What Ethical Dilemmas Do Registered Nurses Face?

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    Nurse Magazine

    What Ethical Dilemmas Do Registered Nurses Face?

    In the compassionate yet complex world of nursing, professionals are often met with ethical challenges that test their principles and decision-making skills. A Director of Nursing opens up about the intricacies of providing compassionate care to unvaccinated patients, while we also present additional answers that delve into the myriad ethical dilemmas faced by those in the field. From the fair distribution of medical resources to addressing colleague misconduct, discover how nurses navigate these tough situations.

    • Compassionate Care for Unvaccinated Patients
    • Managing Workload and Patient Priorities
    • Fair Distribution of Limited Medical Resources
    • Maintaining Patient Confidentiality
    • Respecting Patient Over Personal Beliefs
    • Addressing Colleague Misconduct Ethically

    Compassionate Care for Unvaccinated Patients

    Delivering high-quality care services is crucial in the care and treatment of unvaccinated coronavirus disease (COVID-19) patients. The need to show compassionate care to the patient has been preserved within the codes of conduct for health and social care professionals (American Nurses Association [ANA] Code of Ethics, 2022). We recently had a young unvaccinated COVID-19 patient requiring a lung transplant. The patient had no past medical history and was in good health prior to contracting COVID-19.

    Ethical issues arose when the clinicians started talking about how other vaccinated patients are more worthy of the lung transplant and quality care since the unvaccinated patient chose not to get vaccinated in the first place. However, even if a disease is preventable, healthcare professionals still have ethical obligations to care for their patients.

    As a healthcare leader, I provided education and awareness to our healthcare providers. Developing additional mechanisms for resilience and reflection, despite frustrations from preventable mortality, may assist the professional and the unvaccinated patients they care for. During the winter surge in Los Angeles County, hospitals have the ethical obligation to expand capacity management and concentrate on operations to care for unvaccinated patients, even if it means requiring vaccinated patients to wait for less urgent care, like cancer and heart surgeries.

    It is part of the professional ethics of healthcare personnel to be nonjudgmental toward the patient’s moral character and actions, as they relate to the causes and the background of his disease. Considerations of whether a patient is to blame for his disease should not affect the treatment he receives. In several situations, the nonjudgmental approach is difficult to fully achieve. It is not always easy for healthcare workers to encourage patients while refraining from blaming patients for past failures to carry through such decisions of not getting vaccinated.

    wThe goal of providing efficient care must be guided by the fundamental principles of fairness, equality, and compassion that represent our civil rights laws. Every patient possesses the same dignity and worth as everyone else. The patient had a successful lung transplant, came home to his family, and continued to serve our community.

    Melanie CarikerDirector, Keck Medical Center of USC

    Managing Workload and Patient Priorities

    Registered nurses are often tasked with providing the best possible care to their patients, but they can be hindered by extremely high workloads. The strain of numerous patients requiring simultaneous attention can lead to emotional fatigue and difficulty in making precise medical decisions. Nurses must constantly make tough calls on prioritizing who gets attended to first, which can weigh heavily on their conscience.

    This scenario tests the limits of their professional judgment and their ability to manage time efficiently. Nurses need to communicate effectively with their team and seek support when needed to ensure each patient receives adequate care.

    Fair Distribution of Limited Medical Resources

    Nurses must frequently make tough decisions on how to distribute limited medical supplies and attention among patients who all deserve the best care. This delicate balancing act can lead to mental distress as they try to be fair and use their judgment without favoritism. They are required to assess the situation, considering the urgency and the potential impact of their choices.

    It challenges their ability to remain impartial and to uphold their commitment to care for all patients equally. Nurses must strive to make informed decisions and advocate for additional resources whenever possible.

    Maintaining Patient Confidentiality

    Ensuring that a patient's private information remains confidential can be a complex task for nurses, especially when dealing with inquiries from well-meaning family members. Nurses must uphold the law and the trust of their patients, navigating the fine line between providing necessary information and maintaining confidentiality. They have to use their communication skills to handle sensitive situations without compromising on their professional obligations.

    The nurse's role includes educating families on privacy policies and the importance of respecting patient confidentiality. They should encourage family members to respect these boundaries and to understand that such policies are in place for the patient's protection.

    Respecting Patient Over Personal Beliefs

    Nurses often face situations where their personal beliefs are at odds with their patients' choices, leading to ethical tension. They have to respect the patient's autonomy while sometimes having to set aside their own values, which can be personally challenging. This dilemma requires nurses to demonstrate professionalism and a non-judgmental attitude, providing care that aligns with the patients' decisions.

    It is essential for nurses to engage in ongoing self-reflection and seek guidance through their professional support systems. They are encouraged to participate in open dialogues with peers and supervisors to navigate these conflicts effectively.

    Addressing Colleague Misconduct Ethically

    A nurse may sometimes witness minor misconduct by a colleague, which presents an ethical dilemma: to report the incident or to disregard it. The decision entails weighing the seriousness of the misconduct against the potential repercussions on team dynamics and the colleague's career. Nurses are expected to promote a culture of responsibility and integrity, ensuring that patient safety is never compromised.

    Reporting minor issues can be uncomfortable but necessary to maintain a standard of practice. They should consider the implications of their choice and act in the best interest of maintaining professional standards and patient care.