As a nurse in the medical field for the past ten years, I have learned the differences in my scope of practice in providing care and facility policies. An experience I encountered, was a patient requiring a procedure that I hadn’t been trained on. This situation left me to figure out what I was legally able to do, questioning if I should speak up, and examining if by doing this if it would directly affect my job or having any lasting repercussions.
In my previous role as a Licensed vocational nurse, I worked in the outpatient setting, Perinatology, where there are high-risk pregnant patients. The patient I helped take care of, was early in her pregnancy, approximately 29 weeks, and was a patient who had been seen in this clinical office
…show more content…
Hood mentions, “determining the presence of more than one ethical concern” (Hood, 2013, p. 70), which I felt was the provider asking me to do something she knew was wrong, knowing there were other available resources, and asking me to do something that I had never assisted with or trained to do. After identifying the problem, I needed to identify the morally relevant facts, which takes a closer look at the context of the dilemma (Hood, 2013, p.70). As mentioned before, the doctor seemed at ease knowing what she was doing, telling me the plan, which is a cause of concern for any future outpatient nurse who may possibly work with her, but doesn’t speak up or isn’t aware of her limitations. In this experience, I needed to stop and think to myself, is the choice that I am making legal within my institution and under my scope and license? From there I evaluated the problem, Hood mentions, “examine the ethical norms by reviewing the literature, code of ethics for nursing” (Hood, 2013, p. 70). After encountering that situation and speaking with my manager, I wanted clarification on my job duties as some nurses say it’s a “gray line”, where it depends on your comfort level or the physician you work with in doing things that the nurse possibly shouldn’t be doing. My manager clarified with me that I legally shouldn’t have even offered to go with her
Nurses are required to protect and support their patients if they are to be an efficient patient advocate. Ethically questionable situations are quite common for nurses that conflict with their professionals and personal morals. At times, the patient necessitates the nurse to speak out for them demonstrating
Deontology is an ethical theory concerned with duties and rights. The founder of deontological ethics was a German philosopher named Immanuel Kant. Kant’s deontological perspective implies people are sensitive to moral duties that require or prohibit certain behaviors, irrespective of the consequences (Tanner, Medin, & Iliev, 2008). The main focus of deontology is duty: deontology is derived from the Greek word deon, meaning duty. A duty is morally mandated action, for instance, the duty never to lie and always to keep your word. Based on Kant, even when individuals do not want to act on duty they are ethically obligated to do so (Rich, 2008).
My initial response to the issues was only based on the hospital policies regarding the care of the patients within the hospital. However, when I was guided down the different paths and made to look through the different ethical lens, I found it tough to do so and seem to resort to my core values of autonomy and rationality. By putting the patients’ first, hospital policies, and then their loved ones in the first scenario, I determined that a compromise was necessary. Whereas in the second scenario, I feel as no agreement was needed just staff education (EthicsGame Simulation, 2016). In this particular case, Carlotta, the RN shift supervisor, needed further training to understand the hospital policy on who is or is not considered to be family (EthicsGame Simulation,
Define a critical thinking task that your staff does frequently (Examples: treat high blood sugar, address low blood pressure, pain management, treating fever etc.). Create a concept map or flow chart of the critical thinking process nurses should take to determining the correct intervention. Include how much autonomy a nurse should have to apply personal wisdom to the process. If the critical thinking process was automated list two instances where a nurse may use “wisdom” to override the automated outcome suggested. Note the risks and benefits of using clinical decision making systems.
When the practices in the healthcare delivery system or organization threaten the welfare of the patient, nurses should express their concern to the responsible manager or administrator, or if indicated, to an appropriate higher authority within the institution or agency or to an appropriate external authority” (3.5 protection of patient health and safety by acting on questionable practice, ANA, 2015). The example of the practice is a patient discharge from the rehab facility to the Personal care unit with pending PT/INR results, which turned out to be critical. The admitting nurse demonstrated moral courage by questioning physician who wrote discharge orders and the nurse who completed discharge. Rehab physician refused to address lab results and referred the patient to the PCP. Admitting nurse raised a concern to administration to review discharge protocol and deviation from safe practice. Nurse acted on behalf of the patient and requested readmission to rehab based on patient’s unstable medical
Planning included reaching out to other health organizations, objectives, and goals of health fair were established. The implementation includes getting volunteers, set up for the health fair. The evaluation of the process occurred throughout the implementation and changes were made as needed. The evaluation will be completed by gathering information from health booth to determine the number of participants. Review vendor and participant evaluations about the health fair including how they heard about the health fair, ratings of booths and suggestions for improvements. Record everything to determine changes. Reflection on past experiences and what worked and did not work.
