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Moral Distress: Meadows Hospital
Nurses at Meadows Hospital, a 40-bed rural community hospital in northern Ontario, are faced with what seems an impossible dilemma. Their best efforts to advocate for patients are routinely blocked by the hospital’s physicians and senior leadership.
Two recent examples: When Mr. Rodriguez, a seasoned surgical nurse, requested time to administer an analgesic before a patient’s painful wound debridement, he was told by the surgeon that no pain medication was necessary. The patient was clearly in distress while the debridement was performed and was his nurse. When Mr. Rodriguez reported this experience to his manager, he was told that the nurse’s job is to do what the physician orders. On another occasion, a woman presented to the emergency room with a fractured distal radius. Because a family member with a similar injury had unsatisfactory results (deformity and pain with movement) when treated by the doctor on call that evening, the woman and her husband requested transport to a larger hospital. The doctor on call insisted that it was important to set the fracture as soon as possible and convinced the couple that he could competently perform the procedure. The nurse had reservations about the doctor’s competence and wanted to counsel the couple to be persistent in seeking transport to another facility but knew that her job was on the line if she did. When she reports this to her supervisor, she is told that her job is not to advocate for patients but to be a loyal employee.
Repeated efforts by nurses to address these sorts of challenges have resulted in the persistent message that they can accept the status quo or leave. The managers of the hospital units are tightly allied with the medical director, Chief Nursing Officer and CEO. The problem for the nurses is that it is a 2-hour drive over a mountain range to the nearest hospital and there are no other employment options.
This is a classic example of moral distress. The nurses at Meadows Hospital have been very clear that their primary obligation is to patients and they have repeatedly and unsuccessfully advocated for patients until their jobs were threatened. If they cannot find a champion in a position of authority willing to address their concerns and work with them to creatend sustain a positive work environment, they will have two choices: They can either accept the status quo, sacrifice their personal and professional integrity, and endure the type of moral distress that leads to disengagement and/or moral injury or they can quit their jobs. If they leave this hospital and need to find employment elsewhere, the 4-hour commute will definitely compromise the time they have for their families and similarly constrain their integrity and result in moral distress. There are several provisions in each of the assigned codes of ethics you have studied that address your responsibilities to the patient, the profession, and yourself.
Acquiescing and accepting unsafe or inappropriate practices, even if an individual does not participate in the specific practice, is equivalent to condoning unsafe practice. Nurses should not remain employed in facilities that routinely violate patient rights or require nurses to severely and repeatedly compromise standards of practice or personal morality.
Ideally, the nurses working at Meadows Hospital could seek assistance from their Provincial Nursing Regulatory body. They could also seek help through having a unionized work environment. Collective action, such as collective bargaining or workplace advocacy through a union, may be helpful in creating the desired change. Any agreement reached through such action would ideally be consistent with the profession’s standards of practice, the provincial and federal laws that regulate nursing practice as well as meet the Codes of Ethics for the profession.
Using the above information, apply this scenario to the ethical decision-making framework:
1.Individually Reflect on the case and the commentary. Write down your initial thoughts/reactions.
THEN as a team answer the following questions and submit to this submission portal:
2. Determine who is involved in the case. Name all the parties and their relationship to the patient.
3.Describe the issue. What exactly is the problem or issue to be solved?
4. Assess the situation. What is the team’s “perceptions” and reflections on the situation - in short form?
5.Clarify values. What Ethical Values are involved in this story?
6. Identify ethical principles involved in the case. You can use all your reading and resources to name them.
7. Clarify legal rules. Are there any laws involved in this story?
8. Explore options and alternatives. What are some of the options to solving this problem?

 
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