HA 570 Health Care Ethics Unit 9 Assignment

Unit 9 Assignment

Kaplan University

Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of 6 months, she noticed that all patients admitted from the Shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis. There appeared to be patient abuse in the nursing home. Mrs. Lewis investigated discreetly and found no explanation possible except abuse. In accord with the obligations of the law in her state, she reported the matter to the Department of Welfare Bureau of Inspection.

The Welfare Department investigated immediately, found proof of abuse, and threatened to close down Shady Rest if there were any more recurrences. Mrs. Lewis was overjoyed until her hospital administrator, bypassing the director of nursing, called her in and warned her that she would be fired if she reported any other instances of abuse. Shady Rest sent the hospital a lot of business, and good relations had to be maintained.

Mrs. Lewis was even more shocked when she discovered that the administrator was a golf partner of the owner of Shady Rest and was doing an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a lawyer, who threatened the hospital with exposure and with penalties that would follow if one of its employees failed to follow the reporting provisions of the law on abuse in nursing homes.

Did Mrs. Lewis act correctly? What should she have done if she could not have afforded to consult with a lawyer? In what ways can whistle-blowers protect themselves? Must the art of intimidation be part of the toolbox of healthcare professionals in order to protect their patients? Is power an appropriate consideration in healthcare ethics?

Mrs. Lewis did, in my opinion, act appropriately in this case, regardless of who the persons were in involved. When we are presented with a situation that requires us to make an ethical decision we must make it based on the evidence and the situation, not persons involved, co-workers we like, or the fear of losing our job. As cruel as it sounds, but we as a healthcare professional do have an ethical commitment to our patients first and foremost. She also has an obligation as a healthcare professional and the state law to report any nature of abuse, especially pertaining to vulnerable adults and/or children. When any healthcare professional are hired they are mandated my state requirements to orient the employee on the policies and procedures of suspected abuse. A good example of this would be in my assisted living business. I am mandated by State of Maryland Office of Healthcare Quality, COMAR regulations to orient and train all new employees within 72 hours of their start date on steps to be taken in suspected abuse of any patient. I also have a poster that must be posted at all times about whom and where to contact is abuse is suspected. It can be done anonymously. If it is done anonymously then the state will send a state office of healthcare quality surveyor to my facility investigate the claim? In Mrs. Lewis circumstances, if she would had that option just to report it anonymously then her boss might have suspected that it was her and her job would not be in question. He is merely the administrator, who took a state oath to protect the residents when he was granted his license. His obligation is to patients not his friend. If he has lost sight of what is important then maybe he does not need to be the administrator because of clear misuse of power and regards for patient safety and quality of care.

Having Mrs. Lewis’ administrator use his authority to reprimand her was a deliberate use of power of his position to over step the imposed legal laws of the state as it relate to reporting suspected child abuse. He is in a position to be removed from his own job as an administrator or the chance of being prosecuted by that state’s attorney general. The buddy that is a friend of the hospital administrator that has been turning his head to obvious abuse is in the same position. That is a detriment to any healthcare professional covering for the offenses of another health professional that undermines the quality and care of a patient. As stated before, Mrs. Lewis could have reported the abusive situation anonymously. The person reporting does not have to give a name but just the situation. Due to fact that Mrs. Lewis could not afford a lawyer, she can merely follow the procedures as a whistleblower on the administrator actions. Whistle-blowers are protected by laws in all states and should keep track of all of the information that has taken place while including any conversations with the administrator. “Whistleblower Protection Enhancement Act (WPEA) provides millions of workers with rights they need to report corruption and wrongdoing safely” (whistleblower.org). That being said, if her boss tries to retaliate against her for reporting the abuse she is covered under this act. Under this act an investigation will transpire and she will be protected from any wrong doing. The act also speaks about power and if any person of authority must not use intimidation to execute their office, they do not have power. Power is extremely misused in this case and used in wrong context because of the friendship, but it happens more than we would like to recognize it. To be coercive in all decisions is using the wrong method when it is not appropriate. The misuse of power is unethical in healthcare and should not be considered in healthcare. The reason being is misuse of power ultimately will affect the quality care of the patient. As a healthcare professional the patient is the most important person, not the power or ourselves. Misuse of power has no place ethically in healthcare. Power may be needed when there is a serious situation such as a disaster or someone needs help immediately but only for a short time. It is not to be abused or overused. One should report him also to his manger or owners of nursing home for abuse of power.

