Running head: THE ISSUE OF POWERLESSNESS WITHIN NURSING STUDENTS 1

The Issue of Powerlessness within Nursing Students

Kayla Kilfeather

James Madison University

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Introduction

Powerlessness within the field of nursing is an important, ethically challenging situation

that requires attention. Nursing students in particular experience a greater amount of

powerlessness due to lack of experience, however the issue can travel across multiple realms of

the health care team. In a nursing research article by Judith A. Erlen and Beth Frost, “power” is

defined as “the ability of one person to influence another individual to do what the other wants

done”. (Erlen & Frost, 1991) “Nursing students’ feelings of minimal influence are most directly

contributed to a discouraging educational environment”—complaining about “disrespect, lack of

cooperation, and unprofessional expectations” from nurses working with them (Baraz. Memarian

& Vanaki, 2015). “Research shows that nurses who work in organizations that empower

professional nursing practice have better patient outcomes” (Garner, 2011). The promotion of a

supportive academic environment for nursing students is not only crucial in developing

empowered students, but also empowering the nursing community as a whole in the face of an

ethical dilemma or moral distress.

Background

During my time in nursing school, I encountered a situation during clinical that made me

feel powerless. I was busy in the morning administering medications and tending to the needs of

each patient. As I was walking in between their rooms, however, I noticed that a bed alarm in

another patient’s room kept going off about every ten minutes. I stopped in to check on this

patient when there was no one else available and noticed that they were a high fall-risk and

needed assistance to the bathroom. The patient complained that she needed to void very

frequently as I assisted her each time to the bathroom. She would have episodes of diarrhea each

time she voided and needed assistance with hygiene. The pattern continued throughout the day,
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and either me or the Tech would run each time to help her. When we didn’t get there in time

however, the patient would get up and start walking on her own. As I was concerned for safety as

well as her health (what looked like to be dehydration from voiding so frequently), I found her

nurse and expressed my concerns. I asked in a respectful manner if the patient had been

prescribed any prn anti-diarrheal medications so that she could minimize her trips to the

bathrooms and consequently decrease her risk of falls. The nurse seemed busy on her computer

and said she would “get to it”. I went on caring for my patients, but the bed alarm of the other

patient continued to go off throughout the day. I found the same nurse and again expressed my

concerns, but felt unheard. I preceded to look at the patient’s MAR and found a prescribed prn

loperamide. After a few hours I confronted my preceptor about my concerns, who then spoke

independently with the nurse until the loperamide was administered.

This situation caused me to experience moral distress in two different ways. I was aware

that the right thing to do was to inform the nurse of the situation in hopes that she would take

action, but her unwillingness to listen to my request prevented me from being able to

successfully advocate for my patient. I felt as if moral distress also arose as I was torn between

reminding the nurse multiple times to administer medications to the patient, and being afraid to

come off as disrespectful/not knowing the “right” way to approach the situation. The

combination of these two sources of distress led me to feel extremely powerless as my label of a

“student” caused me to not effectively advocate for a patient.

Methods/Findings

An effective tool used for ethical reasoning in morally distressing situations are the Eight

Key Questions formulated by the Madison Collaborative at James Madison University. “The
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Eight Key Questions reflect the best of humanity’s ethical reasoning traditions… the questions

highlight vital human values: fairness, outcomes, responsibilities, character, liberty, empathy,

authority, and rights” (The Madison Collaborative, 2013). In my clinical situation, I can relate

each of these questions or values into formulating an effective response. In the case of fairness, I

needed to act equitably by balancing the well-being of the patient while maintaining respect for

the patient’s nurse. When thinking about outcomes, I was mainly concerned with achieving the

goal of reliving the patient’s gastrointestinal distress while managing their safety.

Responsibilities and character fit together in this situation, as I felt the moral obligation to

advocate for my patient, and consequently express good character by taking this firm action.

With liberty in mind, I sought out to “do no harm” to my patient, and treat her to the best of my

ability just like I would any other patient. I felt as if the patient’s nurse was disregarding her

freedom and right to receive quality care by ignoring her essential needs. I maintained empathy

with my actions by listening to the patient’s concerns, relating to her struggle, and not giving up

on her care for this reason. In the case of authority, I felt my duty as a student was to report the

instance to my preceptor, while also respecting the nurse I was working with. Finally, in terms of

rights, negligence from the nurse could have resulted in the patient injuring themselves, possibly

leading to legal issues. I felt determined to align my actions as much as possible with the ANA

Nursing Code of Ethics. One provision in the code of ethics that relates to the situation I

experienced is Provision Two, which states, “The nurse’s primary commitment is to the patient,

whether an individual, family, group, or community” (ANA, 2001). This provision emphasizes

the fact that the nurse should have prioritized the patient by listening to my concerns and acting

upon them rather than attending to secondary tasks. This provision also emphasizes the

importance of professional collaboration within nursing when prioritizing the patient. Section 2.3
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states, “By its very nature, collaboration requires mutual trust, recognition, and respect among

the health care team and open dialogue among all parties who have an interest in and a concern

for health outcomes” (ANA, 2001). Being a part of the patient’s health care team, the nurse

should have been more respectful towards me as a student, and be more willing to exchange an

open dialogue in order to optimize the patient’s care.

Conclusion

As uncomfortable as this situation may have been for me, it helped me to learn and grow

professionally as a nurse. I learned that as a student, sometimes I may be looked on as, or even

feel powerless when working with those in a higher authority. No matter my position on the

health care team totem pole, however, I still have a duty to prioritize my patient as well as

advocate for them against other members of the health care team. This ethical situation taught me

that I may not have as much experience as other nurses, doctors, etc., but I do have a voice. That

being said, I would have approached this situation differently by going up to the nurse more than

twice to ask her about my patient or to even professionally address the lack of respect she was

exhibiting towards me. I also would have tried to collaborate with her to see how we could

address the patient’s needs together. Although frustrating, a lack of respectful and efficient

collaboration between team members can be apparent at any professional level of the health care

team. When conflicting situations as such arise, it is important to adhere to the Eight Key

Questions to make the most ethical decision possible. Maintaining fairness, responsibility, and

character just to name a few, is pertinent to advocating and being accountable for optimal patient

care. In the future, I will be more courageous when approaching other nurses, doctors, etc. about

concerns I have towards the patient. I will also regard others with respect so that everyone within

the health care team feels equally empowered to provide their part optimal patient care.
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References

American Nurses Association. (2001). Code of Ethics for Nurses With Interpretive

Statements. https://www.nursingworld.org/practice-policy/nursing-

excellence/ethics/code-of-ethics-for-nurses/

Baraz. Memarian & Vanaki. (2015). Learning challenges of nursing students in clinical

environments: a qualitative study. Journal of Education and Health Promotion.

Garner. C. (2011). Powerlessness Is Bad Practice. https://www.americansentinel.edu/about-

american-sentinel-university/newsroom/learn-how-powerlessness-is-bad-practice-and-

how-to-facilitate-change-for-yourself-and-your-patients

J. A. Erlen, B. Frost. (1991). Nurses’ Perceptions of Powerlessness in Influencing Ethical

Decisions. Western Journal of Nursing Research, 398.

The Madison Collaborative. (2013). The Eight Key Questions. The Eight Key Questions

Handbook. https://www.jmu.edu/mc/Docs/131101%208KQ%20Handout%20Revision.pdf