by Cup Of Nurses | Jul 28, 2023 | Podcast
Navigating Ethical Dilemmas in Nursing Practice: Real-Life Scenarios
Nurses play a critical role in patient care, advocating for their well-being and ensuring ethical standards are upheld. However, the complex nature of healthcare often presents nurses with challenging ethical dilemmas. In this blog post, we will explore real-life scenarios where nurses encounter ethical challenges, ranging from respecting patient autonomy to navigating conflicts of interest. Let’s delve into these thought-provoking scenarios and discuss how nurses can navigate these ethical dilemmas while prioritizing patient safety and care.
Patient Autonomy vs. Beneficence:
Scenario: A pregnant patient with a life-threatening medical condition insists on continuing with a treatment that poses serious risks to her and the unborn child. The medical team believes that the treatment should be postponed until after childbirth to maximize chances of survival for both, but the patient is adamant about proceeding with the treatment. How can the nurse respect the patient’s autonomy while also ensuring the best outcome for both the patient and her baby?
End-of-Life Care:
Scenario: A patient’s advanced directive states they do not want to be kept on life support if they become terminally ill. However, the patient’s family disagrees with this decision and insists on pursuing all available life-sustaining treatments. The patient is unable to communicate due to their condition. How can the nurse advocate for the patient’s end-of-life wishes while balancing the family’s desires and emotions?
Resource Allocation:
Scenario: A hospital is dealing with a surge of patients, and there is a shortage of ventilators in the intensive care unit (ICU). Nurses must decide which patients should receive the limited number of ventilators, knowing that some patients may not survive without this life-saving equipment. Additionally, some patients may have pre-existing health conditions that put them at higher risk for severe complications.
Confidentiality and Privacy:
Scenario: A nurse discovers that a prominent public figure has been admitted to the hospital for a sensitive medical issue. The nurse faces pressure from the media and public to disclose the patient’s condition, but doing so would breach patient confidentiality. How can the nurse uphold patient privacy and confidentiality in the face of external pressures?
Informed Consent:
Scenario: A patient is admitted to the hospital with a life-threatening condition, and urgent surgery is recommended. However, the patient is in a state of confusion and is unable to provide informed consent. The patient’s family is unavailable, and the medical team must make a rapid decision. How can the nurse ensure the patient’s best interests are served while acting in the patient’s best interest under emergent circumstances?
Cultural and Religious Beliefs:
Scenario: A young patient’s parents belong to a religious group that rejects modern medical interventions. The child has a treatable condition, but the parents insist on using only prayer and faith-based remedies. The medical team believes the child’s life could be saved with medical intervention. How can the nurse navigate this ethically challenging situation that involves potentially life-saving medical treatment and respecting the parents’ religious beliefs?
Refusal of Treatment:
Scenario: An adult patient with a severe psychiatric condition refuses to take essential medications, which have previously been effective in managing their symptoms. The patient’s condition worsens significantly, and they pose a danger to themselves and others. The patient’s refusal raises ethical concerns, as they are unable to make rational decisions in their current state. How can the nurse balance respecting the patient’s autonomy with ensuring their safety and well-being?
Whistleblowing:
Scenario: A nurse working in a prestigious hospital discovers that some physicians and surgeons are engaging in unethical practices to manipulate patient data, including falsifying medical records and test results. The purpose of these actions is to move certain patients higher up on transplant lists and make them appear more eligible for specific surgeries, even when other patients may have a more urgent medical need. The nurse is deeply troubled by these manipulations, as they compromise the integrity of patient care, prioritize certain individuals over others unfairly, and potentially put lives at risk. However, the nurse fears the repercussions of reporting this misconduct, knowing that the involved physicians are influential within the hospital and may have strong connections with hospital administrators.
Conflict of Interest:
Scenario: A nurse working in a pharmaceutical company is asked to participate in a research study evaluating a medication produced by the company. The nurse is aware that the medication has potentially serious side effects that are not adequately disclosed to study participants. How can the nurse navigate the conflict between professional obligations and the company’s interests?
