Nurses Have a Moral and Ethical Duty - Essay Example

Nurses have a moral and ethical duty to treat patients but the nursing profession is faced with multiple complex issues which affect nurses’ efforts to be competent (Moody & Pesut, 2006). Most nurses are able to transcend above the organizational problems and serve the patients. Nursing workforce shortages have a negative impact on staff morale and job satisfaction. To this is added the ethical dilemmas to which nurses are exposed to when they are forced to shift departments or units even within the same hospital. This paper will examine the ethical dilemma of nurses when they have to work in general medical-surgical ward despite having been trained and experienced in the psychiatric department. While specialization is increasing in every area, hospitals are shuffling nurses from one unit to another with increased patient loads. Such cost effective measures compromise with the safety and quality and questions are raised on how ethical it is to do so. To make nurse staffing safe and appropriate, it was decided not to use nurse-to-patient ratios as a baseline standard for minimum safe staffing (Gallagher, Kany, Rowell, & Peterson, 1999). Nursing shortage in the United States is largely responsible for shifting nurses from one department to another. It is estimated that by 2010 there will be a shortage of about 800,000 nurses and this shortage already shows dire results (Bodley & Davis, 2003). The shortage is leading to delegation of patient care activities to nurses’ aides and unlicensed assistive personnel. Nurses do not have the managerial support or the control over their environments. Shifting nurses from unit to unit, imposing mandatory overtime, attrition in the profession is unlikely to abate. Psychiatric nursing is a specialized area where the availability of appropriate personnel remains a perennial problem. Patients in the mental health department need kindness and compassion during the acute phase of their illness but Nolan and Bourke (2001) point out that they were forced to live in poor social environment while they were being treated for severe mental illness. The nurses lacked the skills in interpersonal relationships. Nurses in the mental health department reported that the type of intervention had changed and there was a decreased emphasis on dynamic therapy (Nolan & Bourke). Treatment is now based on pharmacology and there was an increased use of cognitive therapies. Independent practice opportunities were lost while advanced certification and prescription authority had increased the scope of practice. Lack of resources is the major challenge facing the mental health nursing. Managed care was a challenge as it diminished the influence of the provider in determining how care should be provided. This threatened the continuity of their positions. Treatment was also difficult as patients were diagnosed with dual illnesses like mental illness with substance abuse or personality disorder. Nurses do not face such challenges in the general medical-surgical wards but there are other considerations which the nurses from psychiatry are not equipped to tackle. The Code of Ethics directs the nursing conduct and establishes general ethical standards which are applicable to all registered nurses (Bodley & Davis). It clarifies that patients interest is the primary concern and certainly over the hospital’s interest when RN’s have to take any decision. Even delegation and collaboration of nursing teams have been specified in the Code of Ethics. The nurses are first required to assess the data relevant to the patient’s needs and then determine the diagnosis. Hence, shifting a nurse from psychiatry to general medical-surgical ward would be against the Code of Ethics as they are not in a position to assess the patient’s needs and determine diagnosis. Psychiatry is specialized and involves training in the area of diagnosis and management of depression, anxiety, and crisis intervention. The psychiatric nurse practitioner’s role may have evolved as the need to meet projected mental health care needs of consumers in primary care settings where NPs work as members of an integrated primary health care team increased. This still does not mean that they can be shifted to other units. Torjuul and Sorlie (2006) contend that it is unethical to do so because nursing is different than medicine. Nurses face ethically difficult situations in trying to find the most appropriate actions to take care of patients. Due to the growth in scientific knowledge and technology and the availability of latest diagnostic equipments and opportunities, surgical procedures are now being carried out on older people with complex issues. Clinical and ethical knowledge and skills are necessary in professional care giving. Responsible nursing actions require adhering to the Code of Ethics. The moral behavior of nurses is shaped by the organizational and professional roles and the settings in which they work. Ethical problems are inseparable from the settings in which they arise (Torjuul & Sorlie). The Code of Ethics lay down stringent rules on nurses and clearly specifies what is expected of them and what would lead to termination/transfer. As such, very often nurses find they have to live with the doctor’s decisions and are unable to decide on the course of treatment. They may recognize the course of treatment but recognize it as being ethically difficult to implement. When nurses are unable to fulfill their professional ideals, their moral self-image and professional identity is threatened, which leads to dissatisfaction, distress and finally attrition. While burnout is common to any branch of nursing, it is particularly found in the psychiatric nurses in their 30s. By this time they have been pursuing a nursing career for a decade and are in the prime of their life possessing large amount of knowledge and experience (Imai, Nakao, Tsuchiya, Kuroda, & Katoh, 2004). This causes high expectations and heavy demands by both superiors and subordinates. Expectation and work demands may lead to physical and mental exhaustion contributing to burnout. At such a situation in profession, it is extremely difficult for nurses to adapt to any other branch of nursing when they are already experiencing burnouts in psychiatry. They are not in a position to learn the technology and specialization necessary for the medical-surgical units. At every stage, Code of Ethics specifies that interest of the patient is above the interest of the hospital. This further emphasizes that shifting psychiatry nurses elsewhere is highly unethical both from the angle of the patient as well as the nurse. Code of Ethics also calls upon the nursing managers to prevent questionable care from occurring and shifting nurses from unit to unit is unethical and questionable. Psychiatry nurses, with years of experience do not need physician supervision as they have expertise and competence to prescribe treatment (Hemmingway, Mitchell, Fenwick & Coates, 2003). This expertise and competence relates to this particular branch of nursing and cannot be applied to the general medical-surgical wards where the competencies and requirements differ totally, and for which these nurses lack the skills and knowledge. This further justifies that shifting nurses from psychiatry to any other unit is in direct violation of Code of Ethics laid down. The American Nurses’ Association (ANA) specifies that one size does not fit all when setting nursing care staffing levels. Staffing should focus on the intensity and complexity of care needed. Staffing should be considered at the macro (budget and organizational) and micro (shift-to-shift) level. Clinical competence of the nurses differs from time to time depending upon the patient needs. Nurses must have management support and they should be valued as strategic assets. Organizational and financial constraints in the hospital cannot take precedence over the patient’s interests at the same time leaving the nurse in an unethical situation struggling in care giving. References: Bodley, A. L., & Davis, S. (2003), USA National labor Relations Board, 18 Nov 2006 Gallagher, R. M., Kany, K. A., Rowell, P. A., & Peterson, C., (1999), ANA’s Nurse Staffing Principles, 18 Nov 2006 Hemmingway, S., Mitchell, S., Fenwick, M., & Coates, K. (2003), Nurse prescribing: The USA experience, 18 Nov 2006 Imai, H., Nakao, H., Tsuchiya, M., Kuroda, Y., & Katoh, T. (2004), Burnout and work environments of public health nurses involved in mental health care, Occupational and Environmental Medicine 2004;61:764-768, BMJ Publishing Group Ltd Moody, R. C., & Pesut, D. J. (2006), The motivation to care, Journal of Health Organization and Management Vol. 20 No. 1, 2006 pp. 15-48 Nolan, P. & Bourke, P. (2002), UK and USA Clinical Mental Health Nurse Specialists’ perceptions of their work, Journal of Psychiatric and Mental Health Nursing, 2002, 9 , 293–300 Torjuul, K. & Sorlie, V. (2006), Nursing is different than medicine: ethical difficulties in the process of care in surgical units, The Authors. Journal compilation, Blackwell Publishing Ltd Read More