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 the ethical quandary posed by nurse ethicist Doug Olsen in his latest article, in the May issue of AJN (free until the first week of June). Having posed the situation described above, he goes on to pinpoint the ethical principles that come into play when making such a decision, explore the pros and cons of disclosing certain information to patients in various related situations, and emphasize both the need for awareness of the patient’s perspective and the necessity for nurses of engaging in honest self-examination.

As with many such situations, there’s not always a right answer; every situation is different, and gray areas do exist. What’s your take?—Jacob Molyneux, senior editor

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