Social Media and Privacy:
Scenario: A nurse posts a photo on social media, inadvertently capturing a patient’s face in the background. Despite not identifying the patient by name, the post leads to the patient’s identity being revealed in the comments section, breaching their privacy. How can the nurse address the inadvertent violation of the patient’s privacy and take appropriate measures to rectify the situation?
As healthcare professionals, nurses face complex ethical dilemmas that require critical thinking, compassion, and a commitment to patient advocacy. By exploring these real-life scenarios, we have gained insight into the challenges nurses may encounter and the importance of upholding ethical principles in providing quality patient care. Through continued education, open communication, and support from colleagues and institutions, nurses can navigate these ethical dilemmas while remaining steadfast in their commitment to patient well-being and safety.
Watch the full episode: https://youtu.be/GFYVgduFV_k
by Cup Of Nurses | Jul 21, 2023 | Podcast
2023 Nursing Strikes and Their Outcomes
Nurses are a crucial part of the healthcare industry, playing a vital role in patient care and well-being. However, in recent years, the United States has witnessed an increase in nurse strikes, which serve as a means for nurses to demand better working conditions and advocate for their rights.
First, we will go over what a strike means and then the nursing strikes we’ve had in 2023.
Understanding Nurse Strikes
A nurse strike is a labor action where nurses refuse to work as a form of protest against their employer. It is a response to various issues such as poor working conditions, inadequate staffing, low wages, and lack of benefits. Nurse strikes aim to bring attention to these concerns and prompt employers to address them by disrupting the provision of healthcare services.
Consequences and Risks of Nurse Strikes
Nurse strikes can have both immediate and long-term consequences for nurses and patients alike. Patients may experience:
- Delays in receiving care
- Potential lack of attention during the strike
Nurses who participate in strikes face:
- Financial loss
- Potential damage to their professional standing
- Disruptions to their personal and family lives
However, nurses typically view strikes as a last resort after exhausting other communication and negotiation channels.
Reasons for Nurse Strikes
Nurses engage in strikes due to several underlying issues, including:
- Poor working conditions
- Low wages
- Inadequate staffing
- Lack of benefits
Increasing demands placed on nurses include:
- Additional roles
- Extra shifts
- Heavier patient loads, contribute to stress, burnout, and compromised patient care.
Impact of Nurse Strikes on Patients
Nurse strikes have a significant impact on patients, affecting their access to quality healthcare. This can result in:
- Increased risks of medical errors, infections, and complications
- Challenges for patients requiring specialized treatment or 24-hour care
- Exacerbation of existing staffing issues, compromising patient safety
Expectations During Nurse Strikes
When nurse strikes are anticipated, several key actions and measures are typically implemented, including:
- Striking nurses providing advance notice
- Employment of temporary replacements, such as travel nurses, to fill staffing gaps
- Transfer of patients to adjacent healthcare institutions
- Hiring temporary employees to assist during the strike
However, the presence of unfamiliar staff and protocols can result in potential inconsistencies in patient care and lower-quality service.
The Future of Nurse Strikes
Given the ongoing challenges faced by nurses, including staffing shortages and inadequate working conditions, nurse strikes are expected to continue in the coming years. The COVID-19 pandemic has exacerbated these issues, with a significant reduction in the nursing workforce. Nurses will likely persist in their demands for:
- Better wages
- Improved working conditions
- Adequate staffing ratios to ensure safe and effective patient care.
