Nursing Ethics and Academic Preparation of the ADN and BSN

Case Scenario: Nursing Ethics

Healthcare providers are in a profound position of trust in regards to the patients in their charge. In the case scenario, an ADN nurse and a transport tech were not sufficiently watchful of an elderly patient due to complacency and the fact that they were having a personal conversation. Although a nurse with an associate’s degree (ADN) and a bachelor’s-level prepared nurse would have different levels of expertise and thus differentiated essential competencies, it is important to note that both nurses would have greater expertise than the transport tech and would have a higher level of responsibility in the scenario. According to the Differentiated Essential Competencies (DECs) of the Texas Board of Nursing (2010), “Competencies were designed to demonstrate the progression of expectations across the types of nursing programs based upon educational preparation” (p.vii). Although some competencies are admittedly redundant and there is overlap between the two types of nurses, it is still important to be reminded of the fact that differences do exist.

Background of DEC and Application

The DEC was issued by the Texas Board of Nursing as a way to delineate the scope of practice from the Licensed Vocational Nurse (LVN) to the Registered Nurse (RN) at the doctoral level to ensure consistency of academic curricula and programs across the state. The scope of the competencies have been expanded to place an increasing emphasis on patient safety. For example, in regards to the above-cited scenario, an APN is required to “implement measures to promote quality and a safe environment for patients, self, and others” and “communicate and collaborate in a timely manner with members of the interdisciplinary health care team to promote and maintain the optimal health status of patients and their families” (DEC, 2004, p.8).

Bachelor’s-level prepared nurses have similar responsibilities in regards to promoting safety and working with all members of a healthcare team. Both types of nurses also have responsibilities in regards to delegating tasks when necessary on a healthcare team and families. But BSNs who have graduated from a four-year program must also communicate as leaders with “populations and communities” as well (DEC, 2004, p.17). Because of their additional education, they also have a leadership role in the wider scope of healthcare practice and function as teachers when acting as supervisors. While ADNs may act in a supervisory capacity to individuals such as the technician, a BSN is charged with acting, “using best practices of management, leadership,” and evaluation” skills (DECs, 2004, p.18).

After the Patient Fall: Legal Requirements and Competencies for Nurses

After the patient in the case scenario experienced a fall, both the ADN and BSN should “comply with mandatory reporting requirements of the Texas Nursing Practice Act” under Texas law and report the incident and in the future accept further training and instruction to ensure that such an incident does not happen again, in accordance with the idea that nurses should “obtain instruction, supervision, or training, as needed, when implementing nursing procedures or practices” (DECs, 2004, p.18). Both nurses also had a duty to evaluate the patient’s initial health status, an obligation which they did not perform adequately, given that the patient had been experiencing diarrhea and weakness.

As noted by Brent (2013), particularly when dealing with vulnerable populations such as the elderly, nurses often have a legal as well as an ethical obligation to report any issues which they encounter when providing care. This does not only include their own errors when providing care, as in the instance of the case scenario, but also the errors of other healthcare providers. In other words, a nurse would have to report the technician’s failure to provide care as well as her own. Reporting statutes include a requirement to report all injuries that the nurse has a good faith belief have arisen from neglect, not simply her own, but those of other providers (Brent 2013). Legally, a nurse will not be penalized, regardless of the case outcome, if the reporting is deemed to be in good faith (Brent 2013). From an ethical perspective, the duty to report is deontological, or rule-bound in nature, even if no harm results to the patient.

But while the ADN merely has a duty to analyze health-related problems and formulate goals, the BSN has an additional duty to synthesize such data. This suggests a greater ethical responsibility on the part of the BSN to teach and lead the healthcare team, and to be aware of the patient’s condition. For example, while the ADN, given her skills, may be said to have had a responsibility to note that the patient was showing signs of fatigue and unsteadiness, the BSN should have been aware of the patient’s previous condition and age and been aware of the fact that the patient might have had some additional health issues.

Additional Competencies for the BSN

Encouraging nurses to obtain at least bachelor’s level preparation has been increasingly stressed as important in the healthcare field, given the technological sophistication of modern medicine and the additional duties required to be performed of nurses in the face of a shortage of primary care physicians. There is also evidence that BSNs are less likely to make errors and having a higher percentage of BSNs improves patient outcomes as a whole for hospitals. According to a study by Blegen (et al. 2013), hospitals with a higher percentage of BSNs or higher degrees had lower mortality rates from congestive heart failure as well as lower rates of failure to resuscitate, deep vein thrombosis, pulmonary embolism (all conditions which are linked to higher-quality care) as well as shorter lengths of patient stays. This underlines the fact that BSNs have an ethical obligation to function at the highest extent of their professional competency as teachers and leaders of other nurses and patients. They have a critical role in fostering safe outcomes by anticipating problems given their knowledge of evidence-based literature.