Our Purpose

All of our group members continuously face similar ethical dilemmas resulting in the inability to provide competent and safe care that patients are entitled to. We as a group, have decided to come together to develop a plan on how we, as nurses, can affect change. It is vital for nurses to empower one another and provide support during stressful situations in the workplace. Equality in the work environment reduces power imbalances. Lastly, it is imperative that nurses unite to have stronger voices in creating policies and rules that ensure the best outcomes for the patients are achieved.

Ethical Situation

A situation arose where a nurse could not live out the value in providing safe, compassionate, competent and ethical care occurred on a busy evening shift on a sub-acute floor. On this particular evening, the nurse had 7 total-care heavy patients, and was expected to administer numerous medications, and provide evening care. During that evening, two of this nurses’ patients fell, and she also had to attend to her partner’s patient, who also had a fall. After ensuring all patients were uninjured, administration of medications, and completion of all assessments, the nurse barely had time to provide evening care. Two of the patients went to bed without being washed. The nurse was unable to do hourly safety checks on her patients, and she felt as if she had gone all evening without seeing some of her patients. She had to stay after her shift to complete two incident reports.

This experience affected the nurse deeply, and she did not feel in the least that she was safely providing care to these patients. The speed at which this nurse had to complete her tasks put her and her patients at risk, and the whole shift felt chaotic. This incident occurred approximately three years ago, and she still has not accepted another shift on the sub acute floor.

The barrier the nurse faced in being able to live this ethical value occurred at an organizational level, and is brought back to budget cuts. This heavy workload occurred because of the cost associated with hiring more nurses, or care aids, to reduce the workload. Another issue may have been staffing issues for this floor; turnover may be high, as other nurses may have similar experiences.

Tuesday, February 15, 2011

Justice:Applying Ethical Principles to Case Study


Justice
Considers the fairness of an action.  Resources should be equally distributed to the masses, thus the same goes for the distribution of burden.

In applying this principle to the case study, the nurse due to her heavy workload, was unable to provide equal care to all her patients.  Because some patients were of higher priority, the distribution of care was unevenly divided.  Based on the situation, it only makes sense for the nurse to give more attention to those patients who fell; however, if the workload was better handled in the first place, then the time allocated to each patient could have been more equally distributed and patients would less likely have fallen.  As a result of cost cuts, the quality of care provided to the patients has declined, this is not fair or is unjust.  The heavy workload for the nurse can be stressful, and physically and mentally draining.  These poor working conditions can easily lead to burnout and moral distress.  In addition, this workplace environment was also unfair to the nurses.

JUSTICE IN THE WORKPLACE

(PROMOTING JUSTICE Oberle, K. & Raffin S., 2008)

·        Nurses have a right to fair compensation for their work and reasonable working conditions.
·        It is unacceptable to put nurses or patients in jeopardy.
·        Nurses have an obligation to:
o   Speak out when they see any kind of injustice of other health care providers or patients
o   Obligation to treat other care providers fairly
o   Be respectful of other patients and co-workers, but also have a right to be treated with respect by patients and co-workers alike
·        Job action may be necessary, which require possible strikes to draw people’s attention to inequities in pay or working conditions.

Workload and Working Conditions
·        Workload and working conditions can have moral implications if they are such that nurses are unable to uphold their value of delivering safe, compassionate, competent, and ethical care.

A recent news story reported the death of a patient who was given a wrong dose of medication by a nurse.

o   If working under highly stressful conditions, with too many patients, it would be easy to see that mistakes were bound to happen.
o   Although it may be easy to place blame on the nurse, perhaps blame should be put on the system that put the nurse in a difficult situation.
o   These kinds of situations are often the basis of strike action.
o   When nurses strike to improve their salaries and working conditions, they are acting to ensure that they are treated justly in the workplace and that working conditions enable them to deliver quality care.

Nursing Mentality
·        Many nurses seem to view nursing as self-sacrifice.  However, nurses deserve to treated justly and should not be put at risk in the context of their work environment.


WEBSITES – IMPROVING PRACTICE ENVIRONMENTS

British Columbia Nurses Union (BCNU) – BC Nurses’ Union urges provincial government to reverse health care cuts after reviewing Canadian Nursing Advisory Committee recommendations.
http://www.bcnu.org/whats_new_media/news_releases/2002/08-21.htm

British Columbia Nurses Union (BCNU) Speaks Out – Improving Conditions for Our Members and Our Patients.
http://www.bcnu.org/publications_forms/update_magazine/2008/pdfs/Apr-May08.pdf

College of Registered Nurses of BC (CRNBC) – Working with Limited Resources
https://www.crnbc.ca/Standards/Lists/StandardResources/404WorkingwithLimitedResources.pdf

College of Registered Nurses of BC (CRNBC) – Quality Practice Environments
https://www.crnbc.ca/Standards/Lists/StandardResources/412qualitypracticeenvironments.pdf

Canadian Nurses Association – Taking Action on Nurse Fatigue
http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS112_Nurse_Fatigue_2010_e.pdf

Canadian Nurses Association (RNAO) – Nurse Fatigue and Patient Safety
http://www.cna-aiic.ca/CNA/practice/safety/full_report_e/files/fatigue_safety_2010_report_e.pdf

CRNBC Patient Safety Fact Sheet
https://www.crnbc.ca/Standards/Lists/StandardResources/463PatientSafety.pdf

Canadian Nurses Association – Staffing Decisions for the Delivery of Safe Nursing Care
http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS67_Staffing_Decisions_Delivery_Safe_Nursing_Care_June_2003_e.pdf

The Canadian Health Services Resources Foundation – Staffing for Safety
http://www.chsrf.ca/Migrated/PDF/ResearchReports/CommissionedResearch/staffing_for_safety_policy_synth_e.pdf

The Canadian Health Services Resources Foundation – Commitment and Care.  The Benefits of a Healthy Workplace for Nurses, their Patients, and the System.
http://www.chsrf.ca/Migrated/PDF/pscomcare_e.pdf

Article: Ethical Staffing.  There can be no compromise: safe staffing is an ethical issue. Nurses need moral courage and organisational support to ensure they work in an environment where they can practice ethically and patients receive the best care possible.
http://findarticles.com/p/articles/mi_hb4839/is_3_12/ai_n29261424/


References
 Oberle, K. & Raffin S. (2008). Promoting Justice. In Ethics in Canadian Nursing Practice:  Navigating the Journey (pp. 217-246). Toronto: ON: Pearson.
Posted by at