Nr 451 Week 7 Discussion, Health Federal Bills In Congress

NR 451 WEEK 7 DISCUSSION, HEALTH FEDERAL BILLS IN CONGRESS An Ethical Dilemma (graded) Nurses face many ethical issues on a daily basis. Consider the following scenario: Your unit has team nursing. As luck would have it, you and your best friend, Jill, are paired as a team this shift. Jill is a new nurse so you feel this is a great opportunity to take her under your wing a bit and show her the ropes. It is a busy shift and you administered Mr. Smith his insulin dose based on the sliding scale before lunch. You chart your medication administration and continuing caring for your patients. An hour later, Jill comes to you terrified because she forgot to chart the insulin she gave Mr. Smith and realized that you also gave the medication. She rushed to take his blood sugar and it was 115. Mr. Smith felt fine and was eating a candy bar his family had snuck in for him. No harm done, in fact he probably needed the extra insulin to compensate for the candy bar he wasn’t supposed to have, Jill explained. Jill begs you not to report this since she is still on probation. She says that she has learned her lesson and since nothing bad happened, why does anyone need to know? What would you do in this situation? Apply ethical principles to explain the rationale for your decision making process. Respond This section lists options that can be used to view responses. Collapse All Print View Show Options Responses Responses are listed below in the following order: response, author and the date and time the response is posted. Sort by Read/Unread Sort by Response Sorted Ascending, click to sort descending Sort by Author Sort by Date/Time* (an instructor response) Collapse Mark as Unread Introductory Post Instructor Card Email this Author 4/22/2015 11:19:49 AM We have all been faced with ethical dilemmas in our practices and in our lives. Please use the ethical principles discussed in the course materials to describe how you would handle the situation in the case above, and discuss why it is important to be aware of and use ethical principles in our practices. Respond Collapse Mark as Unread RE: Introductory Post Shellie Cartwright Email this Author 6/1/2015 2:32:15 AM Dr. Card and classmates, Ethical issues related to healthcare have been discussed and debated for years, and will continue to be for years to come. In my professional career as a nurse I have been directly and indirectly involved in several ethical issues concerning patients, patient family members, physicians, co-workers, and organizational leaders and staff members. As a new nurse I can say I was very uncomfortable bringing these issues forward fearing lack of knowledge, anger towards me as the "whistle blower", or retaliation. As I have grown in my nursing career, my thought process, perception, and ways of addressing these issues has changed. I have become more comfortable as a nurse with an increased knowledge base, ability to deal with negative interactions, and mindset that fear of retaliation can never be a determinant to doing what is right. According to the ANA, an ethical practice of a registered nurse includes "contributes to resolving ethical issues involving healthcare consumers, colleagues, community groups, systems, and other stakeholders" (2010, pg. 47). When considering the scenario above with the nurse friend Jill, ones ethical practices as a co-nurse should not change. In making that statement I also realize this can be much easier said than done. But if approached correctly, Jill, herself, may come to the right and just conclusion that reporting the incident is the prudent thing to do. This weeks lesson speaks to ethical principles in nursing. One principle "autonomy is the right to make your own decisions and choices" (Lesson Week 5, CCN). As a nurse in this situation you would have the opportunity to make your own decision. But, ethically as a nurse you have the obligation to make the appropriate decision to report the incident for safety reasons and potential quality improvement measures. I would explain to Jill that I understand her concern of reporting the incident. If I had a story that could correlate to Jill's, I would use it to make her feel less alone. I would then explain that we all make mistakes, and each mistake is an educational opportunity. In this particular case no harm came to the patient, but what if it happens again, and not necessarily by Jill, but perhaps another nurse, and the outcome for the patient is less favorable. Perhaps this is a flawed system in need of quality improvement. Reporting of errors, mistakes or near misses, is a way to track trending in a current system or process, which may require further investigation. I would also offer to go with her to notify the supervisor, leader or manager of the occurrence. I would as well remind Jill that she is new and on probation for reasons of learning and increasing her knowledge and skill set. Finally, I would agree with Jill that she will never do that again, because this particular incident will remain with her forever. This would be my personal/professional approach to this situation, due to experiences with various failed approaches previously. If I only knew then what I know now! Shellie References American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed). Silver Spring, MD: Author. Lesson Week 5, CCN. Respond Collapse Mark as Read RE: Introductory Post Olivia Dewalt Email this Author 6/2/2015 11:57:47 AM Shellie, You make a good point by saying that though a mistake was made, the incident should ultimately be seen as an opportunity for education and improvement. Especially as no real harm was brought to the patient, this would be a great chance to evaluate processes of communication and med administration for potential improvement. I also like the idea of relating to Jill with personal experience, I've found that that is a useful tool in dealing with patients, families and coworkers alike. Great post! Olivia Respond Collapse Mark as Read RE: Introductory Post Bernardita Aberin Email this Author 6/2/2015 2:12:01 PM Modified:6/2/2015 3:37 PM Shellie, In the course of my nursing career I had encountered nurses, who made medication errors with minor effect, and the nurse filed incidence report on herself. By admitting her own imperfection, and demonstrating honesty, integrity and concern for the safety of the patients, the manager was considerate to the nurse and considered the incidence a learning curve for all. The gap in the process in medication administration was re-evaluated to prevent similar future events and resulted to change in practice. Dual sign-off for high alert medications was implemented, and when the scanner and barcode were adopted in the healthcare system, our organization purchased the system immediately regardless of the cost. I agree with you that nurses are responsible for the safety of the patients, it is the nurses' ethical duty. American Nurses Association (2010). Standard of Professional Performance. Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD Bernardita Respond Collapse Mark as Read RE: Introductory Post Jacklyn Paul Email this Author 6/3/2015 4:46:06 PM Shellie, Loved your post! It is truly a dilemma, should I report my friend or should it keep it a secret. It may seem unkind to report your friend but one must ask what kind of example are you setting for a new nurse. Thank God the patient had cheated and was eating a candy bar, it very easily could have gone the other way and he could have been found cold and clammy especially as the nurses were busy. Beneficence as our lesson states "we have an obligation to do good for our others as nurses." The nurse did good. One reason for the nurse reporting the error is that the unit probably is not very punitive and this incident provided a teaching moment for the new nurse and the staff. In my old unit, the nurse who did wrong would have to make a presentation on that topic in a staff meeting. The input from other staff members would help all realize that they were to be more careful in caring for the patients American Nurses Association.