Nursing Ethics: Reporting Colleague Misconduct as a Moral Agent

Introduction: Ethical Challenges in Nursing Practice

In nursing, one is bound to encounter a wide range of moral and ethical challenges. This is especially true given that nurses routinely work with many different kinds of people, often during the most difficult moments of their lives. All of these individuals carry personal expectations and demands, and trying to balance those demands while harmonizing the needs of everyone involved can be extraordinarily difficult. Nurses must also take into consideration the interests of other stakeholders in the broader care-giving equation. Ultimately, this means that nurses periodically encounter situations that call upon them to reconcile professional duties and obligations with personal values.

When it comes to navigating the ethical and moral challenges of nursing, the relevance of the nursing code of ethics cannot be overstated. In addition to helping nurses address moral dilemmas from within, the code of ethics is also instrumental in averting malpractice litigation or disciplinary issues. Although not every moral and ethical challenge can be resolved by reference to the code of ethics, familiarizing oneself with it does make navigating such challenges considerably easier. According to Smith, Carpenter, and Fitzpatrick (2015), ethical decision-making capabilities develop over time. Our hope, therefore, also lies in constant exposure to circumstances and situations that challenge us from an ethical or moral standpoint.

This paper examines a moral dilemma encountered by the author and analyzes the legal as well as ethical and moral implications that dilemma posed. The role of the author as a moral agent, and the role of her approach to leadership in that situation, are also discussed.

The Moral Dilemma: Incompetent Colleagues and Patient Safety

Nurses encounter a number of moral and ethical dilemmas in practice. Some are easier to resolve upon reflection, while others pose a genuine challenge. The most challenging — and perhaps the most memorable — ethical dilemma the author has faced in recent times involved two colleagues at work. In addition to sheer incompetence, these peers were often extremely rude to patients and their visitors, and frequently neglected basic duties and responsibilities of care. One was a habitual drinker who would regularly show up for shifts smelling of alcohol; the other was a withdrawn colleague who appeared to struggle with stress and anxiety. Both reported for shifts late from time to time and were dismissive of simple patient requests.

The second colleague was particularly notorious for being rude to the relatives and friends of patients. She appeared to regard inquiries about patient progress as a nuisance and would respond dismissively. In one especially alarming incident, the first colleague misread an 800 mg phenytoin IV order as 1800 mg. He was stopped by a coworker only moments before administering the dose — a stroke of luck, given that phenytoin was available only in 250 mg/1 mL vials. The correct dose would have required 3.2 mL across four vials; had he proceeded with the incorrect amount, the patient would most likely have died of an overdose. This incident was never reported.

Faced with the conduct of these two colleagues, the author had to choose between reporting them or remaining silent. The situation was complicated by the fact that the institution was experiencing a serious staffing shortage at the time, with overtime hours commonplace. Reporting two team members for clear incompetence would likely have prompted drastic institutional action — possibly their dismissal — which would have worsened the staffing problem. There was also a human dimension: both colleagues were clearly struggling in their personal lives, and reporting them risked triggering a downward spiral. The author also weighed the possibility that other colleagues might view the act of reporting as a betrayal.

Competing Obligations and the Decision to Report

On the other hand, remaining silent would have allowed both colleagues to continue practicing in exactly the same manner, posing an ongoing threat to patient safety and wellbeing. What the author confronted, at its core, was a conflict between two competing obligations: a perceived duty to protect colleagues, and a professional duty to advocate for patients.

After careful deliberation, the author concluded that speaking directly to the two colleagues was not a viable option, as several others had already attempted this without success. The only valid course of action was to report them. The obligation to safeguard patients overrode the obligation to protect colleagues. In making this choice, the author embraced the whistleblower role, which Mansbach, Kushnir, Ziedenberg, and Bachner (2014) define as "the reporting of illegal, immoral, or illegitimate practices to persons or organizations that may affect the action."

The nursing code of ethics supported this course of action unambiguously: nurses are obligated to advocate for patients and to intervene whenever patient safety or rights are threatened. As Maurits, Veer, Groenewegen, 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." The ethical obligation, therefore, was clear: witnessed misconduct must be promptly reported.

The American Nurses Association Code of Ethics also affirms the obligation to report misconduct in no uncertain terms. It should, however, be noted that having an ethical obligation to report does not necessarily translate into a legal duty to do so. As Burman and Dunphy (2011) point out, various states have different legal reporting requirements, and not all states expressly require nurses to disclose misconduct by colleagues. In the author's state, no such express legal requirement exists.