Compare two different advanced registered nurse roles with regard to ethical guidelines
Compare two different advanced registered nurse roles with regard to ethical guidelines
Compare two different advanced registered nurse roles with regard to ethical guidelines. Are there any differences in the ethical guidelines that govern these roles? What situations might require one role to respond differently, depending on the ethical guidelines?
CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
The Certified Registered Nurse Anesthetist is prepared to provide the full spectrum of patients’ anesthesia care and anesthesia-related care for individuals across the lifespan, whose health status may range from healthy through all recognized levels of acuity, including persons with immediate, severe, or life-threatening illnesses or injury. This care is provided in diverse settings, including hospital surgical suites.
VERSUS
CERTIFIED NURSE PRACTITIONER (CNP)
CNPs are educated and practice at an advanced level to provide care in a range of settings and in one of six patient populations. CNPs are responsible and accountable for health promotion, disease prevention, health education and counseling as well as the diagnosis and management of acute and chronic diseases. They provide initial, ongoing and comprehensive care to patients in family practice, pediatric, neonatal, geriatric, psych/mental health and women’s health/gender-related populations. CNPs are prepared to practice as primary care or acute care nurse practitioners, each population has separate national competencies and unique certifications.
ETHICS
Nurse–Nurse Ethical DilemmasIt seems natural and obvious that all nurses, given their education, would share similar values and beliefs about patient care. Given the wide range of diverse values previously discussed, however, nurse-to-nurse relationships and behaviors may demonstrate variations and give rise to ethical dilemmas. Such nurse-to-nurse ethical dilemmas may, in turn, impact perceptions and professional role behaviors.An area of great concern and challenge for nurses is the nurse-to-nurse ethical dilemma in which nurses espouse different standards of practice. The American Nurses Association’s Code of Ethics for Nurses clearly defines standards of practice, yet not all nurses follow these professional standards. Some nurses support professional standards in the strictest manner whereas other nurses tend to cut corners or ignore some professional standards, resulting in different levels of patient care. Autonomy, beneficence, betrayal, code of ethics, fidelity, nonmaleficence, rationalization, veracity, and personal integrity may all play a role in the standard practice. In some cases, these factors may even lead to substandard practice because they create moral and psychological barriers to change or challenging existing norms.
For licensure, many states require that nurses agree by law to report unprofessional and unsafe practices to the board of nursing. The requirement to report nurses who do not follow the professional standards of practice should not be taken lightly. Specific guidelines are available from the American Nurses Association and each state board of nursing. Examples include the requirement to report to the appropriate state board of nursing in the following situations:Information that a nurse may be mentally or physically unable to safely practice nursing
Conduct involving practicing beyond the scope of practice of the license, such as giving a medication not authorized by a provider or an unauthorized adjustment of a dosage (boundary violation)Conduct that appears to be contributing to high-risk situations or harm to a patient and requiring medical intervention because of the conduct (nonmaleficence)Conduct involving the use of alcohol or chemical substances to the extent that nursing practice may be impaired (nonmaleficence, personal integrity)Actual or suspected drug diversion (nonmaleficence, personal integrity)A pattern of failure to account for medications or waste of control drugs (nonmaleficence, personal integrity)A pattern of inappropriate judgment or nursing skill (rationalization, nonmaleficence, personal integrity)Professional boundary violations, such as sexual conduct with a patient or patient’s family member
Conduct involving theft or exploitation of a patient (boundary violation)Practicing without a valid license (code of ethics)When a nurse identifies or recognizes behaviors believed to be in violation of professional standards and regulations, the issue should be escalated to the next individual in the organizational chain of command or reporting structure to determine how and when to comply with the reporting requirements. The reporting of colleagues can be quite unsettling for the individual and can also impact team dynamics. When an issue is not addressed, however, ethical fading begins and can lead to ethical erosion. Doing the right and ethical thing requires courage and conviction of one’s actions. Additionally, it is our professional obligation to the public to hold fellow nurses accountable to safe practice standards.Substance use disorders are another area of great nurse-to-nurse conflict. Of all the professional issues among nurses, addressing impaired nurse behaviors is probably the most difficult. The number of nurses impaired by substances is of great concern to the profession and the public; such disorders represent the most common reason nurses are reported to boards of nursing (Darbro, 2011). As difficult as it is to report a colleague with probable substance abuse issues, this step is critical in getting impaired nurses into recovery.Reentry into practice from substance use disorders often presents another dilemma for nurses. Nurses who have successfully completed initial rehabilitation and are currently in recovery from substance abuse often have difficulty reentering the practice setting. Practicing nurses are often reluctant to put forth the additional effort to monitor and mentor the returning nurse. One ethical dilemma that arises between nurses who practice safely and the returning nurse pertains to why nurses without substance abuse issues should be expected to oversee and monitor the nurse who violated professional standards. Ethical issues of autonomy, beneficence, fidelity, nonmaleficence, and rationalization are commonly encountered in these situations. CRITICAL THOUGHTTrusting relationships cannot be bought or recruited from the outside; they must develop over time and through experience.Nurse–Patient Ethical DilemmasAnother category of ethical dilemmas is related to the nurse–patient