(2010).Nursing: Scope and Standards of practice (2nded.).Silver Spring, MD: Author Respond Collapse Mark as Read RE: Introductory Post Saynetta George Email this Author 6/3/2015 9:33:22 PM Hi Prof Card and class, As Jill's mentor I would demonstrate beneficence which means "taking a positive action to help others." Our ethics as nurses will not allow me to keep from reporting this incident properly. The purpose of reporting is not to be punished but to inform the nurse to be careful and remember and exercise the 5 rights of medication administration regarding every patient. The nurses who take care of the patient afterward should be on alert to monitor the patient as well. Side effects don't always occur before the first 24 hours. This should be known for safety of other nurses and the patient. Another ethical principle I would implement is Fidelity. As nurses it is our ethical duty to display all of the ethical principles however, fidelity implies we must be the advocate for the patient and not the nurse. Nonmaleficence implies that as Jill's preceptor we must teach her to first do no harm to the patient. Therefore, even if me as the preceptor was willing I]to report the incident, it is unethical and we would both be in violation of this principle. In essence mistakes will be made as nurses. When the nurse places her own fears of reprimand before the patient's that nurse is behaving unethically and will be punished severely if the truth is uncovered accidentally. I cannot allow any nurse to be comfortable with breaking these principles on my team. This is truly unacceptable and displays conduct unbecoming of any nurse. Thank you. Renee WWW.NURSINGWORLD.ORG American Nurses Association (2012). Standard of Professional Performance. Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD Respond (an instructor response) Collapse Mark as Read RE: Introductory Post Instructor Card Email this Author 6/5/2015 3:41:20 PM Good discussion of ethical principles that apply in this situation Saynetta - you have described how you would handle it well. Respond Collapse Mark as Read RE: Introductory Post Saynetta George Email this Author 6/7/2015 1:25:07 PM Hi Professor Card, Thank you very much! As nurses it is our duty to teach our novice nurses the methods and principles that have made us one of the most trusted professions. I would not continue to provide proper care if I did not display proper ethics. Thank you. Renee Respond Collapse Mark as Unread An ethical dilemma Erin Pyatt Email this Author 6/1/2015 3:51:14 AM Professor and Class, As Nurses we have an obligation to report scenarios such as the one above. As defined in our lesson "Non-maleficence means Do no harm. As nurses it is our responsibility to first do no harm." There was no harm to the patient but it would be neglegent to not report this because it was an error at the end of the day. Because no harm has occured at this time does not mean that it wont happen in the future. I would explain to Jill that we have no choice but to report it because it is our duty. I would explain to Jill that when we became Nurses we agreed to the Nursing code of ethics which makes it an obligation to do what is ethically correct. I would explain to Jill that this is a mistake and a learning experience. I would make sure she understands it is not a form of punishment. I would also applaud that she came forward to me and told me and followed an appropriate assessment of the situation by taking a finger stick. I would than encourage her to go foward on her own with this but would also offer to go with her to report it. If she was not willing to report her mistake than I would have no choice but to go foward on my own. Chamberlain College of Nursing, Lesson 5, 2015 Respond (an instructor response) Collapse Mark as Read RE: An ethical dilemma Instructor Card Email this Author 6/2/2015 3:42:23 PM Good discussion of how you would handle this situation Erin - you have described how the ethical principle of non-maleficence applies well. Respond Collapse Mark as Unread an ethical dilemma Christine Gill Email this Author 6/1/2015 6:02:56 AM This is a scenario that does occur often, but real life is always a little different than a dilemma written. When it involves friends it is even more challenging, but as nurses we need to follow ethical guidelines as written by ANA standards of practice. It does say we need to contribute to resolving ethical issues involving colleagues and we also need to take appropriate action in the case of unsafe actions that can endanger patients. (American Nurses Association (2010) I can honestly tell you that my response to this situation is different than it would have been 20 years ago. 20 years ago, I probably would have covered it up and reassured my co worker. Today, I would still reassure my co worker, but explain it is an incident that involves both of us and this is a situation that needs to be looked at so it does not happen again to others. I would show her how to write a very basic report with details only and explain that we need to call the doctor for his specific orders. Each hospital has different forms to fill out and it is necessary for this situation. I would not run to the manager to talk about what happened, but I would still have the report written. In today’s health care environment, the pharmaceutical distribution center (omnicell) should have shown when the last dose was removed and the accucheck is automatically tied to the patient and would bill for the accucheck that was done stat. It would have to be documented why the stat random blood sugar was being drawn. This incident may also show that team nursing may not be the best model of care for this unit. I tend to be a pretty ethical person and I have written reports with co workers about events that have occurred. As nurses, we must always try to resolve any conflict with the interest of the patient and preserve our professional integrity (Provision 2 | Code of Ethics for Nurses With Interpretive Statements). I have come to a time in my life that my values come first and I do not jeopardize my license for others, but I do take my time before I decide exactly what to do. American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD Provision 2 | Code of Ethics for Nurses With Interpretive Statements. Retrieved from Respond (an instructor response) Collapse Mark as Read RE: an ethical dilemma Instructor Card Email this Author 6/2/2015 3:44:01 PM Very good discussion of how you would handle this situation Christine - you have described how Provision 2 | Code of Ethics for Nurses With Interpretive Statements can be applied here well. Respond Collapse Mark as Unread An Ethical Dilemma Erica Bonner Email this Author 6/1/2015 11:15:10 AM Facing ethical issues is a very difficult task that nurses must deal with. This particular one, especially, because it deals with a close friend can make it even worse. In this situation I would have to try to explain to Jill that it is important and in best interest of the patient that we report this mistake. Right now the patient may be fine but if something were to happen, especially because I know about what happened, my license would be on the line as well