Ethical Discussion: Patient Safety vs.

Privacy To Blow the Whistle or to not Blow the Whistle

N362: Jessica Lafaele, Diane Nichols, Tiare Palimoo, Leeah Javier and Brandi Anastacio

Nurse Jessicas life in the Intensive Care Unit with her Best Friend Nurse Diane
Questions to ask yourself:
Who are the key characters? What ethical principals are they battling?

What would you do if put in Jessicas situation?

Key Character: Nurse Jessica

Values: Ethical principles: - Veracity: being honest and speaking the truth - Compassion - Loyalty to employer, patient, friend Laws:
She should know the hospital policies about reporting such situation. According to National State Boards of Nursing (2010), stealing from a client, including medications should be reported immediately. Basically, Nurse Jessica should report any nurse whose behavior is unsafe, incompetent, unethical, affected by the use of alcohol, drugs, or other chemicals, or affected by a physical or mental condition.

- Non-maleficence: Rights: avoidance of harm or - Protect the safety and hurt; core of medical rights of clients. oath and nursing ethics - The right to work in a safe environment

Key Character: Nurse Diane

Ethical Principals - Violating nonmaleficence: harming clients. Violating beneficence: stealing clients medication is not helping them

Values:
- Unreliable - Unethical - Unprofessional Rights: - Confidentiality - Clients rights are violated

Laws:
Registered nurses must understand their ethical, legal, and professional rights and responsibilities and recognize that all actions have consequences.
Hawaii Nurse Practice Act, Chapter 457-12:
- The board has the power to deny, revoke, limit and/or suspend a license and fine a licensed nurse, if found to have habitual intemperance, addiction to, or dependency on alcohol or other habit-forming substances.

Theft is, at the very least, a misdemeanor, also punishable by Federal fines and jail time

Ethical Decision Making Process with EAF: Ethical Assessment Framework

Ethical Assessment Framework (EAF): Assessment

1. Identify the problem: Nurse Diane is taking narcotic medication while on shift.
2. Gather relevant facts: Objective: Narcotic meds are missing on the unit. Diane has a back injury that she no longer receives medication for from her primary care provider. Diane has told Jessica that she has taken medication from the units narcotic drawer for her own use, one time. Subjective: Diane states she is in pain. Dianes doctor feels that she has become dependent on the medication. 3. Identify methods of ethical justification to help resolve the dilemma 4. Consciously clarify relevant values, rights, and duties of patient, self and significant persons associated with the issue(s). *Previous Slides 5. Is there an ethical dilemma present? Yes 6. Identify guidelines from nursing and professional codes of ethics. 7. Identify and use relevant interdisciplinary resources. Ethics committee, ethics consultants, clergy, literature, administrators, lawyers, colleagues, etc. 8. Identify and prioritize alternative actions/options.

EAF: Plan of Action and Implementation

Blow that whistle:
Safety of the patient and Nurse Diane takes precedence over Nurse Dianes Privacy.
Some options for Nurse Jessica:
Inform her manager of her suspicions Anonymously report to her agencys compliance team Be supportive and assist Nurse Diane to seek treatment

Agency Actions
Inform Authorities, excuse Nurse Diane and conduct investigation Assist Nurse Diane in obtaining treatment Institute disciplinary action, i.e. suspension, leave with or without pay

Plan of Action guided by the provisions stated from Code Ethics for Nurses: Provision 1.5 Relationship with colleagues and others
The principle of respect for persons extends to all individuals with whom the nurse interacts. The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise, and to resolving conflict. Nurses function in many roles, including direct care provider, administrator, educator, researcher, and consultant. In each of these roles, the nurse treats colleagues, employees, assistants, and students with respect and compassion

Provision 2.4 Professional Boundaries

The intimate nature of nursing care, the involvement of nurses is important and sometimes highly stressful life events, and the mutual dependence of colleagues working in close concert all present the potential for blurring of limits to professional relationships. Maintaining authenticity and expressing oneself as an individual, while remaining within the bounds established by the purpose of the relationship can be especially difficult in prolonged or long-term relationships Provision 5.4 Preservation of Integrity
Threats to integrity also may include an expectation that the nurse will act in a way that is inconsistent with the values or ethics of the profession, or more specifically a request that is in direct violation of the Code of Ethics. Nurses have a duty to remain consistent with both their personal and professional values and to accept compromise only to the degree that it remains an integrity-preserving compromise. An integrity-preserving compromise does not jeopardize the dignity or well-being of the nurse or others.

In Summary
To summarize, although Nurse Diane is protected under HIPAA as a patient, in regards to her abuse of substances and treatment, her actions interfere with the safety of her patients and her ability to perform in her working environment as a competent nurse. Actions regarding this scenario are guided by the ANA code of ethics:
Provision 1: Respect and compassion for the inherent dignity, worth and uniqueness of every individual. Provision 2: A nurses primary commitment is to patients. Provision 5: The nurse is responsible for maintenance of competency, wholeness of character and preservation of character.

Resources
Cherry, B. & Jacob, S. (2011). Contemporary nursing: issues, trends, and management (5th ed). St. Louis: Elsevier
Kunyk, D., & Austin, W. (2012). Nursing under the influence: A relational ethics perspective. Nursing Ethics, 19(3), 380-389. doi:10.1177/0969733011406767

National Council of State Boards of Nursing. (2010). A health care consumers guide. Retrieved from https://www.ncsbn.org/A_Health_Care_Consumers_Guide.pdf
National Council of States Board of Nursing. (2011). Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs.

Wright, E., McGuiness, T., Moneyham, L. D., Schumacher, J. E., Zwerling, A., & Stullenbarger, N. N. (2012). Opioid Abuse Among Nurse Anesthetists and Anesthesiologists. AANA Journal, 80(2), 120-128.