Quote from getoverit
Essentially the same scenario happened in our ICU tonight, obviously not resolved yet.
The above poster mentioned that nurses must refuse to accept unsafe assignments. Our chief pulmonologist made the exact same suggestion. It sounds good in theory, but what about when nursing managment makes it clear they will fire you if you ever refuse to accept any assignment, regardless of the circumstances? that's the way it is here, and I don't work in a draconian system or anything like that...but I do see where nursing administration talks about patient safety and supporting nurses but in practice they do very little besides making posterboards.
It is said that people demonstrate the ethics and moral values they think they can afford. This results in situational ethics. By situational ethics, I refer to a person participating in something they know to be wrong or unacceptable in one case where they would not participate in the same wrong or unacceptable thing in another case. For example, a nurse believes the patient to staff ratio is unsafe, but accepts the unsafe assignment because of fear of firing.
There's enough that can go wrong without the consequences of situational ethics coming into play. Those who practice these situational ethics will find themselves stuck holding the bag when being so short staffed contributes to a horrible outcome. I have seen this time and time again. Before becoming a nurse, I worked as a medical malpractice investigator (defense work) for the state of Louisiana. I have seen nurses in deposition and in court confronted with the state nurse practice act that holds them responsible for accepting or refusing unsafe assignments. Those nurses certainly wish they had refused the unsafe assignment.
Fear of firing should NOT figure into a person's decision making process. If that's the case then practicing situational ethics will result in all sorts of bad nursing care. If employers don't want to provide adequate materials or supplies or want nurses to cut corners, the nurse who fears being fired will do it. That nurse is trying to keep a job--NOT keeping the patient's safety and well-being a priority.
When nurses or other employees allows themselves to be manipulated to do one small wrong thing, they make it harder on themselves to refuse to do bigger wrong things. Wrong things add up to catastrophes for patients. A nurse's fear of losing a job can cost patients their lives, limbs, livelihoods, or quality of life.
At my first nursing job, I kept a copy of the state nurse practice act in my clipboard. The charge nurse was flabbergasted when I pulled out the nurse practice act and presented it to her when I refused an unsafe assignment. The other nurses were stunned to the point that they didn't speak up and volunteer to take on an unsafe assignment. All the nurses behaved as if they had never heard of the state law. The charge nurse called the nurse manager and they got busy and found staff to come help. I don't know if the nurses were called in or if they floated from another unit. That did not matter to me. My patients were safely provided care.
An employer can fire an employee at any time over anything. For those with strong beliefs about what's right and what's wrong, it's better to be fired and unemployed and able to sleep at night knowing you did the right thing. I know it for a fact. I am living it. I was instructed by my employer to falsify a medical record, and I refused. I was fired. That was five months ago and I'm still unemployed because the economy is circling the bowl. Lest anyone think I'm living "high on the hog" on unemployment, I'm certainly not. I was denied the $247 per week unemployment benefits and I am appealing it.
I have bills and responsibilities just like everyone else. I do not regret refusing to falsify records and I will not regret it. That wasn't my first rodeo. Long before I became a nurse, I worked in other fields. In those situations I faced the fall out and the consequences for doing the right thing. I paid the cost both financially and professionally, and it was worth it to me. Eventually my efforts resulted in changes that were a great benefit to many people. I have always slept well.
I don't believe you can go wrong when you try to do the right thing and keep patient safety and well-being your priority. It may make you unpopular and it may cost you your job, but losing a job is not the end of the world. Losing a patient because you compromised care because of fear of losing a job could certainly result in the loss of your license and the end of your practice in the nursing world. Who wants to contend with that sort of regret?