Kevin L. Meek
Western Governors University
Professional Roles and Values NVT2
December 08, 2012
Ethical Leadership Ethical Leadership in Nursing As advances in healthcare continue to improve the ability to sustain life, as well as for individuals to live longer, bedside nurses are faced more and more with difficult situations related to advance directives, Health Insurance Portability and Accountability Act (HIPAA), as well as to ensure they are functioning within the scope of practice for their state.
State Regulations and Nursing Standards
In Arizona, where the author practices nursing, there are several regulations that are addressed in the presented case study. However, the most important regulation could be that of “Advocate on behalf of a client to promote the client’s best interest” (Rules of the State Board of Nursing, 1995/2009). By advocating for a client/patient the nurse is also held responsible to several other regulations including: • • • Protect confidential information unless obligated by law to disclose the information; Report unprofessional conduct, as defined in A.R.S. § 32-1601(22) Respect a client's rights, concerns, decisions, and dignity; (Rules of the State Board of Nursing, 1995/2009)
The nurse in this scenario is aware of the advance directive that was completed almost seven years prior, but neglects to advocate in the patient’s best interest. “Promote the client’s best interest” also includes respecting their decisions and dignity which this nurse also fails to do, and to hold other medical decision makers (physician and power of attorney) to do the same. Failure of a nurse to follow the ‘Rules of the State Board of Nursing’ in Arizona could lead to license censure, suspension, or even revocation of the nurse’s license. As Arizona is a “compact” state, this action could also prevent the provider from licensure in many states.
Code of Ethics
In following the Code of Ethics for Nurses with Interpretive Statements (American Nurses Association [ANA], 2001, chap. 1), Provision 1 states that a nurse is to “…practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual…”. Furthermore, this provision goes on to indicate that the nurse is to respect “the right to selfdetermination” (ANA, chap. 1.4). As an employee of a faith based Catholic organization, the author also refers to the ‘Ethical and Religious Directives’ that also speak to the ethical responsibility of allowing selfdetermination when they direct, “The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching” (United States Conference of Catholic Bishops [USCCB], 2009, chap. 5) Impact of the Code
Although the situation is difficult and involves deep emotions for both the patient and the family members, the code is very clear in what the role of a nurse is to be. As nurses we are called to uphold our code of ethics for our patients, even when they can’t. The code in this case calls us to raise concern over intubation and to have the honest conversation with the other care team members in regards to following the code. Ethics of Putting a Patient on a Ventilator The ethical implications of placing the patient on the respirator are that it goes against not only the ANA Code of Ethics for nursing, but also violates the scope of practice for the nurse. Unfortunately the ultimate decision to place the patient on the respirator or not is made and acted upon by the physician who has that act within his/her scope of practice, but the nurse must remain an advocate for the patient. The nurse ultimately needs to provide care for the patient if the intubation in fact takes place, but perhaps the nurse could involve the hospitals risk department, ethics committee, and others...