for knowing and not reporting. According to the lesson, beneficence is when nurses have an obligation to do good for others. Beneficence exists in this scenario because it is doing the right thing for the patient. Week 5 Lesson (2015). Evaluating Quality Change. Retrieved from Respond (an instructor response) Collapse Mark as Read RE: An Ethical Dilemma Instructor Card Email this Author 6/2/2015 3:44:57 PM Good discussion of how you would handle this situation Erica - you have described how the ethical principle of beneficience applies well. Respond Collapse Mark as Read RE: An Ethical Dilemma Katherine Goffin Email this Author 6/6/2015 10:04:43 PM Erica, I enjoyed reading about how you would handle the situation. I agree with you and would do the same thing. Like you said, the patient may be fine now, but you don't what could happen later. If I didn't report the situation, I would keep thinking about it and the consequences when I got home. This would weigh on my mind and give me anxiety. Keeping patients safe is our number one priority. -Kate Respond Collapse Mark as Unread RE: An Ethical Dilemma Olivia Dewalt Email this Author 6/1/2015 12:00:27 PM Modified:6/1/2015 12:01 PM This would be an especially tough situation as it involves a friend. However, as our lesson mentions, it is a nurse's responsibility to do good for others, and in this case reporting the incident would benefit other nurses and patients from potential future mistakes similar to this one, which may result in less favorable outcomes. Were I in this situation, I'd do my best to gently explain to Jill that I felt obligated to report it- depending on the facility, that may mean discussing it with a manager or simply filling out an incident report. Regardless of the required steps for reporting incidents, I'd encourage her to bring it up to the manager with the intention of improving policies or process to avoid future errors as well as demonstrating integrity, and offer to be present for moral support if it would make her feel more comfortable. Reference: Chamberlain College of Nursing (2015). Lesson Week 5. Retrieved from American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed). Silver Spring, MD: Author. Respond Collapse Mark as Unread RE: An Ethical Dilemma Erin Pyatt Email this Author 6/2/2015 12:30:10 AM Olivia, I agree with your ideas towards why it must be reported. It not only needs to be reported and documented for the patients safety but also for the units protocols. When a mistake happens we must evaluate our practice and the facilitys protocols and see where it was broken down. If mistakes are made and not addressed not only is it unsafe for our patients but also there is nothing to be changed or fixed if it is not reported or known to be an issue. Respond Collapse Mark as Unread An Ethical Dilema Courtney Gregware Email this Author 6/1/2015 6:23:22 PM Dear Professor and Class, This is an interesting scenario as I feel that it highlights one of the reasons why nurses choose not to report errors. They are concerned that there will be retribution for making a mistake. Ethically nurses practice non-maleficence and don’t want to do harm to our patients. Unfortunately errors occur and with the complexity of care that we give they can harm and even kill our patients. As I precept students or new graduate nurses, I try to think back on errors that I have made and thankfully none have caused harm to a patient to my knowledge, but it is terrifying none-the-less. It is very important to make them feel comfortably to ask questions and to own it when they make a mistake. It will happen, unfortunate but true. I was in charge on a very busy day and gave Tylenol to a patient who needed medication. I opened my electronic MAR, went to the PRN tab, scanned the medication and administered it to the patient. Two hours later the nurse came to me and let me know that they had just given the patient their scheduled Tylenol dose, 45 minutes prior to my administration. I made a medication error and was embarrassed and frustrated that it happened. I completed a QUATTROS to report the incident as there were several issues here. There was a PRN and a scheduled dose, which I did not see and the MAR did not stop me from administering. I should have also looked to see what had been given previously, not what could be given under the PRN tab. No harm was caused, the PRN order was taken out and the patient was fine. It was however system issue that needed to be addressed. I am lucky that my organization wants to know when mistakes are made and does not punish people, unless things are very aggregious. Insulin in this case was an error, but obviously something that could be fixed with the system and some more education. Courtney Reference: Chamberlain College of Nursing, (2015). NR451 RN Capstone Course: Week 5 lesson. Respond Collapse Mark as Read RE: An Ethical Dilema Katelyn Merrill Email this Author 6/2/2015 7:34:54 PM Courtney, You a make a valid point in saying that people are only human and mistakes will be inevitable. The way in which one handles a mistake is key. Even though no harm was done, I do also believe that it should be reported, not to get ones self in trouble because as you mentioned sometimes it could have been caused by another department or system error that may need to be addressed in order to prevent future like scenarios. The hospital that I work at as well, I feel are out to punish those who make mistakes which is unfortunate. They frequently suspend or write up nurses for mistakes or errors even when no harm was done. This is an issue that the hospital should address. Katelyn Merrill Respond Collapse Mark as Read RE: An Ethical Dilema Christine Gill Email this Author 6/3/2015 6:12:35 AM Courtney, You bring up a great point about why nurses do not report. The "Blame Culture" causes many nurses and doctors to hide any errors that may not be discovered. (Leape, 2001). I find it hard to report an error myself which is why I like on line reporting. The information is gathered in one spot and looked at by the quality team or a different task force and hospital wide errors or reports are evaluated and sometimes a common denominator may be found. One of our roles as nurses is to also be part of research process at all times (Dearholt & Dang). Nurses have to be able to recognize the need for change (Lesson 5) and In this scenario, team nursing may not be the best solution for this floor, but without reporting errors, it will not be part change question or possible solution. It is possible, this is the information the task force is looking for to make a determination about team nursing and adding high potential for medication errors may make it to the top of the list now. Great post. Chamberlain College of Nursing, Lesson 5, 2015 Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Leape, L. (2001). Reporting of medical errors. Western Journal of Medicine, 174(3): Retrieved from Respond Collapse Mark as Unread Evaluating Quality Change Bernardita Aberin Email this Author 6/1/2015 9:28:48 PM Prof. Card and class, It is unethical for the nurse to conceal incidence that could endanger the safety of the patients. It is part of the nurse competencies to contribute to the resolution ethical issues involving healthcare consumers, and colleagues (ANA 2010, p. 47). This week’s lesson discussed ethics such as non-maleficence and beneficence (Week 5 Lesson, 2015). If I were a witness to medication error or negligence, I would write an incidence report and speak to our nurse leader. It is nurse’s ethic to do no harm and do good. A nurse could do harm if she failed to report known medication error, and the nurse could do good if she help to solve problems that could compromise the safety of the patients by promoting the use of EBP for quality improvement and safety (Dearholt & Dang 2012). The Institute of Medicine initiated the project RN to BSN and QSEN because of many medication errors committed by nurses. Patient safety is one of the 5 core competencies, and part of patient safety is safe administration of medications (Sherwood & Zomorodi, 2014). Before scanner and bar code were invented, nurses used the 5Rs of medication administration and 2 patient identifiers but still many medication errors were reported. Thanks to modern technology that scanner and bar code were invented and now being used in many hospitals. Medication errors have greatly reduced because of this. American Nurses Association (2010). Standard of Professional Performance. Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15- 22, 72. Retrieved from sessionID=2965 Week 5 Lesson (2015). Evaluating the Qualaity Change. Retrieved from Bernardita Respond (an instructor response) Collapse Mark as Read RE: Evaluating Quality Change Instructor Card Email this Author 6/3/2015 12:56:43 PM Good discussion of ethics Berdardita, and of the nurse's responsibility to practice ethically for the safety of her patients and herself. You have described how you would handle this situation well. Respond Collapse Mark as Read RE: Evaluating Quality Change Lisa Hunt Email this Author 6/7/2015 6:32:47 PM Hi Bernardita, I agree with your post. Technology has given the nurse another tool to ensure patient safety. We are to ensure the patient's safety and this is just one way of reassuring the patient that we are administering medications to the right patient. This allows the nurse to practice the ethic of delivering healthcare in a manner that is safe. If I witnessed a medication error I would also put in a patient safety report. This allows the institution to study the error and see if there is an opportunity to improve the system and or educate staff. As stated in our text competencies should include opportunities to self reflect and address personal learning needs. Reference American Nurses Association (2010). Standard of Professional Performance. Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Lisa Respond Collapse Mark as Read An Ethical Dilemma Annette Sandoval Email this Author 6/2/2015 4:40:11 PM Professor and class, This issue has occurred many times on many units. The best protocol I have encountered where at two facilities that are both Magnet Hospitals. They have an online system that you report anything that happens that may have hurt or potentially hurt a patient or even staff member. The tool is used for collection of information to keep patients safe and see where there may have been a breakdown in the system. It is not a tool for discipline or to use against a nurse. In the scenario, the nurse preceptor can find an opportunity to teach the new nurse about procedure and the duo sign-off. Insulin is a high-risk medication and should be double checked with another RN, also the MD should be notified of the mistake and a note made of it should be documented. We are obligated to do no harm and do good for others, the nurse had no intention on harm or negligence, but may have let tasks take over instead of who, what, where, when and why of our practice. Always ask yourself those questions and trust your gut. Bobbie Reference: Nursing:Scope and standards of practice (2nd ed.). (2010). Silver Spring, MD: American Nurse Association. Week 5 Lesson (2015). Evaluating Quality Change. Retrieved from Respond (an instructor response) Collapse Mark as Read RE: An Ethical Dilemma Instructor Card Email this Author 6/3/2015 12:58:21 PM Good discussion Bobbie - thanks for sharing how this type of situation has been handled at the Magnet facilities you have worked at. This is a good way of handling it for risk management without negative consequences. Respond Collapse Mark as Read RE: An Ethical Dilemma Janice Sikorski Email this Author 6/6/2015 6:17:01 PM Annette, Professor and class, Our institute is a Magnet Facility and we have used an online reporting tool long before achieving Magnet. The procedure would be to call the Nursing Supervisor on duty and have him/her complete the incident report with the staff nurse. This way, there is an impartial judge of the communication or lack of that led to the mistake. As the Rapid Response Team Nurse for many years, we would be responsible for completing these reports. The nurse making the incident would be so anxious that she would be reprimanded for the error that it would be important to allow them to narrate the occurrence to us first in their own words BEFORE completing the report. It is so important to impart to people that mistakes happen and it is ok. Not every mistake results in catastrophe, thankfully, and even those that do cause harm are not necessarily a cause for reprimand. Each and every occurrence should be utilized as a teaching and learning opportunity. And each mistake os not an incident of maleficence. As our lesson this week states “Outcomes of studies are meant for incorporation into practice” (CCN,2015). ~janice Reference: Week 5 Lesson (2015). Evaluating Quality Change. Retrieved from Professor and class, This issue has occurred many times on many units. The best protocol I have encountered where at two facilities that are both Magnet Hospitals. They have an online system that you report anything that happens that may have hurt or potentially hurt a patient or even staff member. The tool is used for collection of information to keep patients safe and see where there may have been a breakdown in the system. It is not a tool for discipline or to use against a nurse. In the scenario, the nurse preceptor can find an opportunity to teach the new nurse about procedure and the duo sign-off. Insulin is a high-risk medication and should be double checked with another RN, also the MD should be notified of the mistake and a note made of it should be documented. We are obligated to do no harm and do good for others, the nurse had no intention on harm or negligence, but may have let tasks take over instead of who, what, where, when and why of our practice. Always ask yourself those questions and trust your gut. Bobbie Reference: Nursing:Scope and standards of practice (2nd ed.). (2010). Silver Spring, MD: American Nurse Association. Week 5 Lesson (2015). Evaluating Quality Change. Retrieved from Professor and class, This issue has occurred many times on many units. The best protocol I have encountered where at two facilities that are both Magnet Hospitals. They have an online system that you report anything that happens that may have hurt or potentially hurt a patient or even staff member. The tool is used for collection of information to keep patients safe and see where there may have been a breakdown in the system. It is not a tool for discipline or to use against a nurse. In the scenario, the nurse preceptor can find an opportunity to teach the new nurse about procedure and the duo sign-off. Insulin is a high-risk medication and should be double checked with another RN, also the MD should be notified of the mistake and a note made of it should be documented. We are obligated to do no harm and do good for others, the nurse had no intention on harm or negligence, but may have let tasks take over instead of who, what, where, when and why of our practice. Always ask yourself those questions and trust your gut. Bobbie Reference: Nursing:Scope and standards of practice (2nd ed.). (2010). Silver Spring, MD: American Nurse Association. Week 5 Lesson (2015). Evaluating Quality