Step 1 Read the scenario:
A new-grad nurse is attending an orientation course for a position on a labor and delivery unit. The course is taught by a member of the nursing staff, who has been working on the unit for over 10 years. The new nurse is instructed on a procedure that is in direct conflict to what the nurse was taught in nursing school. In fact, the nurse was taught that performing the procedure this way could cause serious complications for the patient.
When the nurse raises a concern about the procedure the instructor replies “We have always done it this way, and I expect you to do it too, if you want to work here.”
Step 2 Answer the Prompts:
· How should the new nurse respond to this situation? Why?
· What ethical principles are influencing your decision?
· What legal concepts are influencing your decision?
Step 3 Read other students’ posts and respond to at least two of them.
Read and respond to at least two other students’ posts. Use your personal experience, if it’s relevant, to help support or debate other students’ posts. If differences of opinion occur, debate the issues professionally and provide examples to support your opinions.
NUR435 Student Posts:
Student #1: Nurses (and truly all health care workers) have a duty to provide the best care possible to their patients, balancing the risks and benefits to the patient, and avoiding the risk of causing harm (Haddad & Geiger, 2020). This new nurse is stuck in an “ethical pluralism” dilemma, where there may be many theories as to what is the right or wrong way to perform the procedure on the labor and delivery unit. The new nurse needs to decide her next steps and what is appropriate to make an ethical decision. Medical and ethical decisions should “involve conscientious and judicious use of the best evidence relevant to the care and prognosis of the patient to promote better informed and better justified ethical decision making” (Goldenberg, 2005).
I would suggest the new nurse bring up his/her concern to the nurse instructor and ask why the procedure has been done the way it has for years. If more push back is done by the instructor, I would advise the nurse to request meeting with the unit manager to explain his/her thoughts and concerns and produce evidence-based practice research as to why the “old way” may not be as beneficial to the patient. It could then be determined if additional education is needed for the entire unit and in-services or classes could be provided.
Nurses are bound by the ethical code of non-maleficence, which is to avoid causing harm to patients. Performing a procedure that has been proven to cause more complications and harm would be going against that particular standard. The nurse also has a right to be true to their nursing promises to provide competent and quality care to their patients (fidelity). The nurse must be true to his/her own integrity and moral character, while also being true to patient care.
Besides, legally, the instructor cannot threaten the new nurse by insinuating they will lose their job if they do not perform the procedure in a specific way, for that would not be up to them and would lay with the hiring committee and managers/leaders. Notwithstanding, nurses come across barriers to practices and changes can be difficult to implement. It may take time for new procedural practices to be put in place and become the norm. Nursing is never stagnant, and unfortunately there are always senior nurses who have become stuck in traditional ruts. Yet all it takes is one nurse to challenge the “norm” and pave the way for safer nursing habits and processes.
Student #2: The new nurse should be very courteous with her instructor but explain that she is not comfortable doing things that way and that is not the way that she was shown or told to do the procedure. If the instructor will not listen to reason, then there are numerous other people in the facility that are higher up than the instructor and they need to be told what is going on and why the new nurse will not do things the way the instructor wants her to.
An ethical principle is how does this procedure affect the patient.”The process involves gathering facts, thinking about the options, and negotiating a solution. It also means being sensitive to patients’ values and being able to gain their trust.” (“How Physicians Make Ethical Decisions”, 2021) If it does more harm than good than it is an ethical problem and if our gut tells us that something is not right, 99.9% of the time, we need to listen to that gut feeling. We know that if we have been taught something and it doesn’t feel right or safe that it becomes a moral dilemma for us to face the issue when there is a controversy over it.
“Doctors and other medical professionals also owe a duty of care to their patients (Links to an external site.), to provide treatment that is in line with the “medical standard of care (Links to an external site.),” which is usually defined as the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances that led to the alleged malpractice.
So, medical negligence occurs when a doctor, nurse, surgeon or any other medical professional performs their job in a way that deviates from this accepted medical standard of care. In keeping with our car accident analogy, if a doctor provides treatment that is sub-standard in terms of accepted medical norms under the circumstances, then that doctor has failed to perform his or her duty, and is said to be negligent.” (“Medical Negligence”, 2021)
In the end, it is ultimately our nursing license on the line and we have all worked too hard to allow someone that wants to perform risky procedures to jeopardize our careers.
NUR445 Discussion Post
Step 1 Share your finalized proposal for your course project.
In a post of approximately 150 words, describe your finalized proposal for the course project. Include the quality improvement measure, the location, and the credentials of your preceptor. Share any new feedback, questions, or concerns that have developed.
Step 2 Read other students’ posts and respond to at least two of them.
In each of your response posts, include one creditable research article and summarize or evaluate its use to support your peer’s project.
NUR445 Student Posts:
Student#1: My proposal for the course project includes, interventions to improve team effectiveness and collaboration within the work place. Teamwork is essential for providing care and is therefore prominent in healthcare organizations. A lack of teamwork is often identified as a primary point of vulnerability for quality and safety of care (Buljac et al., 2020). Nurses being able to communicate efficiently during teams rounds and to address patient concerns is vital in providing optimal collaboration of care.
Quality improvement entails continuous efforts to achieve stable and predictable process results, that is, to reduce process variation and improve the outcomes of these processes both for patients and the health care organization and system (“Approaches”, 2017). To improve the ways care is delivered to patients when it comes to inter-professional cooperation. The location is the number one non-profit magnet hospital in the state of Florida, UF Health. The credentials of my preceptor are a master’s degree in nursing education with a minor in hospital administration. Effective collaboration of care encourages intensive care patient population to be active participants in their family’s treatment process. Effective communication and respect are critical when implementing a plan of care, this can cause concerns between attendings and nurses due to lack thereof.
Student #2: My project proposal involves research and evidence-based practice guidelines surrounding automated medication dispensers versus manual medication carts/units. My primary question is what are the differences between automated medication machines and manual units? Leading to my secondary question of are there less medication errors while using automated machines over manual units? My third question is an add-on, looking at those who use medication dispensing systems and their opinions on which they believe is best for their facility/practice.
I plan on using an outcomes measurement, seeing as outcomes-based measurements reflect the impact of the health service or intervention (AHRQ, n.d.). I also plan to look back at electronic medication records to gather data on medication errors, error reporting systems, and observe nurses using both automated and manual medication units to determine their opinions.
This project will be conducted at Cascades at Riverwalk, a rehabilitation and short/long-term nursing facility in Utah. We currently have both types of medication distribution systems. My preceptor is still to be determined and the process is in the works.
0 comments