursing is that not everyone agrees as to what is “unethical.” Some healthcare providers, for example, don’t see a problem with giving lethal doses of pain killers or 100% oxygen (which is also lethal) to patients not expected to recover. They may not openly call it “euthanasia,” but that is what it is.
Can a nurse realistically confront a doctor who gives instructions to that effect?
The preceding example, as common as it probably still is, is only the tip of the iceberg. Most nurses burn out due to many ethical burdens that are, for the most part, unfairly placed on them. Some of the other areas fraught with ethical complexities include:
•Treatment of HIV patients, especially in advanced stages.
•Culturally different individuals with belief systems that either does not recognize western medicine or who greatly mistrust healthcare provider.
•Parents with religious views that greatly limit treatment options (i.e., no blood transfusions, even if that is the only way to save a life).
•Fellow nurses stealing supplies, though only sporadically or in “small supplies.”
Although there is great risk in bravely and aggressively dealing with ethical dilemmas, experts agreed that the best defense is a well-orchestrated, cautious, but proactive offense.
Simply not doing anything, contrary to popular opinion, can also be risky; especially in a state that now hold nurses legally responsible for not reporting mishaps and deficiencies.
Some reminders, guidelines and caveats to keep in mind include:
•Follow the chain of command whenever possible. Most complaints go unresolved or poorly resolved because supervisors are left with hurt feelings that nurses did not first come to them. By doing this, though, keep careful records of all you say and do.
•Make sure that you make a distinction between policies and actions that you personally disagree with and clear violations of protocol, standards, policies and laws. If a procedure that you consider to be unsafe was used, for example, you may be out of your jurisdiction unless you are an expert in the usage thereof; in most cases, doctor’s opinions outweigh nurses. While this may be unfair, it is not something that can successfully challenge unless, again, there was a clear breach of policy, law or protocol.
•Never be afraid to stand up for the rights of patients — in fact, you are expected to do just that. You also have an obligation, however, to be professional about everything you do.
•Follow the protocol set up by your healthcare facility, board of nursing and state guidelines whenever you confront an ethical problem or dilemma.
•Abide the “ethic of care” principles — i.e., attentiveness, responsibility, competence, and responsiveness. If necessary, look this principle up and familiarize yourself with it.
•When possible, seek a work environment (even if you have to make a job change) that provides the “structural empowerment” Kanter outlines: a). access to information; b). support from peers, subordinates and the administration; c). adequate work resources; and d). being given adequate professional development resources. Some nurses keep running into ethical dilemmas because, quite frankly, they are in the wrong work environment.
•Abide by the “first do no harm” principle. Whatever you and your colleagues do cannot violate that principle.
•Ask for advice from seniors, supervisors, fellow nurses, and, if necessary, from lawyers. Get the best advice possible before you take any action.
•Understand that you will just have to let go of some things; you cannot hold yourself responsible for all problems within your facility.
•Strive to do the best possible job you can do. That is your main responsibility.
