Ethical Dilemma Declining a Patient Assignment

Question: Describe about the Ethical Dilemma for Declining a Patient Assignment. Answer: Ranging from nursing education, clinical practice, professional experience placements (PEPs) among other levels of practice, challenges have always been available. Among the most prominent problems are ethical dilemmas (Gaji? 2014, p. 36). Since the inception of professional nursing, the times of Florence Nightingale, various documents have been written about ethics. One of them being Nightingales ethical duties of confidentiality, the centrality of satisfying the patients needs and communication. Various research institutions, governmental and non-governmental organisations, universities and authorities have endeavoured to come up with the soundest remedy to this challenge, but conflicts of interest have rendered it hanging in the balance. There are moral and professional values that guide the practice of nursing but the pressures, decisions, and choices that nurses have to make sometimes pose a challenge (Gallagher 2013, pp.615-616). However, there are a lot of these guidelines tha t support the position that a nurse has a right to refuse any patient assignment as long as the reasons are sound and valid (Getting the balance right between patient protection and nurses rights 2008, p.12). Therefore, these scripts can be used by a nurse as the defence when complaints are presented to the Nursing and Midwifery Board of Australia (NMBA) or the director of nursing in the respective States or at a national level (Schoonover-Shoffner 2007, p.180). With evidence-based information, this paper supports the stand that nurses can deny a patient assignment and further explains how the nurse can respond to the director of nursing services or the NMBA in case a complaint is filed. The bottom line is that the legitimacy of the presented reasons determines the ethicality of the nurses decision to refuse a patient allocation. Therefore, the nurse is free to decide whether to accept or deny an allocation provided that the reasons are valid. In Australia, the NMBA code of ethics and standards of practice guides nurses of all cadres just like any other profession. Personally, I think that the provisions in this code allow nurses to deny a patient assignment in necessary circumstances. First off, the guidance framework of this code records that the details mentioned in each standard are insufficient decisions that a nurse can make. Thus, it gives room for unmentioned decisions like refusing a patient allocation. Again, the framework acknowledges that a formula that helps in solving issues of ethics is not provided in any of the standards (Edmonds, Cashin and Heartfield 2016, p.170). The NMBA first value standard calls for nurses to appreciate every person's quality of care. Furthermore, nurses are mandated to question and report any unethical behaviour. Therefore, even suing or forcing a nurse to care for a patient against personal will is unethical and ought to be reported. It is because forced assignment of a patient may make the nurse provide substandard care because of pressure or fear of personal safety. In fact, the patient is at a greater risk being handled by a pressured nurse than a wilful one. For instance, a nurse who has a mindset that he/she cannot handle an Ebola patient may end up messing with basics like the use of personal protective equipment (PPE) and eventually contract the disease (Ghebrehiwet 2012, p.314). The first standard also says that a nurse can deny participating in patient treatment or care if he/she feels that it is against her conscious. Moreover, it is only acceptable if it holds a moral or religious stand of the nurse. In a nutshell, any nurse in Australia can refuse a patient assignment if such stands are violated. It is imperative to note that a persons religion can affect their professional life and this is still within the legal precincts. A Seventh Day Adventist nurse may refuse to attend to patients on Saturdays because it is the Sabbath (Burzo 2014, p.34). In such a case, the law cannot intervene because the freedom of worship is provided for in the bill of rights of Australia (Hunter 2006, p.38). Furthermore, the Watchtower Society and the Christian Science denominations only believe in prayers as the single tool for healing (Longest and Smith 2011, p.850). Therefore, a nurse dedicated to these denominations may not be comfortable in interventions like administratio n of parenteral drugs or surgery, thus refusing to participate in the care. Developing a personal judgement, understanding, and knowledge in any situation is an attribute that every nurse has to embrace according to not only the Australian Nursing Federation (ANF) but also the NMBA, the government department of health and other national and international organisations (Anmf.org.au, 