Ethical Legal Dilemma in Advanced Nursing Practice



Just like in all types of professions, nursing involves a lot of moral distress in the way they perform their duties. Nurses however, face tougher task since they deal with critical issues about human life. They as such are required of to display utmost professionalism to avoid putting the human life at risk. Practicing nurses may, however, find themselves in situations where they know the right ethical conducts that they need to display but are unable to do so due to other obligations provided by their bosses or the institutions (Repenshek, 2009). Although the healthcare organization that employs the nurses always provide them with codes of conduct in the forms of guidelines that they need to maintain while on duties. Some of these conducts may not concur with the provisions of the nursing profession. Besides, the worst scenario that always encounters the nurses is working with the physicians that are not employees of the hospital. Therefore, the doctor may force the nurse to act against the institution’s requirements. The situation, therefore, causes huge moral dilemma to the nurses as they have to choose which side to obey (McAndrew, Leske, & Schroeter, 2016).

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Case Study

The codes of conduct of the nursing profession require that nurses value the codes of conduct of the hospital. The hospitals always provide the nurses with a delegation of duties that they need to perform their daily tasks. Therefore when a mistake happens in the area beyond the nurses’ duties, then they are likely to face legal charges for absconding their duties. Besides, the nurses need to ensure that they perform all the functions delegated to them by the institution. There is, therefore, a different line of duty between the nurses and the physicians and none should overstretch their lines (Cox, 2008). However, this is not always the case as physicians do delegate extra duties to the nurses against the provisions of the hospitals leading them into moral dilemmas. 

The primary challenge that usually encounters the nurses is that they have the regulations to obey the physicians when attending to patients in the hospitals (Fowler, 2008). Since most of the hospital’s source doctors from outside the institutions, these physicians may not be well-conversant with the provisions of the hospital. However, since the nurses have the mandate of ensuring that the patients’ life is under absolute safety, they will have no choice but to obey the physicians (Milton, 2003). The ethical codes of conduct in the nursing profession also do not allow the nurses to disobey their bosses who in many cases are the doctors (American Nurses Association, 2009). Therefore, the situation puts them in a lot of distress.

Example of Legal Proceeding

An example of moral distress to nurses appeared in the Chase v. Sabin case of 1994 (Hurlbert, 2008). Durward Chase Jr. had sued Dr. Sabin for applying an inadequate anesthetic during the second operation of his eye, a situation that led to damaging of his vitreous humor. Although the doctor had previously administered the plaintiff with sufficient anesthetic during the first operation, the mistake occurred during the second procedure. Dr. Sabin allowed a nurse who was an employee of the hospital to apply the anesthetic on the patient during the second operation. An unlikely scenario occurred where the anesthetic did not last for long as required for the duration of the operation but allowed the patient to wake up to squeeze the eye hard thereby damaging the eye cortex. The court found the doctor to have caused the damage due to negligence by allowing the nurse to perform the duty on behalf of the physician. The nurse, therefore, disobeyed the ethical codes of conduct of the nursing profession by performing the task designated by the doctor.

Conclusions and Recommendations

The American Nurses Association should, therefore, help the nurses by providing the rules that nurses need to apply to relieve them of such moral distress. One of the best ways that the ANA can initiate to assist the nurses in such scenarios is by giving them the voice to air their views to their bosses on the tasks their bosses require them to perform. Since the nurses always obey the physicians, they typically end up performing risky procedures that may endanger their career. Secondly, ANA should give the nurses the support by initiating all the codes of conduct in the learning institutions for the nurses so that they graduate while well-equipped with such knowledge. Dispensing nurses with such pedigree is likely to save the dilemma that encounters them in the field. Finally, ANA should accord the nurses in tackling the legal issues should patients or hospitals take them to courts for breaching the codes of conduct if the action was necessary for saving the life of the patients. Such legal assistance may provide the nurses with freedom of doing what they feel are morally right while attending to a patient with the physicians. 

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  1. American Nurses Association. (2009). Nursing administration: Scope and standards of practice. Nursesbooks. org.
  2. Cox, K. M. (2008). Moral distress: strategies for maintaining moral integrity. Perioperative Nursing Clinics3(3), 197-203.
  3. Fowler, M. D. M. (2008). Guide to the code of ethics for nurses: Interpretation and application. Nursesbooks. org.
  4. Hurlbert, N. M. (2008). Wrongful Death-Statute of Limitations-Michigan’s Statute of Limitations for Wrongful Death Actions is Exclusive, Therefore Precluding the Use of the Common Law Discovery Rule-Trentadue v. Gorton. U. Det. Mercy L. Rev.86, 31.
  5. McAndrew, N. S., Leske, J., & Schroeter, K. (2016). Moral distress in critical care nursing: The state of the science. Nursing Ethics, 0969733016664975.
  6. Milton, C. L. (2003). The American Nurses Association Code of Ethics: A reflection on the ethics of respect and human dignity with nurse as expert. Nursing Science Quarterly16(4), 301-304.
  7. Repenshek, M. (2009). Moral distress: inability to act or discomfort with moral subjectivity?. Nursing Ethics16(6), 734-742.
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