 |
 |
|
Health Care Ethics USA Nurses: The Rodney Dangerfields of Health Care?
Imagine a hospital without nurses. It is like trying to conjure up a restaurant without food or a crowd without people. Yet if they are so critically important, why do so many nurses feel like Rodney Dangerfield - undervalued and sometimes disregarded? It would be foolish to suggest that all nurses in all hospitals feel the same concerns, but there is a thread of deep frustration across nursing that is relevant to both clinical and organizational ethics. This is of particular concern to Catholic healthcare, since we have a special recognition of our responsibility to honor the human dignity of all persons - staff as well as patients. Employees who feel oppressed must be an important focus of organizational ethics. Similarly, since patients benefit when they are treated and cared for by a united and mutually respectful healthcare team, discontented nurses are a matter of concern to clinical ethics as well. The problem does not belong solely to ethics committees; their involvement does not negate the legitimate interest and efforts of Human Resources, Administration, and Security, among others, in addressing these matters. Instead, while ethics brings its own interests, it can at the same time be the driving force coordinating all these initiatives. Some suggest that responsibility for nurses' dissatisfaction falls solely on the shoulders of authoritarian doctors. A recent poll of physicians at one hospital, however, suggests that part of the problem may simply lie in the lack of honest, open, and mutually respectful dialogue. The poll gives insight into how nebulous the place of nurses in healthcare can be. The physician respondents rated the nursing staff as one of the hospital's strongest assets, scoring nurses even higher than they scored their fellow physicians. Yet in that same week, and in that same hospital, a roomful of nurses agreed that they would never call for an ethics consult because they feared the possibility of retribution from attendings. Concerns vary from nurse to nurse and hospital to hospital, but that fear of retribution (as well as a sense of being too easily dismissed, left out of important conversations, and forced to endure whatever disrespect families and patients choose to show them) is an important issue, not only for nurses, but also for patients. These concerns can be relevant to both organizational and clinical ethics committees. In conversations where they feel safe, nurses express one group of concerns that are in the purview of clinical ethics. As medical professionals with the most extended hands-on relationships with patients, nurses are sometimes frustrated about treatment choices made for their patients, and resentful of being left out of conversations about their care. For example, they sometimes express concern that too much is being done after the time has arrived to allow death to come peacefully. At other times, they worry that a family is "letting go too soon." In either case, nurses feel that some surrogates are making inappropriate decisions, and that physicians are buckling too quickly to their demands. An organizational ethics issue related to this is that the physician may be giving in to the surrogates because they are so confrontational that it is easier to do what they want than to fight them. The nurse, however, if given no choice but to take the ongoing verbal abuse, can wear down quickly. While insulting the nursing care given their loved ones can be the way a relative vents understandable frustration, fear, and grief, nurses should not be offered up as sacrificial lambs, forced to absorb it all without recourse. Another concern nurses have is that some patients are not being told the truth about their prognoses, or are not being given sufficient information to make informed decisions. Whether or not the nurses are right that a particular patient's needs are not being addressed correctly, their lack of a sense of empowerment can cause the situation to become a source of brewing frustration. The existence of this kind of situation is an opportunity for ethics committees to collaborate with others to instill confidence in nurses about calling consults to help mediate conversation. In yet another area of discontent, a nurse manager with significant responsibilities in her area describes feeling invisible. Some doctors, she complains, look right past her and her legitimate authority, to take their questions over her head to Administration. The ghosts of olden days, when nurses rose and stood at attention when a physician entered the nursing station, still linger. Organizational and clinical ethics can work together, and with others across the hospital, to address these concerns. The overarching initiative must be to bring about constructive conversation between doctors and nurses, with other efforts undergirding this focus. The first of these would be to increase the comfort level of nurses about calling an ethics consult. Toward this end, ethics committees can facilitate conversations with the Chief Medical Officer and Administration to develop a clearly understood and enforced policy to ensure that a physician will face disciplinary action if he or she intimidates or seeks reprisal against a nurse for exercising a legitimate professional obligation to intervene for the well-being of a patient. Ethics committees can work with Security to develop procedures to support nurses who feel physically endangered by a patient or visitor, and policies can be developed and enforced for the removal of a disruptive visitor from a patient's room, and possibly from the hospital. In the spirit of subsidiarity, ethics committees can work with administrators to make a commitment to politely demur from considering matters that have skipped past a nurse manager or director, returning the matter to the responsible nurse for consideration. Once such policies are in place, HR can help nurses develop skills to implement these new approaches. The result of these efforts will be a new and more powerful nursing force, demanding and commanding well-deserved respect within a hospital that now has policies and procedures in place to ensure that they can do so effectively and safely. All of these efforts will support the success of an improved nurse/physician relationship, which in turn will bring about better patient care - the ultimate mission of healthcare. 
Ann Suziedelis, PhD Suggested Readings Danis, Susanne, ARNP, MSN; Forman, Hariett, RN, EdD; Simek, Peter P. MD. "The Nurse-Physician Relationship: Can It Be Saved?" Nursing Spectrum, 2004, at http://www.nursingspectrum.com/CareerManagement/Articles/nursephysician.htm (accessed 10/1/2006). Sowers, Dave, RN. "The Caring Instinct." Barnes Jewish Hospital Website, 2005, at http://www.barnesjewish.org/groups/default.asp?NavID=1117 Bartholomew, Kathleen. Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication. Marblehead. MA: HCPro-Opus Communications, 2005. |
|
 |