Ethically speaking
CAROL TAYLOR PhD, RN
What we say about sedated patients does matter
HYPOTHETICAL CASE Nurse Green wasn’t surprised when a June 2015 Washington Post article featured a story about a patient undergoing a colonoscopy who inadvertently taped inappropriate comments made about him by his anesthesiologist and physician. The patient, who knew he would be sedated for the procedure, had hit record so he would remember his post-procedure instructions. He did not realize it would tape all the comments during his procedure. When he hit play on the way home, he learned the surgical team had mocked and insulted him as soon as he fell asleep. Jurors awarded the man $500,000 and the anesthesiologist was quickly fired. Green knew one of the surgical teams she routinely worked with made jokes about patients once they were asleep and she was becoming increasingly uncomfortable during their procedures. While the surgeon set the tone, residents and her nurse colleagues were quick to participate. Provision 1 of the ANA Code of Ethics for Nurses (2015) clearly holds nurses re-
sponsible for practicing “with compassion and respect for the inherent dignity, worth and unique attributes of every person.” Provision 3 states nurses are to promote, advocate for and protect the rights, health and safety of the patient. And finally Provision 6.3 holds nurses responsible for contributing to a moral environment that demands respectful interaction among colleagues, mutual peer support and open identification of difficult issues. This includes ongoing professional development of staff in ethical problem solving. It would seem our Code of Ethics not only forbids nurses from taking part in inappropriate conversations about sedated patients but also obligates nurses to change a culture that allows these conversations. It should not take the fear of being recorded to make professional caregivers do the right thing.
SCENARIO 1 Green mentions her discomfort to several colleagues she trusts. Each of them coun- sels her to not “rock the boat.” The surgeons most responsible for humor at the expense of patients tend to be several of the best revenue generators at the hospital and seem to have the respect of senior leadership. “If you want to be part of the ‘in crowd,’ you’ll learn to make your peace with this behav- ior,” she is told. “You don’t have to join in.” One of the reasons Green chose perioper- ative nursing is because of the close-knit relationships in the operative team. In the past, she felt a sense of family among them, EXW QRZ ƮQGV VKH IHHOV XQFRPIRUWDEOH 6KH wants to challenge the culture but is afraid of moving outside of her comfort zone. As her dissatisfaction grows she starts looking for openings in other units at the hospital.
CONSIDER THE FOLLOWING SCENARIOS
Carol Taylor, PhD, RN, is a professor of nursing at Georgetown University School of Nursing and Health Studies, and senior scholar, Kennedy Institute of Ethics.
SCENARIO 2 With some trepidation Green makes an ap- pointment to talk with the OR charge nurse, Nurse Waczinski, who has worked in this OR for 20 years. A no-nonsense leader, VKH UXQV D WLJKW VKLS DQG LV D ƮHUFH DGYR- FDWH IRU QXUVHV 6KH DOVR FRPPDQGV WKH respect of the surgeons. Green isn’t sure her charge nurse will be willing to take her concerns seriously and is surprised when Waczinski asks her how willing she is to work on needed culture change. As it turns out there are more nurses feeling uncomfort- able about the culture, but no one is ready to take leadership to address concerns. Green thinks the Post’s story about the an- esthesiologist might provide the perfect RSSRUWXQLW\ IRU HYHU\RQH WR UHưHFW RQ ZKDW is becoming a toxic environment. Waczinski recommends a meeting with the new COO hired by the CNO. Allegedly he has solid experience in mediation and might be helpful in strategizing how best to build support for a culture change. Assured that her instincts are correct, Green allows herself to start IHHOLQJ KRSHIXO 6KH PHHWV ZLWK WKH RWKHU nurses who share her concerns and they decide to start small until they meet with the COO. Remembering Gandhi’s wise adage, “You must be the change you want to see in the world,” they decide at the very least not to participate in insulting language and to try to redirect the comments. One of the nurses suggests contacting the hospital’s clinical ethics consultant. He is delighted WR UHFHLYH WKH FDOO DQG DƱUPV *UHHQ IRU recognizing disrespect as an ethical issue. •
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