Nursing's Moral Distress

Hellllllo Nurse, BSN, RN · May 25, 2003

NRSKarenRN,

Excellent article. I am currently reading the book "25 Stupid Things Nurses Do to Self Destruct" by Laura Gasparis Vonfrolio, et al.

The article you posted reflects much of what the book is saying.

By being under constant pressure and duress to do the WRONG thing, when we are naturally driven to do the RIGHT thing, but find it almost impossible due to lack of support, lack of time/resources and lack of authority, we are losing ourselves and our profession.

pickledpepperRN · May 25, 2003

Thank you!

This shows that we have to act together. Just one nurse willing to discharge the patient would twart the advocacy of the rest.

We on the night shift in critical care have become very good advocates. BUT only on the nights certain truly fine nurses go along with such plans as transfers to telemetry.

Once the nursing supervisor called the on- call cardiologist when the doctor who refused due to "a gut feelong" went off call. As charge and the RN caring for the patient I told her he had wanted the patient to remain in the unit. She told the doctor on call the labs, EKG, and vital signs from the chart. Wrote, "May transfer if bed needed."

I called that doctor back to inform him the physician he was covering for had refused the transfer just an hour ago.

The patient went into 'flash' pulmonary edema about 2:00 am. He needed mechanical ventilation as well as medication and respiratory therapy.

The supervisor was glad she had not sent a registry nurse home early as she had planned.

The patient sailed through a CABG and was discharged in less than a week.

The doctor tells us he is doing well.

I do wonder about a confused patient for whome I was not as assertive.

I had removed his femoral arterial line hours before. He was physically stable, but needed to stay in bed for several more hours. A patient was infarcting in the ER. The same doctor was on call for cardiology that night. I wanted him to stay or have a sitter on the telemetry unit as he would be the 6th patient for the RN I gave report to. The supervisor took him upstairs. I got busy with clot busters, NTG, heparin, EKGs, a frightened wife, and so on.

Later the doctor told me the patient had gotten out of bed and developed a hematoma. I feel guilty thinking of it because assertive communication could have saved that. There had to be an aide who could stay with him to keep him off his feet. I think he was confused by the medication given in the cath lab. His vitals were OK.

Well I really vented didn't I?

Thanks.

oramar · May 25, 2003

That book CODE GREEN relates back to a lot of the same issues.

angelbear · May 25, 2003

Thank you so much for posting that. I truely struggle with morals in nursing way more than I thought possible. It somehow helps to know that It isnt just me feeling this way.