I chose to go into nursing because I had taken a sports medicine class in high school I enjoyed, and I thought I would be guaranteed a job graduating that had something to do with medicine. I can remember being so excited to learn how about illnesses and medications, and all the difference procedures done in the hospital. At the time I thought a nurse’s job was to do what the physicians said, and I expected set guidelines that would tell me what I was and wasn’t allowed to do. I had no idea that I was entering onto a career path involving so much complexity, and that the skills I had dreamed of learning were such a small part of nursing in comparison to the emotional, decision making, and critical thinking skills that a nursing career requires. Ethics in nursing was not something that had ever crossed my mind when I chose to take this path, however now ethics is something that I think about every day I am practicing, whether in clinical or theory courses. Ethical theories often come from the idea that because we are human we have the obligation to care about other’s best interests (Kozier et al., 2010), however in nursing ethical practice is not just a personal choice but a professional responsibility.
I have come to fully understand that in order to treat my patients in a way that is person centred, I have to treat each person as an individual and realise that every individual has different needs and different rights and preferences to me which may go against my morals and beliefs but I always have to maintain my professional boundaries and treat each individual with respect and dignity. If I was a nurse who witnessed a similar situation to Kat’s, where another healthcare professional was disregarding my patient or any patients views or requests I would go into the patient’s room and find out what the problem was. Then I would politely ask the healthcare professional to step outside of the room and I would gently remind them of the code of ethics ((Kozier, Erb's & Berman, 2010, p.97) and the Registered Nurses standards of practise (2016), and how every individual has the right to make their own independent decisions about their healthcare needs/goals based on their own values, morals and beliefs. I would further explain that the patients are our main priority and it is our responsibility as nurses’ to ensure that the patients are safe and are receiving the proper care. I would then explain to the patient what was happening and apologise to them about the situation, and I would rearrange and try to negotiate with the patient when the procedure could be performed. Then I would notify the Nurse Unit Manager on the ward to ensure that situations like this do not occur
In this essay the author will rationalize the relevance of professional, ethical and legal regulations in the practice of nursing. The author will discuss and analyze the chosen scenario and critically review the action taken in the expense of the patient and the care workers. In addition, the author will also evaluates the strength and limitations of the scenario in a broader issue with reasonable judgement supported by theories and principles of ethical and legal standards.
Section 5.4, which is the preservation of integrity, suggests that nurses will inevitably have to deal with threats to their moral or professional integrity at some point in their careers. Nurses should do their best to maintain professional integrity when met with adversity, weather it be from uncooperative issuance companies, an unsound work environment, or from the patients themselves. When working in an unsound or unsafe work environment that violates law or the ANA code of ethics nurses must go through the proper channels to fix the problem. If a nurse feels that a procedure or treatment their patient is having conflicts with his or her own moral integrity and they cannot participate, the nurse must report they unwilling to tr...
Under the code of ethics for nurses this moral issue is also conflicting because you’re first and foremost obligation is to the patient. Now you also have your institution ethical code conduct that you also has to abide by. Provision 5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth (ANA, 2001, p.18). In this case the nurse owes it to herself in making the right moral decision to preserve integrity and safety of patient and
Nurses as part of regulated health care practitioners are responsible and accountable to abide by the standards, codes and guidelines of nursing practice (NMBA, 2016). The nurse in the case study has breached the standard 1.4 of the Registered nurse standards for practice. According to standard 1.4 the registered nurse should comply with "legislation, regulation, policies, guidelines and other standards or requirements relevant to the context of practice” when making decisions because this will be the foundation of the nurse in delivering high quality services (NMBA, 2016). The nurse in the scenario did not follow the hospital policy concerning “Between the Flags” or “red zone” and a doctor should be notified in this condition. Furthermore, the nurse failed to effectively respond to a deteriorating
In the scenario provided, there were several key factors that could have resulted in a poor quality outcome for the patient. There were a number of tasks assigned to the Licensed Vocational Nurse (LVN), which required special training or competency. It was difficult to validate that the LVN had been deemed competent to perform the more specialized skills with the information available. Clarifying the LVN’s skill set and having full understanding of her training would have been critical for the RN in charge. Further, the LVN was simply not delivering the care that had been assigned. The RN needs to critically evaluate the situation. The LVN may have felt intimidated, lacked the skill, failed to understand the assignment, or any other variety of reasons. The point is the patient was not receiving the care needed and an intervention was required. “Delegation is both an art and a science. It includes cognitive, affective, and intuitive dimensions,” states Marjorie Barter (2002). All RN’s, regardless of assignment, should remember that “leaders do more than delegate, dictate, and direct. Leaders help others achieve their highest potential,” (American Nurses Association). The RN would have been remiss in not pursuing an answer to why the LVN appeared to be avoiding ce...
To complete my labor and delivery rotation for NUR-113, I was assigned to a client in the labor and delivery unit and followed her labor process throughout the duration of my shift, I observed the nurse’s role, doctor’s role, medications given, the patient, the patient’s family and evaluated myself. The client that the RN was assisting was a 21 year old, white unmarried female with O+ blood, at the end of my shift she gave birth to a beautiful baby boy after a few complications during the labor process. Gravida 1, Preterm births 0, Term births 0, Abortions 0, Living Children 1, after the birth ...
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.