Ethical dilemmas encountered by nurses

ktwlpn, LPN · Apr 8, 2010

Administering futile care to an end of life patient against their expressed wishes because the family insists upon it. Some states don't accept living wills as legal documents and many physicians are reluctant to bow to the pressure from the family.

jessrene, LPN · Apr 8, 2010

I work with a doctor who is prejudiced against fat people. It is very difficult sometimes to listen to this sort of unprofessional criticism. If it affects the patient's care, then fine by all means bring it up, but just whining or complaining because someone is an unhealthy weight is disrespectful. The patients don't hear the remarks but I do, and sometimes I have made reference to a patient as a well liked neighbor or obscure relative in order to end the "fat" tirade.

juliaann · Apr 8, 2010

jessrene said:
I work with a doctor who is prejudiced against fat people. It is very difficult sometimes to listen to this sort of unprofessional criticism.

I wonder if we work at the same place? Haha, we have a cardiologist with *NO* people skills. He is blunt and rude and doesn't care. We've had patients leave AMA due to conversations with this doc. He's constantly referring to his patients in terms of their physical appearance at the nurses station, and it's almost always something about weight. Totally unprofessional, but I guess when you're the senior cardiologist you can say whatever you want?

The worst part is, Dr. Cardiologist is not exactly a trim specimen himself.

I understand it's probably frustrating to him that his patients are often obese (what, someone with a heart condition that's overweight? You don't say! It's almost like weight is a risk factor...), and often don't change their habits, and it often lands them right back in the bed (or cath lab...), but man, tact!

Hopeful2011 · Apr 8, 2010

I'm a big believer in the work environment and energy that is brought into an operating room can/will have an effect on that patient's recovery..

I was on a rotation day in the operating room and the surgeon was berating the patient (of course the patient was under anesthesia), complaining that she is "so ****** fat", and he had his bluetooth in his ear, and was constantly having the surgical techs or ME! push the bluetooth button so he could talk on the phone while in surgery!!!!!!!!!!!! Throughout the entire surgery he kept cursing about the patient or just using foul language in his conversation...

I seemed to be the only one who was shocked by it since I was a newbie.. but it just shocked me and almost made me physically ill... It made me change the way I look at surgeons.. I guess from watching Grey's Anatomy.. I figured surgeons would show some sort of concern for the person they are cutting into, but from the experience I had.. it doesn't seem so.. I'm sure there are more professional surgeons out there.. but god help whoever comes into the hands of this surgeon!

LouisVRN, RN · Apr 8, 2010

The biggest ethical dilemma I think in nursing in general is the line of patient autonomy. That being said I'm all for patient autonomy and thus haven't really faced any ethical dilemmas, I try to work with patients toward their goals. That being said the most noted ones I've seen are the refusal of blood transfusions (Jehovah's witnesses) or the refusal of blood transfusions for their child, despite the possible consequences, caring for patients post-op after abortions that weren't medically necessary and end of life issues in general.

Ruby Vee, BSN · Apr 8, 2010

I had a 42 year old patient in an icu bed rotting by inches for over a year because his mommie wasn't ready to say goodbye. She threatened to sue the hospital if we respected the patient's advance directive or his stated wishes when he was able to state them -- so for more than a year we took care of this sad, sick man with intractable pain. I'm still angry about it, years later. I do not trust myself not to tell that woman exactly what I think of her should I ever encounter her outside of my work environment.

I'm also angry at the surgeon, who knew this man's wishes, knew that he basically had nothing to offer that would accomplish anything other than prolong the man's suffering, but did surgery after surgery because mommie demanded it. Never once did anyone I know of hear him say to the family, "we're awfully sorry, but we've done everything we can do and archibald just isn't going to get any better. Ever. The most we can do is to prolong his suffering." I don't know that it would have made a difference if he had, but he didn't even attempt it.

And we have an attending who won't speak to fat nurses except to ridicule or verbally abuse them. I'm fat. He and I don't speak to each other unless forced to. I address my comments to the team at large, and he addresses his comments to me in the form of some pretty ridiculous orders. ("stand patient up and hold him up even if he resists. Do this at 11:45, 15:15 and 18.30.") this jerk will greet my husband when we're walking together, but refuse to look at or say "good morning" to me. Dh thinks it's funny, which I guess is better than if he made up his mind to be upset about it. (dh is a martial arts instructor in his spare time and usually does not take insults to his wife lying down.) I get angry about it sometimes, but it's better for my health if I laugh at it instead, so that's what I try to do.

If your hospital is struck by an earthquake, are you going to save yourself if possible? Or lose your life trying to save your patient who is intubated, on a balloon pump and on cvvhd? Or maybe risk your life trying to save more viable patients? What about if you're the parent of a young child? The single parent of a young child?

When a blizzard blankets your city with 6 feet of snow, and your don is calling everyone at home begging them to come to work -- and you know that you have no pressing responsibilities at home (your husband is staying with your kids, your parents and pets are cared for) and you know that you could get to work because it's just a few short miles on snowshoes or by snowmobile or whatever -- do you go in? Or do you refuse to answer the phone?

One of your co-workers is slurring her speech, falling asleep constantly and doesn't make sense talking. Your narcotic count is off. What do you do?

I'm sure I could think of more.

cardiacmadeline, RN · Apr 8, 2010

ktwlpn said:
Administering futile care to an end of life patient against their expressed wishes because the family insists upon it.Some states don't accept living wills as legal documents and many physicians are reluctant to bow to the pressure from the family.

I agree. It really bothers me when the family goes against the patient's wishes. We once had a patient on our floor who had an advance directive, but because her family wanted us to treat her and did not want her on comfort cares, that is what we did. The patient was basically a vegetable and there was absolutely nothing we could have done to make her better. But because the family wanted us to treat her we did

This included putting a feeding tube in, even against her wishes outlined in her advanced directive. Her POA was actually for putting her on comfort cares and wanted to honor the patient's wishes, but I guess he felt pressured by the family and went with their wishes instead. Sad situation. I think that the family finally did send her to hospice where she died comfortably.

It is too bad that some people view death as this terrible thing and that medicine should be able to fix everything so everyone can live to be 110 yo even if their quality of life is poor. OK, I'll shut up now, I could write pages and pages on this subject........

dishes, BSN, RN · Apr 8, 2010

IMO, out of all the above ethical situations, the description of the surgeon talking on the cell phone while operating on a patient, is the most current . The other ethical issues have been discussed in nursing for years. If you are looking for a topic that has not been discussed frequently in nursing, pick the cell phone surgery issue. The use of cell phones in the OR is an ethical problem that concerns patient's rights and surgical conscience and the American college of surgeons has issued a statement that may provide ideas on how to deal with the situation

dishes

traumalover, RN · Apr 9, 2010

Rescinding DNR orders because the pt can no longer speak for their self and their family is now in charge.

Very angry still about that one. Would explain but gets me very upset, suffice to say, the 81 yo cancer pt was coded despite having terminal liver CA and having been on hospice. Despite the vocal protests of the entire ICU staff. Died with cpr and blood spouting from every orifice, naked, in front of his children who demanded it be done. Then they said "we didn't realize it would be like that." which we'd explained.

pilotron57 · Jul 16, 2014

Screw that surgeon. I bet he isn't a good person either.

klone, MSN, RN · Jul 16, 2014

An OB patient who knows she is HIV+, but has asked that her partner (i.e. the father of the baby) not be told.