Case Two

Case Two

On a July weekend, Mrs. Allesfertig, nursing supervisor of the whole hospital, discovered that the intensive care unit was seriously understaffed. She pulled two nurses with previous ICU experience off other floors to bring the unit up to strength in view of the extreme level of acute care needed. On the following Monday, Dr. Bestknabe, who has overall responsibility for the ICU unit, closed the unit for further admissions until the staffing had been worked out on a permanent basis.

Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU?

In this case, the nurse who was supervising the hospital that weekend used her best judgment in maintaining the quality of care for patients and care for the ICU. At this time, there was no standard of care for an ICU unit that justified that the unit be closed on this particular weekend. Closing an ICU unit requires much care and consideration because there are sick people that may come through the emergency room that rely on the ICU unit for admittance. When the ICU unit is closed the patient typically stays in emergency room until a bed is located in the unit or they are sent to a unit that a step down from the ICU. If they are given a step down then the quality of care could be comprised. Mrs. Allefertig used the resources that she had within the hospital to keep the unit going and not jeopardize the quality of care for the patients was using the resources in the overall hospital for the good of the ICU, while managing the rest of the hospital. It has always been debated who has more authority the doctor or the nurses. In a hospital setting, do physicians have direct authority over any nurse? I realize there are charge nurses/a DoN/a clinical manager, and I also realize physicians tell the nurses what to do regarding the patient’s diagnosis, but would a physician ever have the authority to tell a nurse something that she made the wrong decision on to close an unit based on staffing issues. The better question is was the quality of care compromised because she let the ICU open over the weekend and the answer is no. I have seen firsthand when the unit was not closed but the amount of beds allocated the unit was reduced. Hospitals are licensed per bed per unit and at any time they can DE license the unit for the amount of beds until the staffing issue is rectified.

If a new policy is written on Monday and provides clear directions regarding the authority given to the nursing staff, then the nurses can refuse to admit patients when there is not sufficient staff. The policy would have to identify what would be done with patients that are not admitted. Clearly, in all cases if a nurse is given authority to manage the patient care of a hospital without physician oversight then, he or she would have to make judgment calls at times. Now if the policy is not changed then the physician who is charged of the unit would have to be on call and available to come to hospital to make the appropriate call.

Closing on the unit can also create a financial strain on the hospital. What if the hospital is underfunded? If they underfunded they not be allotted a pool of nurses to pool from thus creating a staffing issue. Many nurses already feel overworked and underpaid, so not giving them authority would create just another thorn in their side. Nurses would rather walk away them put patient care at risk, thus putting their license in jeopardy.

In the end, nurses should be allowed to make the decision whether to close the unit from accepting patients. Nursing are the ones that are on the front line battling for the care of the patients. They are concerned with the overall care and outcome of the patients. As a nurse you would be concerned about what happens to the patients they choose not to accept. They may be placed in harm’s way and not the care they need or deserve in an ICU unit, so therefore change the policy and give the nurses they authority they need to do their jobs efficiently.

References:

Aiken, T. D. (2009). Legal and ethical issues in health occupations (2nd Ed.). St. Louis, MO: Saunders/Elsevier

Advances in Patient Safety: New Directions and Alternative Approaches. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK43663/ on April 1, 2015

Understanding Your Communication Style. Retrieved from: http://www.au.af.mil/au/awc/awcgate/sba/comm_style.htm.

Wright, K. (2010). A Communication Competence Approach to Healthcare Worker Conflict, Job Stress, Job Burnout, and Job Satisfaction. Journal for Healthcare Quality, 33, 3-14.

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