Running

Head: ETHICS PAPER

Ethics Paper
Olivia T. DeFilippo
James Madison University

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INTRODUCTION
Recently, there have been many discussions surrounding the topic of a global
nursing shortage. Each year more than 75,000 applicants are being turned away from
nursing programs because of the current lack of resources (Nardi & Gyurko, 2013). As
healthcare demands continue, hospitals are becoming increasingly understaffed. Aiken,
Clarke, Sloane, Sochalski, and Silber (2002) explored the relationship between nurse
staffing, patient care and nurse retention. Their research concludes that every additional
OR patient leads to a 7% increase in mortality. Inadequate staff nursing is critically
important because it leads to increased negative outcomes and mortality.
BACKGROUND
My patient, with dementia, was admitted into the hospital for hypoxemic
respiratory failure. Upon arrival, he was considered a high fall risk patient and was placed
on a bed alarm. Throughout the day, he would continually stand up on his own despite
his unsteady gait. Each and every time the bed alarm went off the RN and I would rush
into his room to assist him. We explained to him that it was unsafe to get up without the
help of a nurse and that he should use the call bell if and when he needs to use the
bathroom. The patient was very confused but simply nodded as we got him back to bed.
As the day went on, he continued to get up on his own without help. At one point I ran
into his room to find the patient grabbing hold to anything within reach to remain steady
and standing. I quickly helped him sit back down to regain his breath before assisting
him to the bathroom. I explained to my clinical instructor that I was very concerned that
my patient would injure himself the next time he got up without assistance and asked him
if we could request a sitting partner for my patient. My clinical instructor explained that

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one of the RNs went home after feeling ill and therefore the unit was understaffed and
that obtaining a sitting partner for the patient would be impossible. Instead, he suggested
that I work on the computer near my patients room so that the next time he got up I
would be in closer proximity to provide immediate assistance. In this situation I followed
my clinical instructors advice; however, alternatively I could have also consulted the
units charge nurse.
According to Epstein and Delagto (2010), moral distress occurs in situations
where an individual identifies the right action but is unable to act on it. A moral dilemma
occurs when an individual must decide between two or more conflicting actions. In this
clinical situation, I experienced moral distress because I knew in my heart what the right
action was but could I not act on it. As a nurse in training, my main concern is patient
safety. This particular patient was compromising his own safety by continually getting up
without assistance and therefore I felt that the right action would be to intervene by
bringing in a sitting partner to ensure his safety and prevent any potential injuries. My
clinical instructor explained that this would not be a possibility because the hospital was
understaffed. As a student nurse I did not feel that it would be appropriate to go against
my clinical instructors decision or to contact the charge nurse with my concerns. I want
my clinical instructor to think highly of me, trust me and to continue to support me while
I train under his leadership. I felt that and going against his wishes and undermining him
would only compromise our relationship. I felt powerless in this situation because with a
shortage of nurses along with my instructors recommendation, I had to just comply with
the decision regardless of my personal feelings and concerns. In this situation, I felt a
sense of frustration, incompetence and embarrassment for recommending a very viable

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solution which was so quickly dismissed by an authority figure. This is an example of

moral distress and not moral dilemma because I knew what the right action was but when
I tried to act upon it was denied the opportunity to do so. Understandably I was left
feeling insignificant, powerless and defeated.
METHOD
The Madison Collaborative (2013) utilizes the Eight Key Questions as a tool for
making ethical decisions. These questions represent the values of fairness, outcomes,
responsibilities, character, liberty, empathy, authority and rights. I will be using this
method as a way to analyze my ethical situation to identify the possible ethical actions
that can be made.
FINDINGS
In this situation, our actions reflected the first key question of fairness. Since the
hospital was understaffed and had limited resources it would not be fair to take a care
partner away from someone else who may need it more. While my patient was at risk for
getting hurt, a patient on suicide watch would have a greater need for a sitting partner.
When considering the outcomes of this situation, taking away a sitting partner from one
patient for yet another patient would provide both a negative and positive short-term
outcome. Asking a hospital volunteer or family member to sit with my patient would be
the best short-term outcome for my patient, his family and the hospital. Advocating for
adequate staffing would provide the best long-term outcome for the hospital and its
patients. It is my duty as the nurse to protect all patients from harm and ensure their
safety. Consulting the charge nurse with my concerns and ensuring that someone sits with
my patient would be the best way to represent my character as a caring and dedicated

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nurse. While this patient has the liberty to make his own decisions, his dementia prevents
him from understanding the consequences of his actions. When he stands up without
assistance he is clearly putting himself at risk for harm. When thinking about the question
of empathy I would want my family members to have sitting partners to make sure they
are safe at all times. The American Nurses Association (2015) Code of Ethics for Nurses
is a legitimate authority which can help guide nursing practices. Provision 3 of the Code
of Ethics for Nurses states that my duty as a nurse is to advocate and preserve my
patients rights and well-being. Informing the charge nurse about my concerns, getting
my patient a sitting partner and advocating to administration for sitting partners would be
the best decision to protect the patient rights and follow the expectations of the ANA.
CONCLUSION
In this situation I followed my instructors recommendation because I understood
that getting a sitting partner for my patient would be impossible in a hospital which was
operating understaffed. Looking back on this now, I realize that our inaction did not
address the issue of patient safety. If I were to be in this situation again, I would have
been more adamant in my concern and held strong to my convictions and I would have
asked for a volunteer or family member to sit with my patient to ensure his safety.
Through my analysis I now realize that many factors must be examined which ultimately
impact our final decisions, but as a nurse it is my duty to always advocate for patient
safety and wellbeing regardless of the situation. In the future, I plan to be a strong
advocate for sitting partners and that there be significant changes in hospital policy to
prevent understaffing.

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References:
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital
nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA,
288(16), 1987-1993.
American Nurses Association (2015). Provisions of the code of ethics for nurses with
interpretive statements. In Code of ethics for nurses. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthic
sforNurses/Code-of-Ethics-For-Nurses.html
Epstein, E. G., & Delgado, S. (2010). Understanding and addressing moral distress.
Online Journal of Issues in Nursing, 15(3), 1-1.
doi:10.3912/OJIN.Vol15No03Man01
Nardi, D., A., & Gyurko, C., C. (2013). The global nursing faculty shortage: Status and
solutions for change. Journal of Nursing Scholarship, 45(3), 317-326.
doi:10.1111/jnu.12030
The Madison Collaborative (2013). The eight key questions. In The eight key questions
handbook. Retrieved from
https://www.jmu.edu/mc/Docs/131101%208KQ%20Handout%20Revision.pdf