Moral Distress and Patient Advocacy

[Reem Azhari]

My research on nurses and their decisions to blow the whistle on unethical health care practices concluded that moral distress plays a large role in nurses' willingness to report

substandard care. Nurses experience moral distress, which is defined as wanting to do what's right for the patient but not being able to due to political constraints, that statistics show 50% leave their jobs at the bedside within the first 3 years of starting a new position. What can we do as nurse leaders to change that mind set? How can we help our new staff feel comfortable reporting wrongdoing to healthcare leadership? My research shows that the majority of nurses will not come forward due to fear of retaliation. Thoughts? We can discuss this off line as well.

[SoldierNurse22, BSN, RN]

It's a culture change that's needed and a shift toward evidence-based practice despite the "that's how we've always done it" chant that seems to pervade the system. No more of "Danny's in charge of IC and we've done it this way since he's been here" or "this is how the hospital across town is doing it".

In my experience, weak leadership is often the factor that greases the wheels of waste, fraud and abuse. If nurse leaders stood up for nursing, many of the problems we currently have would go away. It seems that most folks are too scared to rock the boat, however, so we continue on in this unsustainable holding pattern where the very system itself and the lives of those within are on the line.

[Reem Azhari]

Thank you for the great feedback. I concur that weak leadership is the root cause of this ethical dilemma. My research also showed that nurses are retaliated against by their own peers as well as their leaders. It's frightening that nursing leadership fosters a culture of silence.

[SoldierNurse22, BSN, RN]

Absolutely--you're right. The leadership isn't simply cowed; it's often complicit in the problem, especially when it comes to retaliation.

I'm glad to hear you're researching this. I've seen this and experienced it myself in the government system. It's a huge, ugly and often ignored problem that must be brought to light!

Without job protection, nurses are top vulnerable. Nursing should not be at-will employment.

[LadyFree28, BSN, LPN, RN]

It's a culture change that's needed and a shift toward evidence-based practice despite the "that's how we've always done it" chant that seems to pervade the system. No more of "Danny's in charge of IC and we've done it this way since he's been here" or "this is how the hospital across town is doing it".

In my experience, weak leadership is often the factor that greases the wheels of waste, fraud and abuse. If nurse leaders stood up for nursing, many of the problems we currently have would go away. It seems that most folks are too scared to rock the boat, however, so we continue on in this unsustainable holding pattern where the very system itself and the lives of those within are on the line.

THIS.

Also the challenge is how standards and practices are different everywhere, instead of a universal commitment to EBP; or at least a system in place for insuring reason and rationale essential to practice.

Depending on the organization, there may be commitment to the bottom line, instead of reason; making the pressure to keep the line even greater.

[Alnitak7]

I wish more violations could be resolved inside the facility. I HATE big productions like calling the state on someone who didn't use gloves during patient care just because a supervisor says we have to report them. They do get together and retaliate and/or will avoid you. In some cases I reported abuse when I was the only one who reported it. In some cases, this got positive results for the patient even when your co-workers think you're trying to make them feel guilty.

[Reem Azhari]

Agreed! The unfortunate reality is that whistle blowing occurs when there is no resolution from within! As nurses enter C-Suite positions, it's my hope this mindset will change.

[PaulBaxter]

I certainly agree with those saying that this is a leadership problem. It is, perhaps, also a wider problem of moral weakness in general. I can't recommend highly enough the book A Failure of Nerve: Leadership in the Age of the Quick fix, by the late Edwin H. Friedman. He speaks to the fact that people in general, and leaders/managers in particular, are always deferring to whoever is seen as the weakest in their group, with the result that people are able to dominate decision making simply by portraying themselves as weak.

http://www.amazon.com/Failure-Nerve-Leadership-Age-Quick/dp/159627042X

[Reem Azhari]

Great post-thank you for sharing. I will definitely add that to my reading list. May I also recommend the book "Willful Blindness" by Margaret Heffernan. The premise is that the truth is too painful and people often re wire their thinking to avoid confrontation. She gives excellent examples and great insight. It's a great read.

[Crazynut]

I have trolled this site for years but never actually post. But this is a topic I'm so passionate about that I just had to create an account. So please excuse my french for what I'm about to say. But I think it is important that every nurse out there hear what I have to say...

As someone who blew the whistle, I can say this. It is a dark place to be. They will retaliate bully and yell at you til they kick you down. They will make up lies and turn your co workers against you. They will tarnish your reputation and then refer you to mental health services because they are "concerned" about your mental stability. They will do this to the point where you question yourself. Question your own sanity. But do not let it get to you. This is the game that they play because they don't have the balls to fire you out right. Because God forbid they possibly might have to pay you unemployment. Or possibly deal with a whistle blower lawsuit down the road. Most whistle blowers are unsuccessful. There are studies done that show most whistle blowers regret it and say they will never do it again. But where does that leave us? How can things ever improve if no one ever stands up and points out all the things that are wrong? So to all those out there considering blowing the whistle. Stop obsessing about it. Stop crying about it and just do it! **** your manager! **** the stupid DON! She's just an old hag that can't nurse to save her life. You can run circles around that ***** anyways! **** the hospital and **** HR! **** the whole mother ******* system! We are nurses. Patients lives are on the line. How would you feel if that was you mom or your dad laying in that hospital bed??? How would you feel if that was your son or daughter in that hospital bed???? When we lose the ability to advocate for our patients we are no longer nurses. We then become robots mindlessly performing meaningless tasks that they can train monkeys to do. I'm sorry but I'm no monkey. I'm a nurse with a brain and a conscience! So just do it! Do some research. It is going to be hell. Get a good lawyer from day -1! Get a good PCP and a good therapist. Get a copy of your medical record and read thru it. They will be cruel. Make a list of all your enemies. They will dig around in your past/personal life. Keep your friends close and enemies even closer. Trust no one! It will be the lowest point in your life. Go ahead and get a script for xanax. You will need it. But at the end of the day it is worth it. You won't get the outcome you are hoping for. But you will cause a stir. Higher ups will get wind and it will effect some kind of change which eventually over time could lead to improvements. It is a part of the ANA's code of ethics. We have a duty to report. Every state is different but most states have a list of certain things that are mandatory reporting. If you don't report then you could get in trouble for turning the other cheek.

So therefore, in conclusion. To answer your homework question Lol Yes moral distress plays a role. But that is what separates the weak from the strong. Do you want to be the weak one? Nope. Didn't think so. Do the right thing. Move on with life. There's so many other jobs out there. Say your piece and bounce. Always push back. Always keep it moving!

Here are a list of sites that helped me during the darkest time in my life! There is light!

Whistleblower Support Fund | Mission

Things to Know About Whistle Blowing

National Whistleblowers Center - Meet the Whistleblowers

http://www.medscape.com/viewarticle/751347

When nurses speak up, they pay a price - American Nurse Today

[Crazynut]

Soooo true! But for it to be handle in house they have to first admit that it is a problem! God forbid they admit they have problems. I mean they did just spend millions putting up a huge new fancy billboard on the side of the highway. Touting their "excellent" care. Hahahaha