Nursing Leadership

Taking a Stand (Leadership)
In nursing, one is bound to encounter a wide range of moral and ethical challenges. This is more so the case given that as nurses, we often have to work with various kinds of people, often during challenging moments in their lives. All these people have personal expectations and demands. Trying to balance these demands and harmonize the various needs of those we come across could be a challenge. This is more so the case given that we also have to take into consideration the interests of other stakeholders in the entire care-giving equation. In the final analysis, this means that from time to time, we encounter situations that call upon us to reconcile our nursing profession duties and obligations with our personal or individual values. It should be noted that when it comes to navigating the ethical and moral minefield, the relevance of the nursing code of ethics cannot be overstated. In addition to helping us address moral dilemmas deep within ourselves, the nursing code of ethics comes in handy in seeking to avert malpractice litigation or disciplinary issues. It is important to note that although not all moral and ethical challenges can be solved or sorted out by way of making references to the nursing code of ethics, familiarizing oneself with the same does indeed make things easier towards this end. According to Smith, Carpenter, and Fitzpatrick (2015), ethical decision making capabilities develop over time. Our hope, therefore, also lays in constant exposure to circumstances or situations that challenge us from an ethical or moral point of view. This text examines a moral dilemma encountered by the author and analyses the legal as well as ethical and moral implications the dilemma posed. The role of the author as a moral agent in the entire situation, and the role of her approach to leadership in the entire setup will also be defined.
I have encountered a number of moral and ethical dilemmas in my nursing practice. Some of these were easier to solve upon reflection, while others posed a real challenge. The most challenging, and perhaps the most memorable ethical/moral dilemma I have faced in recent times involved two of my colleagues at work. In addition to sheer incompetence, the said peers were often extremely rude to patients and their visitors, and often neglected basic duties or roles of care. While one was a habitual drunk and would often show up for his shifts reeking of alcohol, the other was a loner who appeared to have stress and anxiety issues. From time to time, they both reported for shifts late and were dismissive of simple requests of patients. The loner colleague was particularly notorious for being rude to relatives and friends of patents. She appeared to deem enquiries on the progress of patients as a bother of some sort and would be quite dismissive in her responses. In one particular instance, the drunk colleague misread an 800 mg phenytoin IV as 1800 mg. It was through sheer luck that he was stopped by a colleague moments before proceeding with administration of the same. It is important to note that in this case, the said phenytoin was only available in 250 mg/1 mL vials. In that regard therefore, what my colleague ought to have had in the IV bag was an equivalent of 3.2 mL which would have taken a total of four vials. Had my colleague proceeded with the administration, the patient would have most likely died of an overdose. This incident was not reported.
In this case involving my workmates (and teammates), I had the option of either reporting my two colleagues or simply staying quiet. It is important to note that at the time, the institution was facing a serious staffing shortage. Overtime hours were common in an attempt to address the situation. Here were two team members who were being clearly incompetent, yet reporting them would have meant that the institution take drastic action as this would have raised serious concerns. As a matter of fact, they were likely to be sent away. This would have effectively worsened the staffing shortage we were having at the time. Further, the two clearly had issues in their lives. If they were sent away for incompetence, this would most likely trigger a downward spiral in their lives. Did I really want to be responsible for destroying someone else’s life and livelihood? Also, there was the risk that my other colleagues would perhaps view me as a ‘betrayer’ of sorts for speaking up. On the other hand, failure to report these two colleagues of mine would have meant that they continue executing their duties the very same way they had been executing them in the past. This was a great concern as patient safety and wellbeing could continue being threatened in such a case. What I was encountering in this particular case were two competing obligations. There was the perceived obligation of protecting my two colleagues, and that other obligation of standing up to the wellbeing of patients. In the end, I took time to determine all the courses of action available. Talking to the two was out of question as several other colleagues had in the past engaged them without much success. The only valid option was reporting them. My obligation to safeguard the patients’ interests overrode my obligation to protect my two colleagues. I effectively embraced the whistleblower role, which is defined by Mansbach, Kushnir, Ziedenberg, and Bachner (2014) as “the reporting of illegal, immoral, or illegitimate practices to persons or organizations that may affect the action.” It is important to note that in relation to this particular case, our code of ethics obliges us to be advocates for patients. We are called upon to intervene whenever the safety as well as rights of patients are threatened. Indeed, as Maurits, Veer, Groenewegem, and Francke (2016) observe, “according to the International Council of Nurses’ code of ethics, nurses have to take appropriate action to safeguard patients when their health is endangered by a colleague.” In the final analysis, therefore, my ethical obligation was clear: witness misconduct ought to be promptly reported. This is more so the case given that the American Nurses Association Code of Ethics also proclaims this course of action in no uncertain terms. It should, however, be noted that in as much as I had an ethical obligation to report, I did not necessarily have a legal duty to do so. This is more so the case given that as Burman and Dunphy (2011) note, various states have different legal reporting requirements. My state does not expressly require nurses to divulge, reveal, or disclose misconduct on the part of their colleagues
As per the Keirsey Temperament Sorter, I am more of a rational. Towards this end, I tend to be self-assured and controlled, and my judgment of issues is not often influenced by mere feelings or the opinion of other people. I also approach problem solving from a realistic and most reasonable perspective. In this particular dilemma, my leadership approach would play an enabling and facilitative role. It would not be a barrier. This is more so the case given that in this case, I made a decision on the basis of what appeared reasonable and logical. I elected to remain true to the Nursing Code of Ethics and play my role of promoting the wellbeing of patients.





















References
Burman, M.E. & Dunphy, L.M. (2011). Reporting Colleague Misconduct in Advanced Practice Nursing. Journal of Nursing Regulation, 1(4), 26-31.
Mansbach, A., Kushnir, T., Ziedenberg, H. & Bachner, Y.G. (2014). Reporting Misconduct of a Coworker to Protect a Patient: A Comparison between Experienced Nurses and Nursing Students. The Scientific World Journal, 4(8), 84-97.
Maurits, E.M., Veer, A.J., Groenewegem, P.P. & Francke, A.L. (2016). Dealing with Professional Misconduct by Colleagues in Home Care: A Nationwide Survey among Nursing Staff. BMC Nursing, 15(9), 59-68.
Smith, M.J., Carpenter, R. & Fitzpatrick, J.J. (Eds.). (2015). Encyclopedia of Nursing Education. New York, NY: Springer Publishing Company.