Change. Retrieved from Professor and class, This issue has occurred many times on many units. The best protocol I have encountered where at two facilities that are both Magnet Hospitals. They have an online system that you report anything that happens that may have hurt or potentially hurt a patient or even staff member. The tool is used for collection of information to keep patients safe and see where there may have been a breakdown in the system. It is not a tool for discipline or to use against a nurse. In the scenario, the nurse preceptor can find an opportunity to teach the new nurse about procedure and the duo sign-off. Insulin is a high-risk medication and should be double checked with another RN, also the MD should be notified of the mistake and a note made of it should be documented. We are obligated to do no harm and do good for others, the nurse had no intention on harm or negligence, but may have let tasks take over instead of who, what, where, when and why of our practice. Always ask yourself those questions and trust your gut. Bobbie Reference: Nursing:Scope and standards of practice (2nd ed.). (2010). Silver Spring, MD: American Nurse Association. Week 5 Lesson (2015). Evaluating Quality Change. Retrieved from Respond Collapse Mark as Read An ethical dilemma Janice Sikorski Email this Author 6/2/2015 5:17:29 PM Professor and class, Our lesson this week states “It is important to be aware of these values and ethical principles so that each patient is treated in an ethical manner”( CCN 2015). I would say that the Ethical dilemma in this situation would be “Non-maleficence- Do no harm. As nurses it is our responsibility to first do no harm. It is important to weight the risks against benefits”(CCN2015).We are first and foremost responsible to do no harm to any patient. I have always operated in my professional and personal life under the principle of the Golden Rule. I treat each patient the way I would like to be treated. That said, if I had a mistake made against me, I would expect the nurse to report it. There should be no punishment ever made for a medication error whether or not it hurt the patient. There would no mistakes ever reported if there aaas fear of reprimand. That is just good management policy. After all, everyone makes mistakes: Even those of us responsible for people’s lives each day. ~janice Reference: Chamberlain College of Nursing (2015). Lesson Week 5. Respond Collapse Mark as Read RE: An ethical dilemma Parulben Patel Email this Author 6/2/2015 9:19:07 PM Professor Card and Class I agree that there should be no punishment ever made for a medication error whether or not it hurt the patient. Otherwise, there would be no mistakes ever reported if there a fear of reprimand. Medical errors are the eighth leading cause of death in the United States, accounting for annual patient fatalities that would equivalently result from three jumbo jets crashing every two days. In addition, hundreds of thousands of patients sustain preventable error-induced injuries in their medical care each year. Non- maleficence refers to the ethical norm of avoiding causation of harm (CCN, 2015). The provider’s obligation not to injure or harm patients and to refrain from actions that would harm them. This norm captures the complexities of medical practice. The term “actions that would harm” highlights the fallibility of medicine, where harm is not the National Quality Forum advanced disclosure standards for health care professionals and institutions, suggesting that providers should disclose factual information, express regret, and offer an apology in response to medical errors. Always a predictable outcome but based on the probabilities of side effects and complications. Reference: American Nurses Association. (2010). nursing: Scope and standards of practice (2nd ed). Silver Spring, MD: Chamberlain College of Nursing (2015). Lesson Week 5. Retrieved from Respond Collapse Mark as Read An Ethical Dilemma Shelly Smith Email this Author 6/2/2015 8:16:56 PM Hi professor and classmates, Our Week 5 lesson states that nurses face ethical dilemmas on a daily basis (CCN, 2015). Being a new nurse while I have faced a few ethical dilemmas they were nothing major or life and death. In the scenario mentioned above I had to really sit and think about how I would react in that situation. Jill had a medication error because she had the right patient, right medication, but wrong time and ended up administering medication that the patient already received in this case insulin. Medication errors happen as much as nurses have to make ethical decisions in fact a study done 237 randomly selected nurses had 64.55 % of them having a medication error mostly wrong dosage and infusion rate (Cheragi et al, 2013). I am going to be very honest and say that if I was in this situation I may have not reported the incident, (I really can’t come to a conclusion whether I would absolutely not report her though) one because it didn’t cause any harm the patient’s blood sugar was still in acceptable range and honestly also because it is my friend. Not reporting the error would be unethical, and sometimes when people don’t get in trouble for something they have done wrong they may forget get comfortable and do it again so I would have to consider that also. Now if there were harm done to the patient then beyond a doubt I would have reported Jill. Chamberlain College of Nursing. (2015). NR451 RN Capstone Practice: Week 5 lesson. St. Louis, MO: Online Publication Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228–231. Respond (an instructor response) Collapse Mark as Read RE: An Ethical Dilemma Instructor Card Email this Author 6/3/2015 12:59:15 PM Good discussion of ethical principles and the dilemma this situation produces Shellie, you have described how you may have handled the situation well. Respond Collapse Mark as Read RE: An Ethical Dilemma Christine Gill Email this Author 6/4/2015 8:51:25 PM Shelly, Great honesty in your post. I think you mentioned in one of your post that you have not had to deal with many ethical situations yet. If you notice my post, I mentioned I would have answered this differently about 15 years ago and you would have also noticed that I mentioned I would not report Jill, but Jill would report herself. There is a difference. I probably would have said "Oh, I wish you had not told me that, but since you did we have to take actions". There are a couple of things to consider. 1. If anyone ever overheard you choose to cover it up, that is an issue for both of you and what happens next time if someone else does it and tells you? 2. You have to have an order for continued accuchecks and you will want to continue them 3. It has to be written up (by Jill) to determine why this happened and what can be changed to make sure it does not happen again. Why didn't the patient say she had already received a dose of insulin? By the way, I have been on both ends of this scenario and it is not fun. Respond Collapse Mark as Read RE: An Ethical Dilemma Shelly Smith Email this Author 6/7/2015 12:39:37 PM Hi Christine You bring up some great points, I really like your approach in saying that you would allow Jill the opportunity to report herself. If she reports herself she will get more respect from the nurse manager just because she told on herself then the other way around. I am new to nursing and I know one day soon I will have decisions like these to make and i appreciate you being a seasoned nurse sharing your experience with me and bringing up things that I didn't think of when making my decision. Thanks a lot. Shelly Respond Collapse Mark as Read RE: An Ethical Dilemma Lenora Charnovesky