2016). It permits the nurse to make a quality and informed decision of refusing to care for a patient deemed dangerous to self. An example is where a nurse denies caring for a Tb patient because of personally lowered immunity; it is a valid decision. Nonetheless, it is unethical just to dismiss the patient and leave the matter unsettled. The nurse has to explore other options like asking an experienced or willing colleague to handle the case. If this is done, then everybody will be satisfied with the allocation refusal decision. Also, development of the code is permissible in the framework of guidance of the NMBA directives. It means that any event that has been proved beyond a reasonable doubt that it contributes to the development of the nursing profession can be included in the code for continuous professional improvement (Ghebrehiwet 2012, p.314). The second value standard in the NMBA code maintains that nurses have to uphold a sense of personal well-being and it includes a good individual health (Nursingmidwiferyboard.gov.au, 2016). In this regard, the nurse is permitted to decline a patient assignment if the case poses a risk to his/her health. Mostly, the patients problem may become the nurses, for instance, a psychologically unstable person affects the nurse because of empathy. Additionally, a nurse may find an Ebola case too dangerous to handle and refuse to participate. It is not illegal to refuse such cases. Moreover, the standard calls for respect to a colleague's point of view and decision, and I believe this includes the decision to decline a patient allocation. It also emphasizes the need for nurses to appreciate personal respect and kindness as well as that of others. Additionally, in the line of duty, a nurse's personal dignity, and morality has to be upheld (Ghebrehiwet 2012, p.314). By choosing the nursing path in life, one is not ascertained to have ceased being a human. Therefore, he/she is still entitled to the dominant human rights as stipulated in the Australian bill of rights (Hunter 2006, p. 37). In this case, the right to accessing good health care and living in a risk-free environment is considered. Therefore, a nurse is covered by the bill of rights if he/she declines to care for a given patient if a risk to personal health is in place. Diversity has to be embraced, appreciated and respected by nurses as states the NMBA standard value number three (Nursingmidwiferyboard.gov.au, 2016). The diversity includes culture, beliefs, social, economic, political, religious among other attributes. Technically, the standard allows the nurses to decline any allocation if it violates any of the mentioned issues. There are ethical principles that are taught during professional nursing practice and are referred to in various journals. For instance, the principle of autonomy allows people to be self-determined. For example, the meaning of autonomy in the profession of nursing is that there is self-governance and determination of issues. This stand is based on the Online Journal of Issues in Nursing (OJIN) ethical principles (Hunter 2006, p. 37). Additionally, the principle of justice gives room for dispensing care in the fairest way. Therefore, if a nurse feels like the justice is compromised by personal issues, he/she should decline to give the care. It confirms that the nurse has this right. Also, by establishing bodies like the NMBA, the Australian government mandates the nursing profession to regulate its issues and it involves making amendments that improve practice like the safeguarding of nurses' interests (Hunter 2006, p. 37). How a nurse can respond to the NMBA or director of nursing after a complaint. It is inevitable to receive a summon as a result of allegations from various parties in regards to a nurse's decision to decline an assignment of patients. However, there are different ways one can respond to the relevant authorities like the NMBA or the director of nursing. Evidence from credible academic sources and the Australian and international codes of ethics can help exonerate the nurse. In the first place, it is imperative to present the facts of that situation like the patients condition, personal feelings, and the steps undertaken. This way, the panel will have an overview of my decision and probably, I would have triggered their humane side to empathise with me (Anmf.org.au, 2016). I would say that I offered various alternatives before making the decision of declining an allocation. This move conforms to the value standard of quality interventions for the patient. Additionally, the fifth standard mandates nurses always to make decisions that are informed because they will have to give the rationale for it. My decision to seek help from colleagues for a patient whom I deem had jeopardized my life is a noble act from a professional that requires applauding rather than filing a