Ethical Dilemmas in Nursing

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One of the many reasons you may have chosen a career in nursing was a desire to help people. Even though you want to provide the best care possible for your patients, sometimes there are gray areas. If you work as a nurse long enough, you are bound to face an ethical dilemma.

The area of nursing you specialize in and the type of setting in which you work may play a part in the most common ethical dilemmas you face. For example, nurses who work in hospice care may face different issues than those who work in home care. However, regardless of where you work, certain ethical dilemmas are fairly common.

Types of Ethical Dilemmas

End of Life Issues

When you consider end of life care, there are many issues that can arise. For example, you may face an instance where you are required to perform invasive and aggressive procedures for a patient who is terminal. The treatment may seem futile and appear only to cause suffering, but if the patient or person who has power of attorney asks for “everything to be done,” that’s probably what is going to happen. It can be difficult to be a part of prolonging someone’s life when that person appears to be suffering.

Staffing Ratios

There may be instances in your career where you have to work short staffed. Caring for more patients than you feel you can is tough. Large patient workloads can compromise care and increase the likelihood of making mistakes. You can expect to be short staffed on occasion due to sick calls, but if you find your workload is usually too large and you are consistently short staffed, you have a problem.

If your concerns are not being heard by your supervisor, you may wonder if you should take it a step further and go to administration. Raising concerns can take courage, and it’s not always easy to speak up.

The Patient’s Right to Know

Of course, you always want to be truthful with your patients. After all, they have the right to know what’s going on. But sometimes it is not always that cut-and-dry. For example, you may have an adult child who asks you to spare his elderly parent from an upsetting prognosis. It can be difficult to balance compassion and respecting family wishes with your obligation to tell the truth.

It gets even more complicated when you ask yourself if withholding information is the same thing as lying. For instance, if you have a recovering car accident patient who asks about his passenger, is it right to tell your patient that the passenger died?

Tips for Dealing with an Ethical Dilemma

Examine your personal bias: You will not always have the same values as your patients. But you’re human, and sometimes your personal beliefs lead to an emotional reaction. Acknowledging your feelings may help in your assessment of a dilemma.

Know code status: Patients and family members may say one thing, but the doctor’s orders state something else. Make sure you are aware of what your patient’s wishes are and what is ordered. If orders appear to contradict what the patient says, it’s time to page the doc.

Consult with an ethics committee: Many healthcare facilities have ethics committees to help handle ethical dilemmas. Utilize their expertise when needed.  

Establish personal boundaries: If you get too emotionally involved in your patient’s care, it can cloud your judgment. While you should remain friendly and caring, maintain professional boundaries.

Document thoroughly: Ethical dilemmas can have a lot of gray areas. Be sure your documentation is clear, thorough, and accurate. You don’t want to add any confusion to the situation.

Talk it over: If you face an ethical dilemma, it can weigh heavily on your mind. It’s helpful to talk it over. Always maintain confidentiality, but consider discussing your concerns with a supervisor. When you fail to get the support you need, it can increase stress and possibly even lead to burnout.