Who Will Watch the Watchers? Consider Nurses

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Sometimes my surgical mask feels like a gag/by Julianna Paradisi Sometimes my surgical mask feels like a gag/by Julianna Paradisi

Does anyone else find it ironic that, while the National Security Agency (NSA) is seeking to extradite and prosecute the contractor who revealed the agency’s alleged widespread spying on ordinary Americans and visitors from other countries, nurses can get fired for far more local breaches of privacy?

When the government gives 500,000 private contractors access to data hoards compiled from the electronic and phone conversations of U.S. citizens, is HIPAA still relevant?

Two years ago, the nurse blogosphere raged over the expulsion of three nursing students for posting the photo of a placenta on Facebook. Today, in light of the NSA’s potentially far-reaching privacy violations, the decidedly insensitive exploits of those students seem a bit less newsworthy.

More famously, the ordeal of Vickilyn Galle and Anne Mitchell, nurses who were fired after they blew the whistle on medical malpractice while exposing a conflict of interest affecting patient safety within the hospital, illustrates the high accountability placed upon nurses to protect patient privacy. […]

2016-11-21T13:06:59-05:00July 17th, 2013|Ethics, Nursing, Patients|2 Comments
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Obesity as Disease and the Health Care Culture’s Take on Personal Responsibility and Suffering

Doug OlsenBy Doug Olsen, PhD, RN, associate professor, Michigan State University College of Nursing, and AJN contributing editor. Olsen regularly addresses topics related to nursing ethics. His most recent article for AJN was “Helping Patients Who Don’t Help Themselves” (July issue; free until August 15).

Why does the American Medical Association’s recognition of obesity as a disease (AMA, 2013) stir strong feelings? People are just as heavy as before, their health is suffering as much, and the therapies for obesity remain the same. The main difference is that the label may give clinicians a better rationale to seek reimbursement for obesity-related services, which might help increase treatment rates. No one yet knows if the new label will really have an effect on treatment rates; in any case, this is not what people are concerned about.

The issue is what labeling a health problem with a behavioral component as a “disease” implies about personal responsibility—or what people think it means. How does personal responsibility relate to individual suffering?

The relationship between decision making, suffering, and personal responsibility is at the heart of bioethics as it is practiced in the United States. But bioethics didn’t invent our cultural tendency to connect personal responsibility and sympathetic regard for suffering, and our current approach to the issue was developed […]

2017-04-03T12:12:36-04:00July 11th, 2013|Ethics, patient engagement, Public health|0 Comments
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Telling Patients About Staffing Levels: Transparency or Self-Interest?

ethicsscreenshotIt’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?

The situation above is an ethical conundrum because values are in conflict. On one hand, transparency is good and patients have a right to know about administrative factors affecting their care. On the other hand, care should stay focused on a patient’s problems, not the nurse’s.

As the article excerpt above suggests, nurse staffing is a contentious issue having to do with both patient safety and job satisfaction for nurses. We’ve covered this issue many times in the past, most recently in a blog post that got quite a few comments back in January.

But should a nurse ever tell a patient about inadequate staffing? This is […]

2018-03-13T10:49:19-04:00May 9th, 2013|Ethics, Nursing, safe staffing|7 Comments
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Issues Raised by Media Coverage of a Nurse Declining to Do CPR

2016-04-18T15:02:37-04:00March 19th, 2013|Ethics, Nursing|7 Comments
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When Nurse-Patient Boundaries Blur, in Fact or Fiction

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. She currently has an essay appearing in The Examined Life Journal.

Courtesy of the author Courtesy of the author

Professional boundaries, as defined by the National Council of State Boards of Nursing (NCSBN), are “the spaces between the nurse’s power and the patient’s vulnerability.” The NCSBN describes the nurse–patient relationship as a continuum, with “too little care provider involvement” at one end and “too much care provider involvement” on the other.

The ideal therapeutic nurse–patient relationship lies in the middle, with “no definite lines separating the zone of helpfulness from the ends of the continuum.” I don’t love the indeterminate nature of that definition, but I understand it.

Some time ago, I was surprised by a friendship that developed between a patient and me. It was an unusual circumstance, in that the patient was in the ICU for a very long time for chronic problems that didn’t affect his mental capacity. I was his nurse many times, and through idle chatter during routine care we discovered not only a shared appreciation of literature in general, but a fondness for many of the same authors and books. I started thinking of books I’d bring him, hoping to augment the tedium of his hospital stay. At some point, I started thinking […]

2016-11-21T13:08:04-05:00March 15th, 2013|Ethics, nursing perspective, Patients|7 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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