Hi, I have just joined the forum, I have been qualified 2 years now.
I was wondering if anyone can help me with some insight with the following.
I was working a nightshift with another SN that is a jehovah witness, there was a patient who had been admitted earlier that day with a low HB and needed 3 x RCC transfusion asap. The nurse whom I was working with told me that because of her beliefs she would not check or have anything to do with this duty:o. I had to arrange for the hospital co-ordinator at night to come down to the ward to assist me in setting up and checking the RCC. This caused a delay in the pt treatment as I had to wait till the co-ordinater was free to assist:-{
My question is was she right to put her beliefs and values before patient care. I know that there is issues in connection to JW not wishing transfusions for themselves etc., but surely as a nurse practitionare she should be putting the pt needs first?
I wanted to challenge this but being newly qualified at the time I was a bit unsure of my knowledge in this:uhoh3:. The nurse co-ordinater was also reluctant to do this due to political correctness, I have since researched this and have found nothing that forbids them performing this duty for others. Maybe I am looking in the wrong places for this information.
Thanks in advance for any insight anyone can give:up:
Specializes in Peds, CCU, ICU, Cardiac, ER, MS, SNF's,.
Wow, this is a remarkable discussion, and in all my years of nursing (Too Many!) experiences, I have never heard of this type of situation before. Thank You for bringing it to the forum.
I see there are "2 sides to the story", as there are in all that involve more than one human being telling the story.
So there is no cut and dry "right vs wrong" here.
As in many situations that involve moral & ethical dilemmas.
It seems to me that this issue should have been discussed and resolved at the time of the Jehovah Witness' Nurses orientation process, (Suggestions at end of this post.) so that you should have never been put in this situation.
Abortion is frequently used as an example regarding a providers' "rights based on their religious beliefs" to decline caring for a patient who is having or has undergone one.
That is a Very Hot Button Issue for most folks, so let's look at some other Issues where one's personal beliefs/values may differ from what needs to be done to sustain and hopefully improve the life of a patient in other situations.
How about people who are undergoing radical chemo, surgical, and/or radi treatments for a malignancy that we know the odds of achieving 5 more years of life are less than 5%?
Do we give them "false hope" because that is what they are hoping/praying for?
Or do we tell them what we know from researched, evidence based data that we feel that their case is "hopeless" and they should be enjoying whatever little time they have left of their life instead of chasing after medical miracles?
I had to face and make that decision with my own mother, when she was only 42 years old.
The Docs were giving her the treatments and false hopes; when the reality was she had "3-6" months to live.
I chose to be the one to tell her "the truth", because nobody else would. She lasted 9 months total and the last 6 months were enjoyed at home instead of in clinics and facilities after I told her the truth.
How about Organ Transplants? Personally, I would never want one for myself, and doubt that I would choose to donate any at the time of my impending death, if asked to do so. It is part of MY religious beliefs. But do I ever offer that info to a patient who is contemplating or undergoing such? NEVER. I am totally supportive of what my patient desires for their life.
In the USA, our country was founded upon the desire of our forefathers to practice religion in the way they saw fit, not by how the Church of England dictated.
So, as an American, I am respectful of the "To each their own" religiously as long as they are not causing any harm or abuse to others in their practices. (ie animal sacrifices, child brides, etc).
What about medical personnel who are Vegan or Vegetarians? Or who do not eat certain types of animals?
Do they have "the right" to refuse to serve any foods with animal products to their patients? There are several religious organizations who do not use/eat particular or any animal products (Hindu, Wiccan, Jewish, 7th Day Adventists and more).
How about people who do not want their children to receive immunizations? Another "Hot Button" issue that has more than 2 sides to it.
Personally, I do not feel that the vaccines are the problem, but the schedule and Way/routes they are given;
too many at the same time at too young of an age, and the practice of giving SQ/IM vaccines for the illnesses that are spread via the RESPIRATORY system.
Do I refuse to give vaccines because of my personal beliefs, (NOT Religious Based; formed due to my personal research), or do I go along with whatever the CDC & my employer has deemed as their protocol?
I follow what my job requires, not my personal beliefs.
I feel strongly that every employer needs to discuss these type of ethical/moral issues with every new hire at the time of orientation.
Employers neet to have written policies/procedures in place that are for the good of and best outcome of the PATIENT.
Of course employers can allow employees to state and practice their religious/personal beliefs; but the employer should also have the employee sign something that acknowledges that they, the employee, will be held personally responsible if the outcome is harm to the patient due to the employee with-holding or performing care based upon their personal beliefs that led to harm to the patient.
And the delay of a blood transfusion certainly could have led to harm to the patient, who had signed the consent to recieve a transfusion and expected such to be done as soon as possible; not hours later because of somebody's personal religious practices interfered with the administration of the transfusion.
Facilities/employers need to have at least semi-annual ethics and moral reviews of whatever cases such as these come up to help guide them in their decision/policy making.
A facility can refuse to provide certain types of care; in non-life threatening emergencies, (ie. those seeking an elective abortion) they can post this at all of their entrances; so that people know to go seek help elsewhere. "We do not offer nor perform elective abortions at this facility; for information where to acquire one, please speak to one of our (social service, case management, admissions, etc) representative.
But to withhold care based upon a facilities' credo (ie Catholic hospitals do not provide abortions, fine; vs withholding care to a woman who is suffering from post-AB complications) opens up the facility to lawsuits from many.
So please be brave and bring this up to your facilities Ethical , Moral, Legal Committee. Some good may come of this situation so that another patient may not be delayed treatment in the future.
Remember, we all entered this profession to
"Take Care of Others in their time(s) of medical and health needs";
NOT to "Recruit and Reform others to MY personal beliefs and religious practices".
