Navigating Ethical Dilemmas and Professional Challenges in Nursing: A Reflective Analysis

QUESTION

Scenario:

You are a newly hired RN whose first assignment after graduation is in the recovery room of a hospital that specializes in cardiovascular procedures. You have learned the recovery room procedures quickly and have further developed your nursing skill set to meet the demands of the position. After working there for two weeks, you are assigned to Phoebe as a one to one nurse.

Phoebe is a 58-year-old woman who coded during valve replacement surgery and is not doing well in the recovery room. Nurses are only assigned one to one to the most unstable and critical patients. Phoebe finally regains consciousness several hours after surgery, although the endotracheal tube remains in place, and she is still connected to a ventilator. The surgeons speak to Phoebe about the severity of her condition and the likelihood that she may die, then they leave the recovery room.

Phoebe indicates that she wants a pen and a paper pad to write on because she cannot speak with the endotracheal tube in place. She writes about half a page, folds the note, and writes an address on it. Using the pad of paper, she asks you if you will send the letter out for her after you get home. You gladly agree.

Questions:

1. As the nurse caring for Phoebe, what are your priority concerns?

2. Are there any issues with sending the letter for Phoebe? Why or why not?

Scenario Continued:

As you leave the room, you fold the letter and place it in your pocket. As you walk out of the room, you notice that the recovery room supervisor has been watching your interaction with Phoebe. The supervisor motions you over to her, and the following conversation occurs.

Supervisor: What were you doing with the patient?

You: I’m just helping the patient write notes to her daughter.

Supervisor: Recovery room policies don’t allow it, and anyway, it is not part of your job to do such things. You’re here to keep the patients alive after surgery.

You: I was only trying to help the patient mail the note to her daughter because the physicians told her she might die soon.

Supervisor: We are not running a post office here!

You (angry response): Well, what do you want me to do with this note now?

Questions:

3. What ethical principles are involved in this situation?

4. Did you violate any ethical principles? Explain.

5. To whom do the nurses have an obligation? Why?

Scenario Continued:

The supervisor turns her back and walks back into her office. Several days later, the supervisor files an incident report stating that you violated recovery room procedures and were insubordinate because you argued with her. Because you are still in your six-month probationary period, you are reprimanded and then fired from the hospital.

Questions:

6. How might you have handled the situation differently?

7. What communication skills could you have used in dealing with this difficult person?

Scenario Final:

You really loved this position, felt like you were learning a lot, and enjoyed the unit you were working in. You also realized that having been fired from your first job as an RN may make finding a new job more challenging. You set up an appointment with the supervisor and Human Resources in an attempt to get your job back.

Questions:

8. What should you do

first in determining whether or not you were wrongfully terminated?

9. What other elements might have been factors in the supervisor’s response to you?

10. What lessons can be learned from this situation?

ANSWER

Navigating Ethical Dilemmas and Professional Challenges in Nursing: A Reflective Analysis

Introduction

This essay explores a challenging scenario faced by a newly hired RN in a cardiovascular recovery room. The nurse is assigned to care for Phoebe, a critically unstable patient who regains consciousness after valve replacement surgery. The essay addresses the priority concerns in caring for Phoebe, the ethical principles involved in the situation, potential violations of ethical principles, the obligations of nurses, the supervisor’s response, alternative approaches to handling the situation, communication skills for difficult interactions, steps for addressing wrongful termination, factors influencing the supervisor’s response, and lessons learned from the experience.

Priority Concerns in Caring for Phoebe

As the nurse caring for Phoebe, the priority concerns include monitoring her vital signs, ensuring proper oxygenation through the ventilator, assessing and managing any pain or discomfort, monitoring her neurological status, maintaining the stability of the ventilator and endotracheal tube, and providing emotional support to both Phoebe and her family during this critical time. Ensuring Phoebe’s physical and emotional well-being takes precedence in this situation.

Issues with Sending the Letter

There are potential issues with sending the letter for Phoebe. As a nurse, maintaining patient confidentiality and privacy is crucial. Without knowing the contents of the letter or having explicit consent from Phoebe, it would be inappropriate to handle or disclose personal information without proper authorization. Therefore, the nurse should refrain from sending the letter without clear instructions or consent.

Ethical Principles Involved

Several ethical principles come into play in this situation, including autonomy, beneficence, non-maleficence, veracity, and confidentiality. Phoebe’s right to autonomy is respected by providing her with a means to communicate, but the nurse must also ensure that the patient’s well-being is prioritized by adhering to professional standards and maintaining confidentiality.

Potential Violations of Ethical Principles

The nurse may have violated the principle of confidentiality by handling and reading the letter without explicit consent or a clear understanding of its contents. Additionally, arguing with the supervisor can be seen as a breach of professional conduct and could be perceived as a violation of respect and collegiality.

Obligations of Nurses

Nurses have obligations to their patients, including providing safe and competent care, respecting patient autonomy, maintaining confidentiality, and advocating for their patients’ well-being. They are also responsible for following established policies and procedures within their healthcare setting.

Alternative Approaches and Communication Skills

To handle the situation differently, the nurse could have respectfully explained to the supervisor the context and importance of the patient’s request, seeking clarification regarding the policy rather than engaging in an argument. Effective communication skills, such as active listening, empathy, and assertiveness, could have been employed to foster understanding and negotiate a resolution.

Determining Wrongful Termination

To determine whether the termination was wrongful, the nurse should consult the hospital’s policies and employment contract, seeking legal advice if necessary. Understanding the terms of employment and potential violations can guide further actions.

Factors Influencing the Supervisor’s Response

Several factors could have influenced the supervisor’s response, including adherence to established policies, concerns regarding patient privacy and liability, time constraints, and potentially limited understanding of the situation’s context. Stressful work environments and power dynamics may also contribute to the supervisor’s reaction.

Lessons Learned

From this situation, important lessons can be gleaned. First, maintaining patient confidentiality and adhering to professional standards are paramount. Second, effective communication and conflict resolution skills are essential in navigating challenging interactions with supervisors or colleagues. Third, understanding and respecting organizational policies and procedures are crucial for maintaining professional conduct. Finally, reflection on personal actions and continuous professional growth can help nurses navigate ethical dilemmas and professional challenges effectively.

Conclusion

The scenario presented challenges for a newly hired RN in the recovery room, highlighting ethical dilemmas, communication difficulties, and the consequences of an adversarial interaction with a supervisor. By considering the priority concerns in patient care, ethical principles, alternative approaches, and lessons learned, nurses can develop the skills necessary to navigate similar situations more effectively in the future. Through ongoing reflection and growth, nurses can contribute to a supportive and ethical healthcare environment while ensuring the provision of high-quality patient care.