Email this Author 6/7/2015 10:02:55 AM Hello Shelly, Professor Card and class, Shelly, if we let our friend get away without reporting this incident, can we guarantee that the next time we will be notified because we have now given our friend a free pass? When reviewing the above scenario, three nursing virtues that guide me personally and professionally are autonomy, veracity, and as we have all mentioned nonmalfeasance. According to Hood autonomy is described as “individual freedom to make rational and unconstrained decisions,” veracity is “truth-telling,” and nonmalfeasance is described as “doing no harm” (2014). I strongly believe that individuals are capable of making their own informed decisions until the very end. I think that this is hugely important in “patient right” as we maintains what little sense of control some patient’s feel when sick or dying. I also have always been a strong believer in always telling the truth, even if the truth hurts. I have never understood the rationale for lying and have seen the devastation that can occur when lie’s snowball, even the tiniest of lies can cause harm. Lastly, I think that each of us as nurses never intend to do harm to our patients, as this is the foundation for establishing our role as patient advocate. As stated in Hood “effective nurses function as moral agents who assume responsibility and accountability to do no harm” (2014). I believe there have been a number of times that errors just like this one have occurred due to nurses being overloaded with patients. When we are busy we always try to help each other out to ease the burden of an overwhelming assignment. It is important to use clear communication when delegating tasks to other nurses as well as charting the medications we give. In nursing school they would drill in our minds "IF YOU DIDN'T CHART IT DIDN'T HAPPEN.” One of the ANA guidelines in our book that pertains to this situation is that the nurse “speaks up when appropriate to question healthcare practice when necessary for safety and quality improvement” (ANA, 2010). Keeping patients safe is a large part of the nurse’s role in this profession. Sweeping things under the rug because they didn’t cause harm is not the way to address situations like this one. It is better to speak up and come up with a better process for medication administration and communication, so this doesn’t happen again. Reference American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Hood, L. J. (2014). Leddy & Pepper's conceptual bases of professional nursing. (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Respond Collapse Mark as Read RE: An Ethical Dilemma Donna Cobedesh Email this Author 6/7/2015 11:54:33 PM I understand everything that you said and that you feel, but you have to remember your license and your responsibility. You did nothing wrong by administering that medication because your friend did not put it in the computer. Unfortunately once you know and do not report it, you are more guilty than she was. You know of the wrong that was done and you know that legally the patient has the right to know. If you do not report it (friend or not), you are committing fraud. You know what is expected of you once you get your nurse's license. If you do not do what you are legally responsible for, then you are committing a crime. If the nurse is your friend, they should also understand the position that her error puts you in and not want you to do something illegal as well. Every facility I have worked in, it was a rule that you had to report all medication errors. Respond Collapse Mark as Read RE: Ethical Dilemma Bernardita Aberin Email this Author 6/2/2015 8:59:37 PM Modified:6/2/2015 9:11 PM Prof. Card and class, I am re-posting my response to Ethical Dilemma. I do not know how my initial response fell under a different subject. Sorry. It is unethical for the nurse to conceal incidence that could endanger the safety of the patients. It is part of the nurse competencies to contribute to the resolution of ethical issues involving healthcare consumers, and colleagues (ANA 2010, p. 47). This week’s lesson discussed ethics such as non-maleficence and beneficence (Week 5 Lesson, 2015). If I were a witness to medication error or negligence, I would write an incidence report and speak to our nurse leader. It is nurse’s ethic to do no harm and do good. A nurse could do harm if she failed to report known medication error, and the nurse could do good if she help to solve problems that could compromise the safety of the patients. Reporting of unusual incidence is not punitive but implemented to resolve problems that could possibly be repeated in the future; Incidence Report is implemented for quality improvement and safety (Dearholt & Dang 2012). The Institute of Medicine initiated the project RN to BSN and QSEN because of many medication errors committed by nurses. Patient safety is one of the 6 core competencies, and part of patient safety is safe administration of medications (Sherwood & Zomorodi, 2014). Before scanner and bar code were invented, nurses used the 5Rs of medication administration and 2 patient identifiers but still many medication errors were reported. Thanks to modern technology that scanner and bar code were invented and now being used in many hospitals. Medication errors have greatly reduced because of this. American Nurses Association (2010). Standard of Professional Performance. Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15- 22, 72. Retrieved from sessionID=2965 Week 5 Lesson (2015). Evaluating the Quality Change. Retrieved from Bernardita Respond Collapse Mark as Read RE: Ethical Dilemma Parulben Patel Email this Author 6/5/2015 2:02:49 PM Bernardita I agree that a nurse could do harm if she failed to report known medication error, and the nurse could do good if she help to solve problems that could compromise the safety of the patients.A medication error is defined by the National Coordinating Council for Medication Error Reporting and Prevention's, as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health professional, patient, or consumer (Banning, 2005, 3). These errors create a variety of problems for patients, ranging from minor discomfort to substantial change in health status that might prolong hospitalization (Banning, 2005,High error rates with serious consequences are most likely to occur in intensive care units (ICU s), operating rooms, and emergency departments (IOM, 2000). ICUs are error-prone places with error rates as high as 1.7% per day, especially in pediatric and neonatal ICU wards (Tang et al, 2004, 6). All of these areas are critical places with critical patients. Miscommunication and associated errors can often be fatal and increase the overall mortality rate, especially in these highly stressful environments. Parul References: Banning, M. (2005). Medication Errors: Professional Issues and Concerns. Nursing Older People, 18, (#) 27-32. Institute of Medicine. (2000). To Err is Human: Building a Safer Health System. Washington D.C. Department of Health and Human Services. Tang, F., Sheu, S., Yu, S., Wei, I., Chen, C. (2004). Nurses Relate the Contributing Factors Involved in Medication Errors. Journal of Clinical Nursing, 16, (#): 447- 457. Respond Collapse Mark as Unread An Ethical Dilemma Deborah Interlicchio Email this Author 6/3/2015 7:28:57 AM The acronym DECIDES is an effective tool that can assist in making ethical decisions not only for evidence-based practice but to aid in the decision making process (Frederick, 2008). Understanding evidence-based practice is the basis for quality patient care. Using EBP in practice enables quality improvements in the