Question

Nurses at Meadows Hospital, a 40-bed rural community hospital in northern Ontario, are faced with what seems an impossible dilemma. Their best efforts to advocate for patients are routinely blocked by the hospital’s physicians and senior leadership.

Two recent examples: When Mr. Rodriguez, a seasoned surgical nurse, requested time to administer an analgesic before a patient’s painful wound debridement, he was told by the surgeon that no pain medication was necessary. The patient was clearly in distress while the debridement was performed and was his nurse. When Mr. Rodriguez reported this experience to his manager, he was told that the nurse’s job is to do what the physician orders. On another occasion, a woman presented to the emergency room with a fractured distal radius. Because a family member with a similar injury had unsatisfactory results (deformity and pain with movement) when treated by the doctor on call that evening, the woman and her husband requested transport to a larger hospital. The doctor on call insisted that it was important to set the fracture as soon as possible and convinced the couple that he could competently perform the procedure. The nurse had reservations about the doctor’s competence and wanted to counsel the couple to be persistent in seeking transport to another facility but knew that her job was on the line if she did. When she reports this to her supervisor, she is told that her job is not to advocate for patients but to be a loyal employee.

Repeated efforts by nurses to address these sorts of challenges have resulted in the persistent message that they can accept the status quo or leave. The managers of the hospital units are tightly allied with the medical director, Chief Nursing Officer and CEO. The problem for the nurses is that it is a 2-hour drive over a mountain range to the nearest hospital and there are no other employment options.

This is a classic example of moral distress. The nurses at Meadows Hospital have been very clear that their primary obligation is to patients and they have repeatedly and unsuccessfully advocated for patients until their jobs were threatened. If they cannot find a champion in a position of authority willing to address their concerns and work with them to create and sustain a positive work environment, they will have two choices: They can either accept the status quo, sacrifice their personal and professional integrity, and endure the type of moral distress that leads to disengagement and/or moral injury or they can quit their jobs. If they leave this hospital and need to find employment elsewhere, the 4-hour commute will definitely compromise the time they have for their families and similarly constrain their integrity and result in moral distress. There are several provisions in each of the assigned codes of ethics you have studied that address your responsibilities to the patient, the profession, and yourself.

Acquiescing and accepting unsafe or inappropriate practices, even if an individual does not participate in the specific practice, is equivalent to condoning unsafe practice. Nurses should not remain employed in facilities that routinely violate patient rights or require nurses to severely and repeatedly compromise standards of practice or personal morality.

Ideally, the nurses working at Meadows Hospital could seek assistance from their Provincial Nursing Regulatory body. They could also seek help through having a unionized work environment. Collective action, such as collective bargaining or workplace advocacy through a union, may be helpful in creating the desired change. Any agreement reached through such action would ideally be consistent with the profession’s standards of practice, the provincial and federal laws that regulate nursing practice as well as meet the Codes of Ethics for the profession.

Questions

. Determine who is involved in the case. Name all the parties and their relationship to the patient.

3.Describe the issue. What exactly is the problem or issue to be solved?

4. Assess the situation. What is the team’s "perceptions" and reflections on the situation - in short form?

5.Clarify values. What Ethical Values are involved in this story?

6. Identify ethical principles involved in the case. You can use all your reading and resources to name them.

7. Clarify legal rules. Are there any laws involved in this story?

8. Explore options and alternatives. What are some of the options to solving this problem?

9. Decide the course of action. As a team, come to a consensus on the course of action from your list in #8.

Answer 1

1)Who all are involved in this case?

A)the surgeon

b) Hospital manager

c)Docter on call

d)Nursing supervisor

e)Medical director

f)cheif nursing officer

2) Women and her husband

3)What is the main issue and what exactly have to solved?

Main issue is there is no any ethical understanding between employees and the management.Hospital employees and management should need an international understanding of what is acceptable and wrong.In this story the management is not obeying any ethical values and not considering the nurses or patients.management should treat the patient and the staff in good manner,and have to give choices to them also.

4)Team perception and reflection about the situation?

The team they are saying that the nurses job is to do what is in doctors order,here there is no any choice for nurse in the case of patent care.The team perception is that nurses job is not to do advocate for patients but to be a loyal emploee.They are taking by their side and not giving any important for the patient rights.

5)What ethical values are involved in this story?

Ethical values involved in this story are:

(a)Patient confidentiality.

(b)Patient relationship

(c)Malpractice and negligence

6)What ethical principles are involved in this story?

a)Autonomy: rights of the patient to retain control over his body. Patient have the rights to take final decision for the treatment.

b) Beneficence:In this principle health care provider must do all they can do for the benefit for patient in each situation,and it should be good for the patient.

c)Non maleficence:To do ;no harm. Whatever the decision taking for the patient it should not harm to the patient.

d)Justis

7)Any laws involved in this story?

If the patient is arising a complaints to the court it will affect the organisation .Court can stay the hospital and can panish the persons involved in this ,because patents rights are ignored in this story.

What opinion to solve this problem?

One of the most important assets of any hospital is its employees . Hospital organization should take good care for their employees.They have to consider about employees thinking,working environment, and whether they are satisfied with work or not.When employees are satisfied with work their retension rate will be high. Hospital organization should take a leading role in encouraging ethical behaviour in their organisation,because ethics have a positive relationships with profits and over all success of an organisation.

9)Consensus on the ourse of action?

The hospital management should consider the emotional and moral values of the nurses.They shoud follow ethical practices to reduce the stress and increase trust between employees.it will reduce conflicts and increase job satisfaction.Implementing ethical values helps to increase the job satisfaction.