This one isn’t really about nursing ethics, though it has plenty of implications for the ethics of nurse managers.
Hospital settles nurse’s discrimination suit.
After settling one lawsuit, a second was pending Friday against a Flint, Mich., hospital accused of honoring of a swastika-tattooed man’s request that African-American nurses not care for his newborn….
My main comment: The “customer” isn’t always right.
But fodder for discussion: what can (or do) hospitals do to handle such problems? What can or should they do when patients express preferences that are clearly discriminatory?
Posted in ethics |
As has been widely reported, a recent study indicates that almost half of New Zealand nurses have considered leaving their jobs out of ‘moral distress.’ The high rate of moral distress among nurses is not surprising, given the morally-significant nature of their work. In fact, that’s a feature of clinical work of all kinds. I made this general point in reference to a specific clinical context almost a decade ago, in the Canadian Journal of Psychiatry, in an article called Treatment Resistance in Anorexia Nervosa and the Pervasiveness of Ethics in Clinical Decision making. Here’s a quote that sums up the main point:
But it is useful to remind ourselves that an ethical issue is not something that arises every few weeks in clinical settings, in those regrettable moments of crisis in which clinicians feel the need to seek advice from ethics consultants or committees. Ethical issues of an acute nature may (we hope) be rare, but ethics—the making of value judgements, of weighing our actions against shared standards—is a task inherent to clinical life.
As the New Zealand study illustrates, it’s a point that applies to nursing practice quite generally.
Posted in moral distress, workplace |
From PBS: Next Health Care Mandate: Flu Shots for Medical Workers?
Brandon Hostler’s arm is usually among the first extended for the annual flu shot at Ruby Memorial Hospital in Morgantown, W.Va. He is, after all, a registered nurse — he knows it can do some good.
But if that shot ever becomes mandatory, he will balk.
“I wouldn’t quit or switch jobs,” he said. “But we are health care professionals. We know the risks and the benefits, and to force us to do something like that and not have a say in it, I think it would be offensive and unwanted.”
This story nicely points out two different facets of one of the most important values in the world of healthcare, namely autonomy.
Why is autonomy important? On one hand, it is important for its own sake. We simply value the ability to choose for ourselves. On the other hand, we value autonomy because we generally believe that when people choose for themselves, they will choose better than when others choose for them. Both of those facets of autonomy appear in the story above. Some nurses are hesitant about the flu shot because they’re uncertain about whether the risks are worth the benefits; others think the benefits are there, but still want the freedom, for its own sake, to say “no thanks.”
But there are also limits on autonomy. And in particular, membership in a profession brings a whole bunch of such limits. The benefits of professionalism involve a kind of quid pro quo — society asks things in return. The hard question, of course, is whether any particular limit on autonomy — such as mandatory flu shots — is or should be part of that bargain.
Posted in autonomy, ethics, professionalism, workplace | 2 Comments »
When is unethical behaviour by a nurse not a matter of ‘nursing ethics’?
From the Wisconsin State Journal: “Nurse disciplined for using donor program credit card for personal use”
A registered nurse who used a Neenah hospital’s organ donor program credit card to take cruises and vacations with her husband has been disciplined by the state Board of Nursing.
The board suspended the license of Peggy Grambsch, of Poy Sippi, for six months on Jan. 26. It also ordered Grambsch to take a nursing ethics course and pay $750….
It’s hard to blame the board for requiring that Grambsch take an ethics course. But it’s hardly likely to be the right remedy here. First, the behaviour she engaged in is, as far a I can see, a matter of outright criminality, rather than subtly unethical behaviour. Secondly, to the extent that there are ethical issues here — misappropriation of funds is of course unethical, in addition to being illegal — I suspect such issues are not covered in most nursing ethics courses. If I were on that board, I would have insisted on a business ethics course, especially one with a section on financial integrity and ethics in the workplace.
Posted in ethics, hospitals, law, workplace |
Who cares for the care-givers?
From the Wall Street Journal: Helping Nurses Cope With Compassion Fatigue
New programs are underway to help nurses cope with compassion fatigue, an occupational hazard for caregivers that also puts patients at risk of substandard care….
Though the intense emotional demands on nurses are as old as the profession itself, researchers have only in recent years begun to study the effects of compassion fatigue, a form of burnout compounded by secondary traumatic stress….
It’s good to see that this article discusses the impact of compassion fatigue not just on nurses, but also on patients. But of course, while impact on patient care is the ‘trump card’ of the world of healthcare, it shouldn’t be forgotten that institutions of all kinds have a fundamental obligation to safeguard the mental and emotional health of employees.
Posted in ethics | 1 Comment »
Finger pointing is easy. Figuring out what to do about labour relations in healthcare is harder.
See this recent story: Patient Dies During Hospital Labor Dispute
California authorities are investigating the death of a patient at an Oakland hospital that police and hospital and union officials said resulted from a medication error made during a labor dispute between nurses and the health system that runs the hospital.
Police and officials at Alta Bates Summit Medical Center told the local media the woman died after she received an incorrect dose of medication administered by a replacement nurse. At the time, regular staff nurses employed by Sutter Health System were locked out following a one-day strike by 23,000 nurses across the state….
A couple of things differentiate labour disputes in healthcare from labour disputes in, say, the auto industry. One is that in healthcare, the “labourers” tend to be licensed professionals, subject to a code of ethics, etc.
The other difference is that, in healthcare, there’s always a shared focal point for ethical argumentation, namely the patient. Both sides in a healthcare labour dispute have to put some of their most central arguments in terms of patient wellbeing. In the auto industry, by comparison, there’s much less common ground. Sure, both GM and the UAW have an interest in making sure the company stays in business. But beyond that, it’s “us vs. them.” Every dollar gained by the workers is a dollar lost by someone else (managers, shareholders, etc.) In healthcare everyone has to bow to patient interests. You can be as cynical as you want about the other side, but you still know that, in public at least, the arguments they give must give priority to patient wellbeing.
One final note: an ethicist quoted in the story above blames inadequate compensation for troubles like this. I’m skeptical about that. I don’t doubt that wages are an issue. But higher wages wouldn’t necessarily mean fewer labour disputes. You would likely still see the regular cycle of negotiation, strike, contract, period of calm, and then renewed negotiations. And so on. And after all, wages aren’t the key issue in the eyes of nurses, are they? What do you think?
Posted in hospitals, medication, safety, unions, workplace | 2 Comments »
Nursing ethics isn’t just about ethical standards for nurses; it’s also about the stances that nurses and nursing organizations take on issues of health policy.
See this story, from the BBC: RCN wants longer hospital visiting hours
Hospital visiting times should be extended so patients’ relatives can become more involved in their care, the Royal College of Nursing has said.
RCN head Peter Carter said he did not want relatives performing tasks nurses were employed to carry out, but that there were “real benefits” for patients when family members helped with care.
But patients’ groups warned such a move could be “the tip of the iceberg”….
Make sure to read the comments under the BBC story — they reveal lots of additional reasons for and against extending visiting hours.
What do you think?
Posted in family, hospitals, patients | 2 Comments »