Are Nursing Strikes Ethical? New Research Raises the Stakes

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.

In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.

These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units […]

2016-11-21T13:18:09-05:00April 16th, 2010|career, Ethics, nursing perspective|5 Comments
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Want to Achieve the ‘Greatest Good’? Listen to Your Patients

Ethical dilemmas abound in nursing practice. Consider these commonplace scenarios:

* An angry patient threatens to leave the hospital against medical advice. Should you hold him against his will?

* A cancer patient fears chemotherapy. Should you give less detailed information about the effects of anticancer drugs?

* An obese home care patient with pressure ulcers refuses to cooperate in turning. Should you turn her anyway?

Such conflicts between the patient’s wishes and the nurse’s perception of the patient’s best interests occur regularly. That doesn’t make these ethical dilemmas any easier to resolve, but how nurses approach them can significantly affect clinical outcomes. Taking the time to listen to patients—and to integrate relationship skills with principles of ethical practice—can help nurses achieve solutions that are both ethical and appropriate for individual patients.

ky olsen/via Flickr

That’s from the February issue of AJN, in which nurse–ethicist Doug Olsen (who has in the past written for this blog on ethical issues related to mandated H1N1 vaccinations for nurses) offers a thoughtful discussion that may resonate for all nurses who’ve ever faced a situation like those in the above examples. It may seem obvious or cliched to say that listening to patients can help solve apparently intractable problems—but just because listening as a skill is hard to measure doesn’t mean that it’s not sometimes effective where more rigid tactics would fail.

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2016-11-21T13:19:32-05:00February 9th, 2010|Ethics, Nursing, patient engagement|0 Comments
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Poor Assessment of Nursing Home Residents’ Pain — What Can Be Done?

A recent study sought to find out whether relatives and caregivers (proxies) understood residents’ pain well enough to assist in pain assessment and to discover what factors affected their judgments of pain. The findings showed, however, that their reports didn’t consistently match the pain ratings of nursing home residents themselves.

It’s particularly difficult to assess pain in cognitively impaired nursing home residents. This means that there’s a lot of suffering that goes untreated. This AJN article in the December issue discusses the findings of a new study on the topic and offers some recommendations we obtained from the study authors. Here’s another excerpt:

The authors suggest that pain management in nursing homes could be improved through caregiver education, including the implementation of pain assessment education in combination with treatment. They recommend basic training for nurses and nursing assistants on pain, pain behavior, and pharmacologic and nonpharmacologic pain treatment, such as “massage, applying warmth, mobility[, and] distractions with music or story telling.” They also suggest that “treatment effects could be determined more easily using a pain observation scale.”

So check out the article, and also let us know what else can we do to more accurately assess the pain of nursing home residents.

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2016-11-21T13:20:34-05:00December 16th, 2009|nursing research, pain management|0 Comments
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What Do Medical Researchers and Legislators Have in Common? Conflict of Interest, for One

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

LiebermanProtestIn a not-so-old blog post I did last month, I reported on a conference I attended in Vancouver.  There, editors from JAMA presented a study revealing that ghostwriting was a major problem for the leading medical journals. Articles were being drafted by writers other than the researchers. In some cases, the writers didn’t have access to all the data, which meant that analyses, conclusions, and—in some cases—recommendations for treatment were based on incomplete or misinterpreted findings.  As described in a New York Times article on the issue, medical product and pharmaceutical companies have much to gain if the safety and efficacy of their products are reported in a positive light.

Conflict of interest is a major concern whenever someone who stands to personally benefit can influence a decision. The National Institutes of Health, which is the leading medical and health research agency in this country, has imposed strict rules for employees limiting consulting and speaking fees involving outside companies and institutions that may have a stake in research outcomes. Most government agencies, research or not, impose rules to avoid conflicts of interest.

Last week, NBC News reported that protestors staged a sit-in at the Hartford, Connecticut, offices of Senator Joe Lieberman, demanding that he stop taking campaign contributions from insurance companies. 

2016-11-21T13:21:04-05:00November 16th, 2009|Ethics, health care policy|0 Comments
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Voluntarily Stopping Eating and Drinking (VSED): What Is It and How Does It Work?

Is there a legal end-of-life option for people who are terminally ill or whose quality of life has reached what they feel to be an unbearable level? Even in states without right-to-die laws, there is. It’s  called voluntarily stopping eating and drinking (VSED). Judith Schwarz wrote about VSED in the September 2009 issue of AJN. The article includes a case study. Here’s an excerpt:

Gertrude (not her real name; other identifying details have been changed) was 99 years old. Having survived the Holocaust and overcome many other challenges in her long life, she thought it ironic that she had to ask her children to help her die.

Although she was not terminally ill, the quality of her life was significantly diminished by many chronic ailments. Despite two hearing aids, her hearing loss was such that she could no longer indulge her one remaining pleasure: listening to classical music. She had fallen and broken a hip when she was 96 and now had to use a wheelchair when moving around her apartment. She had severe arthritis, and she rarely left her apartment except for medical appointments. All friends and many family members had long since died, and her deteriorating vision-a result of a recent bout of shingles-left her unable to read or watch television. After years of living with these and other chronic conditions, she told her family she was tired of life and was ready to leave. Her children and grandchildren told her to be patient. She was almost 100; […]

2016-10-23T10:59:26-04:00September 18th, 2009|Ethics, Nursing, Patients|1 Comment
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