healthcare setting. D- detect ways for improving performance Empower employees as internal detectives E- evaluate all potential alternatives Process of exploring improved solutions C-commitment from stakeholders to change Pursue the most visionary alternative I-Input of critical information from team Collection and analysis of date D- decision made by stakeholder Decision maker organizing participation E-execute decision rapidly Perform action plan In the scenario described it is our moral obligation to do what is right for the patient, regardless of the negative outcomes for the nurse. As a practicing nurse we follow the four basic principles of ethics. If the event were not reported Non-Maleficence would be violated. The error would not be reported correctly in the number of events that occurred and quality improvement would not be able to improve the situation in the future. Taking all of these issues into consideration the nurse would need to report the event regardless of the consciences the new nurse may experience. This event can be a tool for change in improving medication administration. Placing safeguards in the computer program when administering medication would be a way to reduce future errors of medication administration. Reference: Dearholt, Sandra, and Deborah Dang. "Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines Second Edition. AORN Journal: 426. Print. Frederick. "DECIDE: A Decision-making Model for More Effective Decisions Making by Health Care Managers." Health Care Manager 27.1 (2008): 118-27. Print. Respond Edit Collapse Mark as Read RE: An Ethical Dilemma Shellie Cartwright Email this Author 6/7/2015 10:15:02 PM Modified:6/7/2015 10:16 PM Deborah, I enjoyed your post. The acronym for DECIDES is excellent. I especially like D for detect ways for improving performance-empowering employees. One of the things I enjoy most about my job is the ability to empower the staff. The staff come to me with situations or issues they would rather not deal with. We talk about the situation and I encourage them and talk through the situation with them. I empower them to do what is right and handle the situation on their own to help them grow in their profession. Ethical situations will always present themselves throughout any nurses or clinical staff persons' career. Learning ways to deal with these situations is important. The E within the acronym DECIDES relates to evaluation and process improvements. This is an important aspect in any healthcare facility. Each healthcare facility is responsible for improving processes to improve quality of care to patients. If a change is necessary it is also essential evaluate the new change process for success. According to Derhollt & Dang, "decision-makers may support wide implementation of the change, request a small test of the change to validate results, revise the plan or recommendations, or reject the implementation plan" (2012, pg. 154). Shellie Cartwright Reference Dearholt, S., & Dang, D. (2012). John Hopkins nursing evidence-based practice (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Respond Collapse Mark as Read An Ethical Dilemma and Dr. Seuss Jillian Hoover Email this Author 6/3/2015 8:12:14 AM Professor and Class, This would be a non-issue at Cox Health. All employees are encouraged to report medication errors. The company realizes that we are imperfect human beings just like everyone else. While it is important that we use all the equipment and protocols that are in place to prevent errors such as Jill's from occurring, errors are still part of our everyday life. Our ANA text tells us that an ethical nurse, "speaks up when appropriate to question healthcare practice when necessary for safety and quality improvement. As medical professionals we are striving for the best outcomes for our patients. If by reporting errors so that they can be investigated we find a method to prevent that error from occurring again, why would we not report our mistakes! This does not mean that it is not an uncomfortable process, but it is the best for our patients. We can learn many things from the mistakes that we make. To Quote a Doctor- Dr. Suess: "I'm sorry to say so but, sadly it's true that bang-ups and hang-upscan happen to you." -- Dr. Seuss "Maybe you didn't do things the way you should, but admitting you are wrong will make you look good." - Dr. Seuss "Unless someone like you cares a whole awful lot, nothing is going to get better. It's not." -- Dr. Seuss [on EBP ;)] Jillian American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author Respond Collapse Mark as Read RE: An Ethical Dilemma and Dr. Seuss Erica Bonner Email this Author 6/3/2015 9:42:05 AM Jillian, Knowing that your company understands that nurses are not perfect human beings and are encouraged to report mistakes is very important. If more places were like this then people wouldn't be so afraid of what would happen to them in case of a mistake but instead worry more about what could happen to the patient if we didn't correct the mistake. Thank you for sharing. Erica Respond Collapse Mark as Read RE: An Ethical Dilemma and Dr. Seuss Courtney Gregware Email this Author 6/3/2015 7:38:34 PM Dear Jillian, I love the Dr. Suess quotes, he is really one of my favorites. I really feel that it is very important as professional registered nurses that we work hard to take control of our practice and responsibility when mistakes are made. Multiple studies have shown that many errors do not occur because it is the nurses fault. It is system issues and checks that should be done more rigorously to assure that patients are not harmed. Nurses and providers really need to stand up and take responsibility for errors as they occur. Organizations need to take the time to build a culture that is not one of blame. Courtney References: Vogelsmeier, A.A., Scott-Cawiezell, J., (2015). A just culture: the role of nursing leadership. Journal of nursing care quality. Retrieved from: Respond Collapse Mark as Read An Ethical Dilemma Jessica Quinn Email this Author 6/3/2015 12:54:26 PM According to the ANA Nursing Standards, “the registered nurse must take appropriate action regarding instances of illegal, unethical, or inappropriate behavior that can endanger or jeopardize the best interests of the healthcare consumer or situation” (ANA, 2010, pg. 47). Nurses must follow a code of ethics in order to do no harm (non-maleficence) and promote beneficence and justice (Chamberlain Online Lesson). This is tough situation but in the hospital, nurses must act as co-workers and healthcare professionals and not “best friends.” Since you and Jill are caring for patients as a team, then both of your licenses would be on the line if something were to go wrong. So, I would tell Jill that we would have to report it as a medication error, tell the nurse manager and report the incident to the doctor. In order for issues to get sorted out and for healthcare to improve, incidents and mistakes must be reported so we can learn from it and evolve. According to the lesson, the DECIDE model written by Kristina L. Guo is a great resource to help deliberate tough decisions. The Journal article states that “The DECIDE model stands for D-Define the problem, E-Establish the criteria, C-Consider all alternatives, I-Identify the best alternative, D-Develop and implement a plan of action, and E-Evaluate and monitor the solution and feedback when necessary” (Guo, 2008, pgs. 118-127). This is a good model to work out ethical issues and monitor solutions. In the scenario, Jill and her friend would both be accountable for this incident and would have to be monitored and educated on how to prevent this from happening next time. In the healthcare world, nurses must practice diligently and communicate with one another and co-workers in order to advocate for the patients. References American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: N. Chamberlain Online Lesson. 