"Of course employers can allow employees to state and practice their religious/personal beliefs; but the employer should also have the employee sign something that acknowledges that they, the employee, will be held personally responsible if the outcome is harm to the patient due to the employee with-holding or performing care based upon their personal beliefs that led to harm to the patient."
:yeah:
I have to admit I have pondered over this a lot...whom would be liable if things deteriorated. On this occassion the lady got her RCC within time window allowed but the potential for this outcome to be different was there.
I work in a small hospital 10 wards (one a day area) and often we are short staffed o/n on 1 occassion only 2 wards had full qouta of staff o/n (scary-I know:o, I x SN and NA to 20-24 pt.) If the night co-ordinator had been on an arrest call, she would not have been able to attend for a while.
I guess if ever that situation occurred again I would have spoke to SN in ward closest to ours and arranged the JW nurse to cover there floor till she came over and assisted me with task:-) (I wonder whom would be liable if an incident occured on their floor whilst they were assisting me?) It could go on, and on...but that is what I would do in future....
I can't fathom why the SN (JW) herself didn't not suggest or do any of this as, as a JW she would have been in this situation before in her 7 years of practise.
Specializes in Peds, CCU, ICU, Cardiac, ER, MS, SNF's,.
"...I have to admit I have pondered over this a lot...whom would be liable if things deteriorated. On this occassion the lady got her RCC within time window allowed but the potential for this outcome to be different was there..."
Exactly! "The Potential" for this outcome to be different was there.
This is why it is the Facility/Employer's Ethical/Moral and Legal responsibility starts at the time of Employee Orientation; to make it very clear where they stand on controversial issues and what standards of care they expect from their employees before the employee ever renders any patient care.
The employee who declines to render care based upon their "personal/religious beliefs" may choose to do such, with full knowledge that they will be held personally accountable for their actions or lack of actions if any ACTUAL Harm to the patient is the outcome.
Once it is spelled out clearly to the new employee, that such decisions could become a personal malpractice suit in the future; where the facility will not back up the employee one bit; they may think again about imposing their personal/religious beliefs upon a patient who has consented to and is seeking any particular treatment.
Of course, this is quite different from refusing to carry out or participate in anything that one believes will be harmful to a patient; that is a whole 'nother part of nursing, that we as Patient Advocates, also need to be aware of and have the courage to practice at all times; even when it means "David fighting Goliath" type of scenarios.
To end, I'll just say, G*D bless all nurses. We do and handle what few can even contemplate when ALL the factors and potential outcomes are considered. Gypsy.
Specializes in Peds, CCU, ICU, Cardiac, ER, MS, SNF's,.
Yes, I think there are many people, in all professions, who never miss an opportunity to express what makes them "unique, different, special, and/or righteous" because of their personal beliefs.
It's a way of elevating one's self to by making it known that "Their way is the right/only way".
I have alot of "personal beliefs"; some religiously based, some not.
But they are Personal, and that's why they are called Personal I believe!!!
Imagypsy, thank you for your posts. I'd like to add a thought. In nursing we are supposed to use evidenced based practice which is why we don't refuse to administer meds that evidence has shown to be effective and necessary. If a pt's H&H were high, I could see questioning or even refusing an order to transfuse PRBC. However, if the H&H were low, evidence based practice has shown PRBCs to be an appropriate and necessary treatment.
I am one of Jehovah's Witnesses and have been a nurse for 24 years, primarily in labor and delivery...not once has this ever been a problem, i made it clear that i would do everything but spike the bag from day one.....All of you that have such issues with us...have you ever seen a delay in treatment??? It seems to be the usual witness bashing...btw, i generally work level 3 L and D and have had no issues..I think you have covered this issue ad nauseum..
That nurse was out of line. Her beliefs end at the surface of her own skin and she has to honor the beliefs of her patients.
Anybody who is too religiously prissy to check in blood and hang it, to dispense birth control pills in a pharmacy, or do anything else that is specified in the professional practice act belongs in a church, not dealing with patients.
I have no want to bash Witnesses, or any other religion. My view is, if your religion prevents you from any aspect of care, you should choose a new career. Be it any religion, or personal viewpoint, when you choose healthcare, you no longer matter, only the patients.
That nurse was out of line. Her beliefs end at the surface of her own skin and she has to honor the beliefs of her patients.
Anybody who is too religiously prissy to check in blood and hang it, to dispense birth control pills in a pharmacy, or do anything else that is specified in the professional practice act belongs in a church, not dealing with patients.
That's my two cents.
In your vast experience, how many delays have you seen??? You failed to address that, so i'm guessing...none!! I am proud to say I worked in a hospital in NY where not one but two of the ER docs were Jehovah's Witnesses..according to your thinking(or lack there of) they should never have worked in that department, well what department would be acceptable for a doctor that doesnt believe in blood transfusions??? They worked there many years without any problems. As far as the nurse being out of line, I wasn't aware that you were there. I can't speak for her as I was not there. I will give her the benefit of the doubt, it takes years to figure out how to work in healthcare without violating gods laws, she was probably a lovely young girl trying to be moral and ethical. Your tone:referring to"prissy" people, and we were not discussing"birth control"(which BTW we are happy to dispense) sounds like more of the old nurse eating the young...also sounds a bit like you are just needing to vent...perhaps you could find a constructive way to do that????
If I hadn't have been so new I probably would have been better equiped to deal with the situation, then there would probably not have been much of an issue. Also may I add that prior to going through my training I was a NA for many yrs and I worked with a JW for as many with no issues whatsoever, I did not even know they were a JW until we had been colleagues for 3+ yrs, I thought highly of them then and still do, so no JW bashing from my corner also.
:yeah:
Medic09, BSN, RN, EMT-P
441 Posts
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