Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of 6 months, she noticed that all patients admitted from the Shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis.
In each case, answer the questions at the end of the case and
give researched references to support your assertions; also,
explain what would be the ethical course of action and the legal
requirements for action in the case.
Case One
Mrs. Lewis was head nurse on a medical surgical floor in a
community hospital with 250 beds. Over the course of 6 months, she
noticed that all patients admitted from the Shady Rest Nursing Home
had signs of severe injuries other than those connected with the
admitting diagnosis. There appeared to be patient abuse in the
nursing home. Mrs. Lewis investigated discreetly and found no
explanation possible except abuse. In accord with the obligations
of the law in her state, she reported the matter to the Department
of Welfare Bureau of Inspection.
The Welfare Department investigated immediately, found proof
of abuse, and threatened to close down Shady Rest if there were any
more recurrences. Mrs. Lewis was overjoyed until her hospital
administrator, bypassing the director of nursing, called her in and
warned her that she would be fired if she reported any other
instances of abuse. Shady Rest sent the hospital a lot of business,
and good relations had to be maintained.
Mrs. Lewis was even more shocked when she discovered that the
administrator was a golf partner of the owner of Shady Rest and was
doing an old buddy a favor. Despite fears of retaliation, Mrs.
Lewis consulted a lawyer, who threatened the hospital with exposure
and with penalties that would follow if one of its employees failed
to follow the reporting provisions of the law on abuse in nursing
homes.
Did Mrs. Lewis act correctly? What should she have done if
she could not have afforded to consult with a lawyer? In what ways
can whistle-blowers protect themselves? Must the art of
intimidation be part of the toolbox of healthcare professionals in
order to protect their patients? Is power an appropriate
consideration in healthcare ethics?
Case Two
On a July weekend, Mrs. Allesfertig, nursing supervisor of
the whole hospital, discovered that the intensive care unit was
seriously understaffed. She pulled two nurses with previous ICU
experience off other floors to bring the unit up to strength in
view of the extreme level of acute care needed. On the following
Monday, Dr. Bestknabe, who has overall responsibility for the ICU
unit, closed the unit for further admissions until the staffing had
been worked out on a permanent basis.
Should the new staffing policy give the nurses authority to
refuse to admit patients when the staff is not sufficient to handle
them? (In some hospitals, nurses have this authority.) Can any
policy take precedence over the professional judgment of trained
ICU nurses?
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