Introduction
In their practice, nurses face many ethical dilemmas; guided by the Code of Ethics and Code of Conduct, they have to make choices that are beneficial for the patients and correspond to a hospital’s policy and rules. One of the multi-faceted issues in the APN field is accidental mistakes. Looking upon the ethical and legal side of this question, this paper argues that establishing a moral community within which nurses can share their experiences would be beneficial for avoiding violating ethical principles and respective laws in this area.
Malpractice Case
Nurses in stressful settings attending simultaneously to several patients are especially prone to making mistakes. In their practice, nurses often face the dilemma of honesty versus withholding information. For the patient’s benefit, all mistakes should be disclosed to doctors or a head nurse; however, even harmless mistakes serve to erode trust in a nurse’s capacities and reliability.
Ethical Decision-Making Dilemma
The main document that suggests ways of dealing with nurses’ ethical problems is the Code of Ethics. The Codes of Ethics guidelines (2015) state the following, “When errors or near misses occur, nurses must […] ensure responsible disclosure of errors to patients” (p.11). However, reporting mistakes erodes trust in the nursing profession, especially on the part of a patient. Nurses do not want to be seen as unreliable or not caring about a patient’s needs.
Legal Decision-Making Dilemma
Considering the legal side of the issue, the nurse could be subject to several punitive measures, depending on the circumstances. As Musacchio (2019) states, these measures “include professional discipline by the governmental entity […], being named as a defendant in a private civil lawsuit for malpractice and/or negligence, and potentially being brought up on criminal charges” (p.1). Recently, there have been cases when nurses were convicted to years of prison for administrating medicines leading to the death of patients. While there is no excuse for such actions, the nurses may be scared to report even harmless mistakes since they may not know how grave their actions are.
Relevant Codes of Conduct Applying to Nursing and Chosen APN Field
First Code of Conduct
The principles expressed in the Code of Ethics are supported by the nurses’ Code of Conduct, which reasserts the central place of a patient in the healthcare system. The Code of Conduct states, “The nurse’s primary professional responsibility is to people requiring nursing care.” According to this Code, all mistakes should be disclosed to promote patients’ safety.
Second Code of Conduct
Further, the Code of Conduct names trustworthiness and integrity among the essential nurses’ qualities. Mistakes erode trust between the patient and the nurse, and the latter may be viewed as incompetent and careless. Many nurses choose not to report to avoid this, especially when they know there has been no harm done. In this way, the Code of trustworthiness can be compromised.
Third Code of Conduct
Finally, the nurse is responsible for sustaining professional values, including responsiveness to patients’ needs (Code of Professional Conduct for Nurses). Mistakes in the nursing practice run counter to APA’s Code of Conduct, making it difficult to report them. If these are medical mistakes, professional responsibility can be questioned by the nurse’s superiors and the patient himself and his family. Furthermore, mistakes run counter to professional values, and the violator may be seen as not upholding them.
Violation Constituting a Civil or Criminal Act
Ethical Principle
The violation of ethical principles constitutes a civil or a criminal act depending on what circumstances the violation led to. In case of harmless mistakes, the violation will be treated as a civil action, and no punishment will follow. However, if keeping silent leads to serious impairment or death of a patient, the nurse will be charged with a criminal offense.
One law
There is no universal law applicable to all cases of concealing mistakes in nursing since harmless mistakes do not constitute any legal violation. However, in most cases where harm to the patient can be proven, the nurse will face the charge of malpractice. In case the mistake is unintentional, it will constitute a civil act. If the nurse’s intent to cause harm to the patient either by malpractice or keeping silent about malpractice can be proven, the violation will constitute a criminal act.
Decision
Decision Demonstrating Integrity
To reduce the number of mistakes and, at the same time to alleviate keeping silent about them, a moral community, suggested by Dr. Wocial, may be established. Wocial (2018) defines a moral community as “a place where its members are encouraged […] to engage in deliberations and negotiations about what is the right course of action”. In a moral community, people are free to discuss their failures in the professional sphere since they are not afraid to be punished. Wocial (2018) states, “[…] leaders embrace honest mistakes as opportunities to learn, not reasons to punish”. Nurses are encouraged to reflect on why the situations of malpractice happened if they were stressed or in a hurry, and from these reflections and discussions, they learn to prevent mistakes from happening.
Decision Preventing Violation of the Ethical Principle
When there are no drastic circumstances, a moral community may take collective responsibility, which would result in a greater number of mistakes reported and, consequently, better healthcare service for the patients. Moreover, patients and medical heads should be encouraged to see mistakes as a necessary part of learning, thus encouraging nurses to share failures.
Decision Preventing the Law from Being Violated
To diminish the fear of reporting, a system of anonymous reporting of mistakes through online services could be established. This way, mistakes could be reported practically without delays which could severely curtail drastic circumstances they may lead to. This way, in cases where grave damage to the patient’s health was done, it would be easy to find a guilty person; however, in all other cases, nurses won’t hesitate to report.
Recommendations
In situations of moral distress, I recommend nurses not to block their feeling but share their failures with family and friends, remembering that no one is perfect and mistakes are a necessary part of education. Secondly, I recommend notifying the doctor if the mistakes occur; it is essential not only for a patient’s safety but also helps to overcome fears and doubts as to the right course of action. Thirdly, nurses are recommended to communicate within the moral community to alleviate stress, horror, and remorse when they become aware of their failures.
References
The Code of Ethics for Nurses (2015). Web.
Code of Professional Conduct for Nurses. Web.
Fedele, R. (2017). The rise of burnout: An emerging challenge facing nurses and midwives. Australian Nursing and Midwifery Journal, 25(5), 18-23.
Musacchio, J. A. (2019) Criminal charges for medical mistakes? A tough pill to swallow. In ANA-New York Nurse (2nd ed.) (pp. 16-17).
Ritchie, V., O’Rourke, T., & Stahlke, S (2018). Nurse practitioners’ experiences of moral distress in the continuing care setting. The Journal for Nurse Practitioners – JNP, 14(10), 745-752.
Wocial, L.D. (2018) In search of a moral community.OJIN: The Online Journal of Issues in Nursing, 23(1). Web.