Nurses are required to make many immediate decisions in their assigned duties. Unfortunately, in recent years, patient care has often been compromised as a nursing shortage crisis has escalated to epic proportions. Increased patient loads have resulted in often hasty nursing decisions as responsibilities and hours worked have increased. Although precious time must be spread thin to accommodate higher numbers of patients, nurses must exercise their morals through consistency in ethical behaviors. According to Peggy Chinn (1), "Many ethical issues, such as end-of-life decision making, have increased in complexity. Other issues, such as advocacy and choice, have changed in certain respects but are more clearly centrally situated within nursing's ethical domain."
As a result, nurses are held accountable for a variety of decisions in nursing practice and in many instances, a patient's life depends on such decisions to survive. Gastmans (496) states that "Generally, the goal of nursing activity is described as the promotion of the well-being of the patient by providing good care in the wider meaning of the word (i.e. The physical as well as the psychological, relational, social, moral, and spiritual levels). Nurses participate in an ethical practice. In each particular situation, they have to make personal choices and decisions based on the good that nursing practice sets as a goal. The ethical practice becomes concrete through the personal relationship between the nurse and the patient. The quality of nursing care must always be seen in the light of the relationship between a unique nurse and a unique patient. The patient cannot be considered as a passive object to which a core strategy is to be applied." The following will provide a discussion of nursing ethics and the situations that often lead to a compromise of quality patient care and radical ethical decision-making processes in nursing practice, and conclusions will be drawn regarding the ways in which ethical dilemmas can be resolved.
Data Collection and Assessment of Data
Patients often encounter incidents where they require additional care and treatment. Unfortunately, in those times of need, other patients are often neglected because full attention is required elsewhere. As a result, shortcuts are often taken in daily nursing practice in regards to patient needs. A primary concern of nurse administrators is the allocation of resources to provide the best possible patient care in times when staffing shortages are highly prevalent: "Nurse administrators are faced with several difficulties in allocating resources. A conflict exists between nurses' perceived need to contain costs and the need to do what is reasonably possible to promote the health of an individual" (Sariknoda-Woitas and Robinson 75). As a result of limited resources and excessive responsibilities, nurses are constantly faced with many situations that require their immediate attention. Nursing responsibilities are often spread too thin and often a lack of control over patient practice results in mistakes and errors. A lack of control over nursing practice is the ethical dilemma that will be discussed in the remainder of this paper.
A fictional situation will be presented that can easily be mirrored in real life situations. A nurse begins her assigned shift at 7AM. She arrives at 6:40 AM to prepare for the day and to review her assigned patient load. She is dismayed to discover that she will be assigned seven patients that day because two nurses have called in sick. Therefore, she immediately realizes that she must utilize her time well throughout the day. At 9AM, she encounters her first distress call of the day as a patient rings her bell for assistance. The nurse enters the room and finds the patient experiencing chest pain. She performs an assessment of the situation and recognizes that she requires assistance from other staff. All the while, she has forgotten that five minutes earlier, another patient with a history of mental instability requested assistance with his IV as it was bothering him. She promised to return to fix the problem, but she then became distracted by the patient with chest pain. As another nurse and a patient care assistant arrive, the patient's condition worsens and eventually, she stops breathing. A code blue is called and a doctor arrives shortly thereafter.
Unfortunately, after attempting to resuscitate the patient for several minutes, the patient dies. The nurse is noticeably disturbed by the turn of events and leaves the room so that the nursing assistants can properly clean up the patient. Over an hour has passed since the nurse last visited the room of the patient with the IV problem, and she finally recalls that the patient requires assistance. She enters the room and the patient is very displeased that he has been ignored, and the nurse apologizes and attempts to explain that an emergency required her attention. She replaces the patient's IV and notices that excessive bruising has occurred as the patient tried to remove it himself in the interim as he became agitated from the soreness in his arm. Once the situation has been settled, the nurse is disturbed because she neglected to check on the patient in need. She makes notes on the patient's IV change and bruising, but she does not acknowledge the lack of patient attention in the chart. Although the decision is not extreme, the nurse is plagued with guilt for her decision to withhold information regarding the reasons for the patient's bruising. The nurse has always practiced with the utmost ethical judgment in her five years of service. However, she is faced with significant pressures in her daily activities and the stress became too great to overcome. The healthcare organization has always set the standard for quality and ethical behavior in the local geographic area, and their status as a Magnet hospital for nursing excellence has demonstrated their ability to attract and retain a pool of excellent, highly qualified nurses. Unfortunately, no matter what the situation may be, nurses are faced with such great pressure that they are often required to prioritize their responsibilities that lead to the compromise of quality care.
The primary ethical consideration in this problem is defined as neglecting to check on a patient with an IV problem who took matters into his own hands when his assigned nurse failed to return for a follow-up visit when her presence was required in an emergency situation. As a result, the nurse abandoned her ethical framework when she reported the bruising resulting from the patient's need to pull out the IV, but did not report the time lapse in care that resulted in the physical consequences. The patient is not likely to suffer any permanent damage from the events of the incident, but the physical effects are apparent during the remainder of the hospital stay. Unfortunately, incidents such as the one described here are relatively common during a nursing shortage, when responsibilities and demands are in excess during assigned shifts and patient care ultimately suffers. According to Judith A. Erlen, "Nurses feel overwhelmed by this [nursing] shortage. They are exhausted because they are carrying demanding patient loads and are working overtime. There are not enough nurses to provide the quality of patient care that is needed; the number of staff is inadequate. Hospitalized patients are more acutely ill; nurses have more patients in their caseload. Eight-hour shifts are often becoming 16-hour shifts. These factors are taking their toll. Nurses are fearful that they will make mistakes, will harm patients, and will harm themselves" (62). Unfortunately, in this particular situation, the nurse was so overwhelmed by the emergency that she failed to recognize the importance of the IV patient and did not ask another nurse to check on him. This can be attributed to the time required to assist the patient with chest pain, but the nurse might have been able to grab another nurse on her way to the other room. Unfortunately, the patient is now left with temporary bruising that is causing soreness and discomfort. The nurse feels responsible but is ashamed to admit her neglect in formal charting. Therefore, she does not disclose this information as she is required. Many external factors contribute to the problem in question, including the overall design of the healthcare delivery system as well as the excessive demands placed on fewer available nurses to perform at maximum performance levels throughout the shift. It is possible that the nurse will experience a number of long-term consequences as a result of her decision: "The goal of nursing is to provide respectful, competent care to protect the welfare of patients. Yet, most nurses are employees of an institution. As a result, conflicts arise for nurses because the institution's policies and the needs of the patient may be at odds" (Erlen 77). Care is often compromised as a result of the necessity to provide quality care for a large number of patients simultaneously, and this situation opens the door to a variety of ethical considerations.
Consideration of Possible Actions
In relation to utilitarian principles, the potential health of the patient affected and the overall happiness…