Before beginning clinicals later this month, I have been required to take a course involving current health-care professional issues, with a major emphasis on Nursing Ethics. Nursing Ethics is a subdivision of Bioethics, which is a relatively new field of philosophy, having evolved primarily in the last 40 years or so, according to my textbook. This would make sense, since that has been the time during which the most recent set of major advances in medical technology have created complex new moral and ethical dilemmas.
I realize this has happened previously during human history; it seems to me that it happens in spurts, with advances in our ability to provide health care.
So in addition to the scientific and technological questions of 'How-To' that we have to ask and answer in each situation with each patient, we are also required to ask and answer moral and ethical questions of 'How-Should'. Using Kohlberg's model of biopsychosocial development, nurses are required to be morally mature individuals (for some reason that makes me laugh every time I read it) who have reached the postconventional stage of development.
With all this in view, the instructor and the textbook urge each student very strongly to develop a definite set of ethics, since we will be making all our 'How-Should' decisions from the vantage point of our own worldview. We do have the guidelines set forth by nursing organizations, such as the ANA and the international equivalent whose exact name I can't recall at this moment, but it is recognized that we as individuals need a strong platform of our own to stand on when we face each decision, particularly during rotations in places such as the Emergency Department.
There are nursing forums and so forth which I take advantage of, as well as being a part of the student nurse community on campus. However, I would also like the perspective of fellow-Druids in developing my own approach to nursing, which is what this post is trying to be about.
Naturally a personal code of ethics is created on an individual basis; however, as I see it one of the purposes of a community such as this is to create an atmosphere for open discussion and thoughtful consideration of these things together. I have a personal moral code, but I humbly recognize its probable imperfections and inconsistencies. I would like to resolve some of these if possible before being faced with it in the heat of the moment, as it were, and for a discussion of issues such as this I would like the input of other Druids.
If that makes sense (and I really hope it does), perhaps some of you would be willing to offer input regarding various hypothetical dilemmas. Naturally anything I post here will be ambiguous and general, given the fact that one vital attribute of a nurse is discretion and confidentiality.
Health care as a profession/vocation is a difficult road, fraught with emotional burdens as well as intellectual and physical challenges. I would deeply value any help you can all offer with the theoretical part of figuring things out; I value the input of others because I realize the necessarily limited perspective I bring to any situation, potential or actual.
When I pose a question here on this board, I'm asking as a Druid first. I would ask as a Nurse first on a nursing discussion board, or in a study group or with my clinical group.
All that being said, here is the first dilemma, which is disappointingly much more to do with bureaucracy than with any exciting bioethical hot-buttons like stem cell research or euthanasia (those are coming, however!): there is a serious nursing shortage; this results in severe understaffing situations. [BTW, legally, student nurses are equally culpable with licensed nurses for anything that goes wrong; we have liability insurance same as they do, and so forth. I'm not complaining, I think that's fair - I wouldn't want any less for my own loved ones when they are given nursing care.]
However: if one day I show up for work at a hospital, and accept an assignment, I am culpable for anything that may happen regardless of how overworked I am. The situation is complex, but the question is, if I know when I show up that there are too few nurses, do I do as much good as possible despite the inevitable shortcomings, or do I refuse to accept the assignment on the principle that the hospital should accept the responsibility of properly providing for patient care? To accept it and be overworked can lead to exhaustion, burnout, and dangerously increased incidence of mistakes; if nothing goes wrong, despite the understaffing, bureaucracy tends to think there's no need for spending more money on adequate staffing. So long-term, it seems right to refuse such an assignment.
Short-term, however, and knowing myself as I do, I seriously doubt I could show up to work and refuse an assignment; because I could not walk away from patients knowing I could help them, and because the guilt would probably crush me. I have always been on some level terrified of authority, and the moment someone looks at me sternly I would probably scurry away with my stethoscope and hope I didn't make mistakes.
As a druid, with the worldview that all life is sacred and deserving of the utmost respect I can give it, yet with the simultaneous belief that death is not the disastrous end-all that many other worldviews paint it to be, I feel that a good argument might be made for either decision. Hence the dilemma.
Sorry for rambling on so long; thank you to anyone who reads this, whether or not you respond. I hope some of you can and will discuss these things with me, so as to give me a clearer lens through which to perceive decisions that must be made instantaneously, but have the impact of issues that deserve long, careful deliberation.