2015. Ethics. Retrieved from Chamberlain Online Learning Portal. Guo, K. 2008. DECIDE: A decision-making model for more effective decision making by health care managers. The Health Care Manager, 27(2), 118–127. Retrieved from Respond Collapse Mark as Read RE: An Ethical Dilemma Dawn Nelis Email this Author 6/6/2015 2:11:10 AM Hello Jessica, That is a Great acronym. I would be willing to bet that it is very effective when deciding tough decisions. having to " C- consider all alternatives" this is in an important step in regards to the scenario given in this weeks discussion. What are your alternatives? To turn the other cheek and dismiss the mistake made by the student or do just the opposite? I like how you take a team approach and tell Jill that " WE" have to report the med error. Instead of "I'm going to report you" or "you must tell your instructor" . I feel like this leads to a more positive learning experience for the student. Thanks for sharing. Dawn. Respond Collapse Mark as Read Ethical Dilemma Dianne Johnson Email this Author 6/3/2015 2:18:00 PM Professor Card and Class, In the ANA (2010) Scope of Standards and Practice for nursing, I read that regarding such an ethical issue such as this, the standard is: “Takes appropriate action regarding instances of illegal, unethical, or inappropriate behavior that can endanger or jeopardize the best interests of the healthcare consumer or situations”. That being said…this example pulls at the heart strings and the compassion in nurses can be misdirected here because it is a friend who is worried and scared because of potential consequences that would result from reporting the incident. Alexander Pope has been quoted (1711)…”To err is human…”. This won’t be the first time she makes a mistake, and probably won’t be the last, so learning sooner or later the right thing to do is to fill out the variance report as our institution calls it and let the doctor know, which is appropriate. We have all had to make that phone call at some point and it’s never easy, but our lesson this week CCN (2015) states how we all need to know the procedures that our place of employment has for these ethical situations. Better for her to be guided along in this process with her friend to support than walking it alone at some other point in time. More importantly, what does the patient deserve? What if the blood sugar is good now, but based on the type of insulin, it spikes an hour or two later? The doctor may change needlessly the dose they take, causing future imbalances in the blood sugars. I agree also with another post that there would be a question anyway later on as to why the unscheduled blood sugar? Usually these things find us out, which would result in even worse consequences for the new nurse and yourself as well. Her values may be different than yours and we all need to look inside at times like these, but a good friend speaks the truth in love, and she may need her friend to keep her accountable in doing the right thing for all involved. Dianne, America Nurses Association. (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Spring, MD: Author. Pope, A. (2013). To err is human…1711. Kindle Books and More. Retrieved from: Chamberlain School of Nursing (2015). NR451. Ethics. Retrieved from: Respond Collapse Mark as Read RE: Ethical Dilemma Shelly Smith Email this Author 6/3/2015 7:46:29 PM Hi Diane You bring up some great points and I love the questions that you asked especially the one about what if the blood sugar drops later on. I really didn't read into the scenario that much but based on the fact that it was a before lunch dose I am guessing that it may be a rapid acting or short acting insulin which onsets between 15 mins for rapid, 30-60 for short acting. Maybe the scenario was for no adverse reaction to happen for us to justify or overlook the fact that a medication error did actually take place.I have read some reactions and most people seem to be saying they would actually report Jill, but I think we should actually consider the situation and place one of our real friend in the picture as Jill then consider what we would do because I have seen nurses and physicians cover for co workers who aren't even their friend out of work. Shelly Respond Collapse Mark as Read RE: Ethical Dilemma Dianne Johnson Email this Author 6/4/2015 10:05:09 PM Shelly, I agree. We do need to consider these very real questions before they happen. That way, when confronted with the difficult ethical issues, it's simply settled what has to be done. Report the error, yes because its the right thing to do even if we don't think there are repercussions down the way or not. Thanks for your comments. Dianne Respond Collapse Mark as Read An Ethical Dilemma Lenora Charnovesky Email this Author 6/3/2015 7:43:29 PM Hello Professor Card and class, In this situation, both nurses compromised the safety of the patient Mr. Smith. The seasoned nurse has a duty to report the occurrence, which unfortunately is an incident. Actually it’s a medication error, which could have ended fatally. The incident should not only be reported but, used as a teaching tool to identify ways to prevent another occurrence and identify inefficiencies. Jill should have learned a valuable lesson form this occurrence. Jill has learned the hard way the first rule of nursing, which is one of the basic principles of ethics, non-maleficence, which means to do no harm (CNN, 2015). As stated in the text, ( ANA 2010), " Factors related to quality, safety, and effectiveness has to be evaluated by quality control, to prevent similar incidents. Factors in this scenario are: short staffing, patient acuity, and extra orientation time for new hires. As described in an article Medication Errors: Don't let them happen to you, " Heavier workloads also are associated with medication errors. The nursing shortage has increased workloads by increasing the number of patients for which a nurse is responsible." References American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Scope of Nursing Practice Medication Errors: Don't let them happen to you. American Nurse Today Volume 5, Number 3. Retrieved from Respond Collapse Mark as Read RE: An Ethical Dilemma Heather Shingler Email this Author 6/7/2015 6:50:02 AM Leonora, You brought up some great points regarding short staffing and the need to evaluatesafety and quality to prevent similar incidents. Our text tells us "registered nurses regularly evaluate safety, effectiveness, and cost in the planning and delivery of nursing care." (ANA, 2010) Even if we have to use error to evaluate nursing care, we owe our patients a complete evaluation. Heather American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author. Scope of Nursing Practice Respond Collapse Mark as Read Ethical Dilemma Heather Shingler Email this Author 6/3/2015 7:50:46 PM Professor and class, This is an interesting dilemma. My gut reaction would be that based on the theory of non-maleficence as discussed in this weeks lesson I should explain to Jill the potential results to the patient, and assist her to take the proper steps to report it. However, non-maleficence as per our lesson also means "it is important to weight the risks against benefits." (CCN, 2015) While health care has pushed over the years to remove punitive reporting, many institutes still practice in that manner. I have seen nurses make minor medication errors