Taking a Moral, or Ethical, Stand in Today’s Society

Taking a Moral, or Ethical, Stand in Today’s Society

As a leader there are certain challenges that one should always expect to arise. At some point in the nurse’s career, they will come across a moral, ethical, or legal issue that must be resolved and at that point they will need to decide if it is in their best interests to make a stand or continue to roll with the punches. To take that stance, one must first know the differences between moral, ethical, or legal dilemmas. The purpose of this paper is to evaluate an issue and consider how I would act as a moral agent or advocate, facilitating the resolution of the issue for a positive outcome.

Conceptual Frameworks of Ethical Constructs

According to Marquis (2017): Ethics is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are. In many facilities, there are now ethical committees available to answer any questions a staff member may have about issues they determine to be questionable in content or application. These committees are generally made up of someone from the education department, chaplain services (if available), senior management personnel and longstanding nurses from various floors or disciplines.

There are multiple terms used to define moral issues within the nursing field, however three of the most important definitions include moral distress, moral outrage, and moral or ethical dilemma. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action (Marquis, 2017). Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it (Marquis, 2017). Lastly, the most difficult of all moral issues is termed a moral or ethical dilemma, which may be described as being forced to choose between two or more undesirable alternatives (Marquis, 2017).

The primary purpose of law and legislation is to protect the patient and the nurse (Marquis, 2017). Laws and legislation define the scope of acceptable practice and protect individual rights (Marquis, 2017). Nurses who are aware of their rights and duties in legal matters are better able to protect themselves against liability or loss of professional licensure (Marquis, 2017). It is of vital importance for the practicing nurse to stay abreast of all new changes to the legal aspects of their career. Not only will these changes affect patient rights, but also how the nurse is required to perform their duties and maintain their licensure.

An Ethical Issue With Moral Grounding

An ethical issue that I had when I first became a nurse involved a woman and her daughter that had gotten into a car accident. The mother had broken her leg in two places and remained in the hospital for four days while the doctors argued over what they were going to do with her. They had refused to fix the fractures because the family had no health insurance. Rather than shipping her out immediately to a facility that would care for her, the doctors continued to argue and shift care amongst each other while avoiding actually taking responsibility.

The nurses that cared for this lady throughout the four days were angry about the lack of care being delivered, but none of the nurses were willing to stand up to the doctors in order to garner the help needed for this family. On the last day she was there, I was her nurse. She was crying because she hadn’t been allowed to have enough pain medication to sustain her elevated pain levels while being connected to traction. This went beyond what I was willing to put up with as a new nurse. At the time that I began working as a nurse I had already been running my husband’s successful company and had about 12 years worth of business experience on my side.

This attitude gave me a confidence that many of my fellow new hires lacked. I believed, and still firmly believe, that all life should be treated equally and with dignity, regardless of the amount of money they had in their bank accounts. If I wasn’t getting the answer I liked I was not afraid of going over anyone’s head until I got what I wanted. When I went into the lady’s room and saw her crying from the pain and saw how it upset the entire family dynamic it infuriated me. I immediately got on the phone with her primary who tried to give me the run around. He directed me to the orthopedic surgeon and stated that he was the one who was trying to find a surgeon to accept her without insurance. I called the surgeon who informed me that he did not deal with pain meds and to call her primary. After notifying the primary of this statement he had the gall to try to attack me. Not a wise move on his part as I immediately let him know that his negligence on this patient’s behalf bordered on criminal.

I hung up with him and immediately went to the hospital administrator’s office. I explained the situation to him and told him the patient had been in the hospital for the last four days with minimal pain medication and that this was going to turn into a PR nightmare if we did not act immediately and get this patient either in the operating room or transferred to another facility. The house supervisor was immediately brought in and the physician and surgeon were also called. In the end, the patient was transferred within two hours to a county facility where the surgeon was waiting to take her to surgery. The hospital administrator was quick to reprimand the physician and the surgeon was fired due to this being yet another complaint placed in his file.

Ultimately, the patient was taken care of, but it was too little too late. Her family notified a local news channel of the shabby treatment she received and the hospital had to undergo an extensive investigation from the state. For myself, I was commended for taking the initiative and going above and beyond for my patients. I steadily rose in the ranks there until I became the manger on the floor. To me, this was an invaluable lesson in many different areas for my future career. I chose to be an advocate for my patient rather than to accept her situation as the other nurses had done. I took a risk that I would possibly lose my job by my actions that day, but I did not regret the decisions I made or the peace that it brought to the family and patient.

Due to the bad press the hospital received, they began to utilize classes for the physicians and staff in ethics and it became mandatory for all people unable to pay, or with a lack of health benefits, to be transferred to other facilities within an eight hour window of diagnosis. According to Ghazal, Saleem, and Amlani (2014): as a quality indicator, health care organizations can continuously observe the patterns of error and use this data to improve their system. This need for an ethics committee to be readily available to the staff is a definitive way for the nurses and staff to be able to utilize as many resources as they can while taking care of patients.

Self-Assessment Leadership Style

According to my Kiersey Temperament Sorter results I fall under the guardian style of leadership. Guardians tend to be dutiful, cautious, humble, and focused on credentials and traditions (Personality Test – Keirsey Temperament Test, n.d.). They pride themselves on being dependable, helpful, and hard working (Personality Test – Keirsey Temperament Test, n.d.). Guardians make loyal friends, responsible parents, and stabilizing leaders. They also considered the cornerstone of society and make up 45% of the population (Personality Test – Keirsey Temperament Test, n.d.). They are meticulous about schedules, proper procedures, and following the rules (Personality Test – Keirsey Temperament Test, n.d.). These leadership qualities have shown to be a very large part of who I am, not only as a nurse but also in my private life. It is this set of skills and personality traits that lead me to be the conscientious nurse that I am. They have governed my practice and will continue to do so throughout the rest of my career.

Though these attributes seem splendid on the surface, they can also present their own challenges. Some of these challenges include an inability to always see the gray areas of situations. Loyalty is a giant part of who I am and that tends to make me see close friendships through rose-colored glasses at times. I have a hard time showing very much emotion, even though I do have emotions, and people tend to be intimidated by me. I believe in facts and have little time or patience for nonsense while I am at work. I have very definite boundaries and tend to stay within those confines until I become familiar with those around me. These drawbacks are things that I must work at on a continual basis and must keep uppermost in my consciousness at all times in order to put those around me at ease.

Summary

In every career there will come a time for each person where they will be forced into an ethical, moral, or legal dilemma of some sort. In order to make the best possible decisions it is imperative that we understand the constructs of ethics, morals, and legal standards. These times can be frightening to many, as most people do not want to cause waves within their organizations, however when lives are at stake courage cannot be allowed to flag. My staunch beliefs in right and wrong have carried me successfully throughout my life and career. These choices can be intimidating at times, but I try to always err on the side of my patients.

References

Ghazal, L., Saleem, Z., & Amlani, G. (2014). Resolving ethical dilemma: An application of a theoretical model. Khyber Medical University Journal. 6(3). 135-138. Retrieved May 6, 2018 from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=3&sid=e09714ae-0f4e-4b1d-bc41-817df1ba9e5f%40sessionmgr103

Kiersey Temperament Website. (n.d.). Personality Test. Retrieved May 6, 2018 from https://profile.keirsey.com/#/temperament

Marquis, B. (2017). Leadership Roles and Management Functions in Nursing: Theory and Application, 9th Edition. Wolters Kluwer Health, 20170126. VitalBook file.