Everyday Ethical challenges?

Just be sure to do what you know is right.

If you are not sure, ask someone.

Always wait to get confirmation if you are not sure

about something.

Always be sure there is a policy to back you up.

Document everything to protect yourself.

You may not agree with the physician or other

provider, but just follow orders and nursing practice

act. Stay professional while you work....let off

steam off duty.

If you feel there is an order that you are afraid to

complete, check with your teacher....mentor....

for explanation or reassurance, or to validate

that your feelings are correct and the appropriate

response as a next step.

Don't bring your problems to work.

Don't let other staff bring their personal problems

to you or waste your time at work with them.

This will save you a lot of heartache.

Have a friend to talk to off duty.

Learn to have a thick skin and deflect comments

from others that are hurtful....don't let it show that

they have hurt you.

If you are totally stressed, take a time out and go

to the bathroom and take some deep breaths...or go

to the break room...or outside.....or the chapel....just

be sure someone knows you are off the unit.

I hope I didn't scare you even more.

My pointers are meant to be helpful.

I think it is hard when you hear physicians telling pt's. things which don't reflect the full picture acurately or putting a particular slant on things to influence the pt. to decide one way or another. I am not implying this is malicious. Many times it is done out of "kindness". In order to make a decision, a patient or parent, must be given all of the facts objectively (IMHO).

Two things I run into pretty frequently:

1) patient is failing; everything that can be done outside of heroic measures has been done, and family won't make patient DNR. It's hard to continue to force medication, tube feedings, etc on a pt whose body can no longer make use of them when we could be concentrating on comfort measures to make the inevitable more comfortable. There are some times when having to make this kind of decision is more than a family member is capable of. I can't tell them what to do and I think it's important for them to arrive at a decision in their own time but sometimes ya gotta help them-gently- to see the way things really are.

2) Non compliant patient who won't take say, much needed cardiac medication and BP/ heart rate going out of control. There's a fine line between being very, very persuasive and forcing if the patient is mentally competent...

well, this one involves confidentiality. i work two part time jobs. i work as a part time oncology/palliative care nurse and my other job is the night shift rn at a ltc home. last month, i discovered that one of the daughters of a resident at the ltc home was a patient in the palliative care unit. the daughter deteriorated rapidly. i knew the resident was very worried about her daughter. i remember her commenting that one should never bury their kids before them.

after a while, i became worried about the mother. i knew where her daughter was and i also knew that she was very poor. but confidentiality rules dictate that i could not give out info about either of them. it was horrible and difficult for me to keep my mouth shut or even think about how to handle this situation. also, being part time night shift at both places, i was often left "out of the loop." so, i played "little birdie" and spoke to some of the full timers at both places and suggested arranging a visit.

but, it all worked out. the ltc home arranged for the mother to visit the daughter in the hospital. i was working that evening at the hospital. the visit was good. the daughter died two weeks later. but i was so glad the mother could visit with her daughter.