complaint. A case in point is where I have been allocated excess patients in the ICU, and I may be feeling exhausted, I would only deny the allocation. Furthermore, this is sparing the patients from an exhausted nurse who would underperform by only worsening their situation (Gallagher 2009, p. 828). Additionally, the ANF gives the standard ratio of a nurse to patients in Australia. In a regular medical or surgical ward, one nurse has to care for four patients, and in an emergency department, a nurse needs to have a maximum of three patients (Anmf.org.au, 2016). Therefore, if I am allocated more than the required number of patients, it is a right for me to decline that duty. There are other problems that are beyond a single nurses control like the insufficient number of nurses and hospital equipment in Australia (Anmf.org.au, 2016). Such problems lead to overworking, exhaustion and even poor motivation of the nurses. It would be only human for the panel to consider a complaint based on such claims as having no legal grounds. In South Australia, nurses declined to care for patients who had a second-trimester abortion because of a conscientious value. These are details recorded by the Australian Journal of Obstetric, Gynaecological and Neonatal Nursing (JOGNN). I would remind them that my case is not the first one in existence and the rationale is what matters and not the weight of the case as the complainant may have put it. Furthermore, insisting on the outcome of the South Australian case as a valid and legal action by the nurses would elicit some sense of reality for the panel. Comparing my scenario with this situation gives me a right to exercise declining a patient allocation because it is the same body that defended the South Australian nurses (Friedrich 2014, p. 1958). The right of registered nurses in regards declining an assignment of a patient has been reiterated in the American Nurses Association (ANA) position statement. It states that in writing, a nurse can reject, accept or object a patient allocation that he/she is put at a serious risk as well as the patient (Porter 2013, p. 33). Relating to the NMBA code, there is an allowance for involving other international professional guidelines like the International Council of Nurses (ICN) in regulating personal practice (Gallagher 2009, p. 828). Pursuant to the provision, I made the decision to decline the patient allocation because it was posing a risk to my health and probably could affect my family, friends, and even colleagues. Okeefe and Kushelew, (2016) state that some American nurses working for the World Health organisation (WHO) refused to go to West Africa when there was an Ebola outbreak in 2014 because they felt it would endanger their entire lives. Nobody sued them for rejecting their purported duty. I would ask the panel to consider such a case and religiously determine their verdict. Moreover, Okeefe and Kushelew suggest three questions that have to be deliberated before making a final decision. Consider if there was a nurse-patient relationship, if the nurse gave a notice and if the employer could be able to reassign the task. I would confirm that all these factors existed in my case. By confirming these, it means that there were alternative solutions like reassignment and the complaints were just presented anyway (Friedrich 2014, p. 1958). There are endeavours by various authorities to undermine the practice of nursing, and many people have contributed to this fact. It is imperative for the panel to note that people will manipulate any lawful activities to frustrate a nurses effort. For example, the Nebraskan for Humane Care was an amendment that was suggested in Nebraska, the United States. It was proposing that a patient's food, medication, and water would not be withdrawn even when she/he was having terminal illness. However, there was evidence supporting the normal practice of withdrawing these factors. If it would have been passed, then ICU nurses in Nebraska could be oppressed and probably be sued for unfair reasons (VA Nebraska-Western Iowa Health Care System 2008, p.184). The panel should recall that every person blames the nurse for not doing their duty and probably suggest that if they would have rejected the task, the better. In similar terms, the complainants may have taken advantage of some clauses in the NMBA guidelines as their basis of the argument, which is totally out of the equation. The sixth value standard states that nurses should value a culture of safety in practice. Here, it considers both the patient and the nurse (While 2011, p. 258). For this reason, I made the refusal decision because of feeling a threat to my health. If it is on the cultural basis, then I would still refuse to take part. Furthermore, it was not only my safety but also that of my friends, family, colleagues and even other people that