During my placement as a student nurse last holiday in an acute medical ward of a public hospital, I faced several nursing ethical dilemmas. The most outstanding one happened when my relationship with the core workers of the institution was put to test. The nursing dilemma that I found myself in touched on issues concerning the role of the nurse in safeguarding the safety of patients when their health is put at risk by the actions of co-workers. According to the code of conduct guidelines, student nurses work under registered nurse (RN) direct supervision. I was therefore supposed to work under the instructions of a senior RN in the first week of my placement. The ward’s superintendent tasked the RN and me to care for patients in the infectious rooms.
When we started working, I was shocked to see that she entered patients’ rooms that require contact isolation precautions without putting on personal protective equipment (PPE). Moreover, she extensively neglected appropriate hand hygiene precautions several times between patients. At one point in time, she gave me a Panadol to deliver to a patient and upon asking her to accompany me she dismissed me by stating “Oh, it’s just a Panadol and I have checked it. I have to finish my nursing notes”.
To resolve this nursing ethical dilemma, I used the MORAL model which is basically a 5 step ethical decision making model premised on the acronym MORAL: M- massage the dilemma, O- outline the options, R- review criteria and resolve the dilemma, A- affirm position and act, and L- look back and evaluate the entire process as described by Ghazal, Saleem, and Amlani (2014, p.136).
Since I was still a nurse student and I was yet to be familiar with my fellow co-workers especially with their personal behaviors and traits, this situation literally put me in an ethical dilemma. I was torn between abiding by the codes of ethics guiding the conduct of nurses pertaining the safeguarding of patients’ safety when their health is at risk out of the actions of co-workers or compromising them to ensure my safe stay at the acute medical ward. The Nursing and Midwifery Board of Australia, (2018) and the International Council of Nurses (2012) assert that nurses have a responsibility of forging and sustaining a collaborative and respectful relationship with all co-workers in the nursing profession. Moreover, nurses are expected to safeguard patients’ health and safety especially when co-workers endanger the same.
Option 1- Do nothing by keeping the observation of the malpractice to myself. This was meant to secure my safe stay and effective completion of my nursing placement at the hospital. This was prompted by the fact that, I didn’t know the possible reactions of the nurse and the hospital management against me. In any case, it was upon the hospital’s management to enforce the safety standards of patients.
Option 2- Confront the nurse and make it clear to her that she is contravening critical patient safety practices that may jeopardize their health outcomes. This option was in line with the International Council of Nurses (2012) requirements that nurses ought to take necessary actions to not only guide but also support co-workers to assume ethical conduct in their practice. This requirement was a formidable defense if in case the nurse decided to retaliate.
Option 3- Report the malpractice to the management for appropriate action to be taken against the nurse. This might have jeopardized her performance rating as a senior nurse but definitely, it was critical in putting the management on high alert about what was happening in the wards.
Option one allowed me to evade the possible reprimand and workplace abuse from fellow co-workers but inevitably allowed the compromise on patients’ safety. Option two gave me an opportunity to support and guide the senior nurse to practice safely and under the confines of ethical conduct, even though there was a possibility of reprimand. Option three gave me an opportunity to share with the management the malpractices happening in the wards for appropriate action to be taken. This option secured me from possible workplace abuse. Alternative three seemed appropriate to me since it presented a ‘win-win’ situation in which I was secure from possible workplace abuse, and the patients’ safety requirements were bound to be addressed. Besides, the senior nurse was bound to be summoned to ask her to change her behavior.
I approached the management one morning and reported the matter to the acute medical ward superintendent. Surprisingly, my observations were well received and I was promised that action would be taken to avert the situation. I was assured that the management would take stern action against whoever tried to abuse me for reporting such critical patients’ safety breaches. Indeed Aitamaa, Leino-Kilpi, Puukka, and Suhonen, (2010, pp.469-482) assert that one of the most fundamental roles of the codes of ethics in the nursing profession constitutes the active support and guidance between co-workers to uphold best nursing practices as well as reporting the same to management when it really necessitates. Moreover, Kangasniemi, Pakkanen, and Korhonen (2015, pp.1744-1757) observe that being ethical during practice helps elevate the patients’ trust and confidence in the nursing service provision.
Due to her senior position, the best approach was to report her to the management for action to be taken from there. This action shielded me from possible workplace abuse and intimidation besides helping restore confidence in patients that their health and safety was assured. De Casterlé, Izumi, Godfrey and Denhaerynck (2008, pp.540-549); Erdil, and Korkmaz, (2009, pp.589-598.) observe that when student nurse dares to confront senior RNs directly, it can cause conflicts, lack of trust and further compromise on patient safety.
Moreover, by reporting her, it further reinforced my stern of observing nursing practice standards, codes, and ethics besides allowing me a chance not to compromise on my personal beliefs and values. Patients in rooms that require contact isolation precautions require high safety standards and compromising on guidelines such as not putting on PPE or not observing appropriate hand hygiene can really compromise on their health (Trick, et al., 2009, pp.2003-2009). As such reporting, the case was the most appropriate action to take to prevent further safety compromise besides securing my safe stay at the facility.
References
Aitamaa, E., Leino-Kilpi, H., Puukka, P. and Suhonen, R., 2010. Ethical problems in nursing management: the role of codes of ethics. Nursing ethics, 17(4), pp.469-482.
De Casterlé, B.D., Izumi, S., Godfrey, N.S. and Denhaerynck, K., 2008. Nurses’ responses to ethical dilemmas in nursing practice: meta?analysis. Journal of advanced nursing, 63(6), pp.540-549.
Erdil, F. and Korkmaz, F., 2009. Ethical problems observed by student nurses. Nursing ethics, 16(5), pp.589-598.
Ghazal, L., Saleem, Z. and Amlani, G., 2014. Resolving ethical dilemma: An application of a theoretical model. Khyber Medical University Journal, 6(3), p.135. Available at: https://ecommons.aku.edu/pakistan_fhs_son/65
Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.
Nursing and Midwifery Board of Australia, 2018. Code of Ethics for Nurses in Australia Available from https://www.google.com/search?q=Code+of+Ethicsfor+Nurses+in+Australia&ie=utf-8&oe=utf-8&client=firefox-b-ab
Trick, W.E., Weinstein, R.A., DeMarais, P.L., Tomaska, W., Nathan, C., McAllister, S.K., Hageman, J.C., Rice, T.W., Westbrook, G. and Jarvis, W.R., 2009. Comparison of routine glove use and contact?isolation precautions to prevent transmission of multidrug?resistant bacteria in a long?term care facility. Journal of the American Geriatrics Society, 52(12), pp.2003-2009.
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