relationship. During the course of providing patient care, numerous ethical dilemmas can emerge. Issues related to decision-making authority, pain management, the dying process, futile care, patient privacy, and communication among providers often arise; when they do, they require investigation and resolution.Historically, physicians directed patient care treatment based on the belief that physicians possessed the best and most reliable information about medical treatments. Patient autonomy was subordinated to the expertise of the physician. More recently, this relationship has undergone a transition. Today, the patient or user of the healthcare system owns his or her decisions about healthcare treatments and has personal autonomy. For example, autonomy can come into conflict with beneficence when a patient disagrees with recommendations that healthcare professionals believe are in the patient’s best interest. When the patient’s wishes conflict with his or her welfare, the wishes of a mentally competent patient will prevail even if healthcare providers believe the patient’s choice is not in his or her best interest. Patient knowledge, culture, religion, or other values can all be sources of disagreement with providers.Patient restraint is another recurring challenge for nurses in ensuring a safe environment. Restraining a patient necessarily decreases patient autonomy in favor of beneficence or nonmaleficence. Similarly, when a patient or family selects palliative care rather than seeking out all possible care at the end of life in support of patient autonomy, nurses may disagree with that decision; they may believe that appropriate care is not being provided and that harm is being brought upon the patient by withholding antibiotics or tube feedings.Another nurse–patient ethical dilemma is related to technology, specifically to monitoring alarms. The management of alarms on monitoring equipment has attracted much attention recently. As the number of monitoring devices increases, the number of associated alarms has also increased, rendering the patient care environment a cacophony of sounds. The noise and false alarms have resulted in “alarm fatigue,” with nurses often turning off alarms to decrease the noise and interruptions from false alarms (Inglesby, 2011). Several concepts and principles are involved in these types of situations, including rationalization, nonmaleficence, morality, beneficence, and personal integrity.Nurse–Organization Ethical DilemmaA third category of ethical dilemmas involves conflicts between the nurse and the organization. Interactions between an employer and an employee can lead to ethical dilemmas in several ways. Certainly, it is important to be clear how an organization addresses ethical patient care situations. When nurses’ values, individual patients’ needs, and the demands of the organization are not in agreement, an ethical dilemma emerges. Caregivers become disenfranchised and dissatisfied with their work. For example, if caregivers believe their primary obligation to the patient (health advocacy) is compromised, an ethical dilemma is present. Being able to work in an organization in which difficult patient care problems are discussed and decided so that the primary obligation to the patient is honored is essential for caregiver satisfaction and retention. In such an environment, caregivers are empowered, trusted, and included in the decision-making processes of ethical dilemmas. Conversely, nurse–organization ethical dilemmas may occur when disputes arise regarding error management, staffing adequacy, technology management, and other elements.Another nurse–organization ethical dilemma between nurses and the organization is related to the management of errors. Historically, if a nurse committed an error, he or she was disciplined for poor practice. More recently, the investigation of errors and considerations of a just culture have emerged as important considerations in the management of errors (Benner, Malloch, & Sheets, 2010). Specifically, the recognition that errors are inevitable in a human system, the nature of the interconnectedness of systems, and the morality of treating individuals fairly and humanely when an error occurs have dramatically shifted the management of errors in healthcare organizations. This shift in thinking has resulted from error research and the development of systems theory, which collectively indicate that practice deficiencies can seldom be understood in isolation and that individuals are rarely responsible for anything but the most egregious errors (Goeschel, 2011). The new dilemma is to assign accountability and administer sanctions with fairness rather than to find and punish a single scapegoat. REFLECTIVE QUESTIONFor each of these behaviors, identify an ethical principle that positive behavior supports.Staffing adequacy is also associated with ethical dilemmas. When nurse staffing is less than adequate, patient care can be compromised. When a nurse does not report to work and no replacement is available, for example, the nurses on the shift must take on additional responsibilities beyond their capabilities. Nurses have accepted this situation in the belief that patient care would be worse if they refused the additional, unreasonable assignment and they were the only ones who could protect the patient. The principles of beneficence, nonmaleficence, ethical fading, fidelity, rationalization, boundaries, and rationalization are all potential explanations for this ethical dilemma.Documentation technology is another source of ethical dilemmas. The ongoing influx of new technologies to document and monitor patient care has resulted in increased access to information and challenges in documenting care in a timely and individual manner. The wider availability of protected and private patient information in an electronic environment has sometimes resulted in inappropriate disclosure of confidential patient information. An employee who accesses patient information without a caregiver relationship to that patient may be subject to discipline and termination of employment. Principles of beneficence, betrayal, fidelity, nonmaleficence, personal integrity, rationalization, and veracity can all be involved in understanding these types of ethical dilemmas. See Box 6-2.
THIS INFROMATION COMES FROM MY TEXT BOOK
Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Jones & Bartlett Learning.
https://bibliu.com/app/#/view/books/9781284146554/epub/EPUB/xhtml/17_Chapter06_02.html#page_292
References
https://www.ncsbn.org/nursing-regulation/practice/aprn.page
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