I may interact with. It is only natural for me to care for other people (Nursingworld.org, 2016). Lastly, nursing institutions teach their learners on such a matter. The Royal College of Nursing in the UK provides various rationales that warrant a nurses refusal of a patient assignment (The Royal College of Nursing, 2016). They include a risk to or existence of any form of violence, an area that a nurse has not specialised in, an unlawful activity like abortion, a personally known patient and following ones conscience. Again, I would say that I was taught this at my university. The NMBA ascertains these institutions, therefore, it is absurd if they prosecute the content of the curriculum. Additionally, the lecturers are qualified enough and most probably are experienced in the nursing field (Learn.ana-nursingknowledge.org, 2016). It cannot be that they teach us the wrong professional requirements. In conclusion, it is right for a nurse to refuse an allocation of a patient because of legitimate reasons. They can defend themselves using the NMBA code of ethics and standards of practice. The value standards range from the first one up to the sixth, and they all can be explained to support the nurse's position. They include dispensing quality health care to everyone, the respect and value of diversity, making informed decisions, and valuing kindness and respect for self and others. Aside from the NMBA, other bodies like ANA, ANF, ICN, and journals have evidence that supports this position. For instance, ANF provides the ratios of the nurse to patients as one to three and one to four in a regular medical-surgical ward and an emergency department. Additionally, authorities like the State of Nebraska have endeavoured to demean nursing. Also, cases of patient allocation refusal exist, for instance, the South Australian nurses who refused to care for second-trimester abortion patients. Also, religious affiliations like the SDA and Christian Science can make a nurse decline the patient assignment, and they are valid. Reference List Anmf.org.au. (2016).Australian Nursing Midwifery Federation. [online] Available at: https://anmf.org.au/news/entry/nurse-and-midwife-patient-ratios-to-become-law [Accessed 1 Oct. 2016]. Burzo, E. (2014). Book Reviews: Stefan Hschele, Interchurch, and Interfaith Relations. Seventh-day Adventist Statements and Documents.Review of Ecumenical Studies Sibiu, 6(2). Edmonds, L., Cashin, A. and Heartfield, M. (2016). Comparison of Australian specialty nurse standards with registered nurse standards.Int Nurs Rev, 63(2), pp.162-179. Friedrich, M. (2014). Ebola Outbreak in West Africa.JAMA, 311(19), p.1958. Gaji?, V. (2014). Ethical dilemmas in nursing practice / Eti?ke dileme u sestrinskoj praksi.SZNJ, 1(1), p.36. Gallagher, A. (2009). International Council of Nurses 24th Quadrennial Conference, Durban, South Africa, 27 June -- 4 July 2009.Nursing Ethics, 16(6), pp.827-829. Gallagher, A. (2013). Values for contemporary nursing practice: Waving or drowning?.Nursing Ethics, 20(6), pp.615-616. Getting the balance right between patient protection and nurses rights. (2008).Nursing Standard, 23(6), pp.12-13. Ghebrehiwet, T. (2012). Reflections on nursing ethics.Nursing Ethics, 19(3), pp.313-315. Hunter, P. (2006). Bill of rights [digital rights management].Engineering Technology, 1(8), pp.36-40. Learn.ana-nursingknowledge.org. (2016).Nursing Knowledge Center. [online] Available at: https://learn.ana-nursingknowledge.org/ [Accessed 1 Oct. 2016]. Longest, K., and Smith, C. (2011). Conflicting or Compatible: Beliefs About Religion and Science Among Emerging Adults in the United States1.Sociological Forum, 26(4), pp.846-869. Nursingmidwiferyboard.gov.au. (2016).Nursing and Midwifery Board of Australia - Professional Codes Guidelines. [online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements.aspx [Accessed 4 Oct. 2016]. Nursingworld.org. (2016).Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment. [online] Available at: https://nursingworld.org/rnrightsps [Accessed 1 Oct. 2016]. O'Keefe, E. and Kushelew, I. (2016). Asserting credibility and capability: professional practice standards in Australia.Journal of Aesthetic Nursing, 5(2), pp.89-93. Porter, R. (2013). The American Nurses Association Code of Ethics.Journal of the Dermatology Nurses Association, 5(1), pp.31-34. Schoonover-Shoffner, K. (2007). Thinking Through Ethical Dilemmas.Journal of Christian Nursing, 24(4), p.180. The Royal College of Nursing. (2016).Refusal to treat | Advice Guides | Royal College of Nursing. [online] Available at: https://www.rcn.org.uk/get-help/rcn-advice/refusal-to-treat [Accessed 1 Oct. 2016]. VA Nebraska-Western Iowa Health Care System. (2008).Bariatric Nursing and Surgical Patient Care, 3(3), pp.183-187. While A. (2011). Nurses with special interests.British Journal of Community Nursing, 16(5), pp.258-258.