Based on the first case, Mrs. Lewis acted correctly by contacting a lawyer. When inappropriate activity occurs in the workplace, and management does not act upon it, then someone has to act. Mrs. Lewis is a whistleblower, which is defined as “an attempt by a member or former member of an organization to issue a warning to the public about a serious wrongdoing or danger created or concealed by an organization” (Davis & Konishi, 2007). By taking a stand, Mrs. Lewis is advocating for the abused patients of the nursing home.
In the vignette, Mrs. Lewis hired a lawyer to protect herself from being intimidated by the hospital administrator. However, if she did not hire a lawyer, Mrs. Lewis most likely would have been protected. More than two-thirds of the states in the United States have legislation to protect whistleblowers from retaliation, including termination of employment (Grant, 2002). Before reporting on a wrongdoing in someone's organization, someone should see what laws their particular state have for protection of whistleblowers. Aside from legislative protection, people can hire legal representation to protect their rights. There are other resources for whistleblowers as well. Web sites, such as the National Whistleblower Center (http://whistleblower.org/index.html) are non-profit advocacy organizations that help whistleblower know their rights.
Physicians and nurses take an oath that swears to do everything possible to keep their patients’ best interests in mind. When injustices occur like in the first case, these professionals need to do everything in their power to act for their patients. While there are better initial forms of communication to highlight a problem, intimidation needs to be in a healthcare provider’s toolbox to show that they are serious about achieving change in the organization. In today’s healthcare setting, hospital administrators have a lot of power and often act in the best financial interests of the organization. Whistleblowers have the authority to have their voice heard and needs to be an appropriate consideration in ethical situations when the wronged party is powerless to initiate change.
The second vignette discusses nurse staffing in the ICU and should nurses have the authority to refuse admissions if they have insufficient coverage. ICUs exist for higher acuity patients to have increased monitoring by nurses. Studies have shown that appropriate nurse staffing lead to better patient outcomes (Penoyer, 2010). When critical care nurses take on too many patients, the overall care of each patient suffers, which could lead to increased patient mortality (Cho, Hwang, & Kim, 2008). The question that arises is if the nursing staff has nurses elsewhere in the hospital that can be pulled with ICU experience. If this is the case, then they should be pulled, and the staffing policy should not be followed. Patients are admitted to the ICU for a particular reason and need increased nursing supervision. If these patients are refused admission to the ICU, then they would be on the general floor, with an even worse nurse to patient ratio. This will put the patient at increased danger of sub-standard care. In the case where no additional nurses can be pulled into the intensive care unit, then the patient should go wherever they will receive the best care, either the floor or the ICU.
When discussing hospital policy versus the rights of the patient, it is understood that policy helps to protect the hospital and its employees, but decisions should always be made to put the patient’s best interests forward. The role of the hospital is to treat the sick. The hospital and its members should do everything it is power to provide an environment to promote healing. If there is a viable option available to admit a patient to an ICU, then everything should be done to ensure that each patient is where they need to be. Hospital policy and nurse staffing should not take precedence over the judgment of trained ICU nurses. These nurses know what is best for the patients and the other nurses on the unit. Hobbling nurses’ decision-making capabilities with hospital policy that does not put the patients and staffs needs first; then damage will be done to both parties.
References
Cho, S.H., Hwang, J.H., Kim, J. (2008) Nurse staffing and patient mortality in intensive care units. Nurse Researcher. 57(5), 322-330.
Davis, A.J. & Konishi, E. (2007). Whistleblowing in Japan. Nursing Ethics, 4(2), 194-2001.
Grant, C. (2002). Whistle blowers: Saints of secular culture. Journal of Business Ethics, 39, 391-399.
National Whistleblowers Center. (n.d.). News from the center. Retrieved February 23, 2016 from http://www.whistleblowers.org/
Penoyer, D.A. (2010) Nurse staffing and patient outcomes in critical care: a concise review Critical Care Medicine, 38(7), 1521-1528
