Case One
Mrs. Lewis was head nurse on a medical surgical floor in a
community hospital with 250 beds. Over the course of 6 months, she
noticed that all patients admitted from
the Shady Rest Nursing Home had signs of severe injuries
other than those connected with the admitting diagnosis. There
appeared to be patient abuse in the nursing
home. Mrs. Lewis investigated discreetly and found no
explanation possible except abuse. In accord with the obligations
of the law in her state, she reported the
matter to the Department of Welfare Bureau of Inspection.
The Welfare Department investigated immediately, found proof
of abuse, and threatened to close down Shady Rest if there were any
more recurrences. Mrs. Lewis was
overjoyed until her hospital administrator, bypassing the
director of nursing, called her in and warned her that she would be
fired if she reported any other instances
of abuse. Shady Rest sent the hospital a lot of business, and
good relations had to be maintained.
Mrs. Lewis was even more shocked when she discovered that the
administrator was a golf partner of the owner of Shady Rest and was
doing an old buddy a favor. Despite
fears of retaliation, Mrs. Lewis consulted a lawyer, who
threatened the hospital with exposure and with penalties that would
follow if one of its employees failed to
follow the reporting provisions of the law on abuse in
nursing homes.
Did Mrs. Lewis act correctly? What should she have done if
she could not have afforded to consult with a lawyer? In what ways
can whistle-blowers protect themselves?
Must the art of intimidation be part of the toolbox of
healthcare professionals in order to protect their patients? Is
power an appropriate consideration in healthcare
ethics?
Case Two
On a July weekend, Mrs. Allesfertig, nursing supervisor of
the whole hospital, discovered that the intensive care unit was
seriously understaffed. She pulled two
nurses with previous ICU experience off other floors to bring
the unit up to strength in view of the extreme level of acute care
needed. On the following Monday, Dr.
Bestknabe, who has overall responsibility for the ICU unit,
closed the unit for further admissions until the staffing had been
worked out on a permanent basis.
Should the new staffing policy give the nurses authority to
refuse to admit patients when the staff is not sufficient to handle
them? (In some hospitals, nurses have
this authority.) Can any policy take precedence over the
professional judgment of trained ICU nurses?
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