Consider the case, Nurses caught between a rock and a hard place.

Nurses at Memorial Hospital, a 40 bed rural community hospital, 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 so was his nurse. When Mr. Rodriguez reported this experience to the supervisor 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 nursing supervisor is tightly allied with medical director and Chief of ED (CEP). The problem for the nurses is that it is a 2 hour drive over the mountain to the nearest hospital and there are no other employment options.

Answer the following questions: 1) Which ethical principles are being violated in this scenario according to the ANA Ethics Definitions? 2) Which Code of Ethics provision best describes the nurse’s dilemma in this situation? 3) Where might the nurses at Memorial Hospital find resources to help in intervening to resolve their moral dilemma?

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