Nurse Strikes in 2023
The following are notable nurse strikes that occurred in the year 2023:
January 2023: Seven Hospitals in New York City
Who: 12,000 nurses at seven hospitals in New York City, including:
- Health System of BronxCare
- Hospital Medical Center of Flushing
- Medical Center of Maimonides
- Mount Sinai Bronx
- Mt. Sinai Medical Center
- Mount Sinai West and Morningside
- University Medical Center of Richmond
Reason: The strike was in response to:
- Inadequate staff members
- Frequent staff turnover
- Fatigue
Outcome: After a three-day strike, the parties reached an agreement on a three-year contract. The contract included the following provisions:
- Introduction of enhanced staffing standards and enforcement
- Improvement in healthcare benefits
- Salary increases of 7%, 6%, and 5% over the three-year contract period
January 9-11, 2023: Montefiore Medical Center and Mount Sinai Hospital, New York
Who: 7,000 nurses at Montefiore Medical Center in the Bronx and Mount Sinai Hospital in Manhattan, New York
Reason: The strike was in response to:
- Numerous staffing shortages
- Fatigued nurses from pandemic-related overwork
- Inadequate training process for new nurses
- Nurses managing dangerously high caseloads
Outcome: After coming to tentative deals with management on better staffing and pay, the strike was ended by thousands of New York City nurses. The tentative agreements at Montefiore Medical Center in the Bronx and Mount Sinai Hospital in Manhattan involve raises totaling 19% over three years.
January 2023: MyMichigan Alma and McLaren Central in Michigan
Who: 150 nurses work at MyMichigan Alma and 100 at McLaren Central in Michigan
Reason: Nurses at MyMichigan Alma and McLaren Central had been working under expired contracts since November 2022.
They claimed that hospitals engaged in unfair labor practices, such as bad faith negotiating.
Outcome: A strike was averted as agreements were reached before a settlement.
- Agreements were reached, preventing the need for a work stoppage.
- A new three-year contract was approved by the nurses at McLaren Central Hospital in Mount Pleasant, and nurses at MyMichigan Alma endorsed their tentative deal.
- Both contracts were immediately implemented upon ratification.
February 27, 2023: South Shore University Hospital Northwell Health (SSUH) in Bay Shore, New York
Who: 800 employees at South Shore University Hospital Northwell Health (SSUH) in Bay Shore, New York
Reason: The strike was in response to:
- Better salaries
- Safe staffing ratios
Outcome: A strike was averted as a tentative deal was struck. The tentative agreement includes provisions for:
- Wage increase
- Improved compensation to retain nurses
- Enforcement of safe staffing standards
- Enhancements to retiree health benefits
March 20, 2023: Henry Mayo Newhall Hospital in Valencia, California
Who: 700 employees at Henry Mayo Newhall Hospital
Reason: The strike was in response to:
- Unfair contract
- Retaliation threats against workers’ rights to engage in concerted union activity
- Interference with union bargaining committee member’s participation in contract negotiations
- Failure to provide timely information requested for negotiations
- Refusal to address low wages in negotiations
Outcome: This one-day strike marked the first strike in the union’s 19-year history. The purpose of the strike was to pressure the hospital’s management to cease illegal bargaining strategies and engage in sincere talks to address high employee turnover. Discussions for a new collective bargaining agreement are underway between employees and Henry Mayo.
March 28, 2023: MarinHealth Medical Center in Greenbrae, California
Who: Nearly 600 nurses at MarinHealth Medical Center
Reason: The strike was in response to:
- Alleged hospital administration’s refusal to address nurses’ concerns regarding patient care, safe staffing, nurse retention, and recruitment
Outcome: A strike was averted as registered nurses tentatively agreed to a three-year contract on March 21, 2023. The contract includes provisions for:
- Health and safety measures
- Provision of personal protective equipment (PPE)
- Establishment of an Infectious Disease Subcommittee
- Implementation of safe staffing provisions
- Health benefits improvements
- Measures to enhance nurse retention and recruitment
- A 16.5% wage increase over three years
May 2-4, 2023: St. Rose Hospital in Hayward, California, and John Muir Behavioral Health Center in Concord, California
Who: 200 registered nurses at St. Rose Hospital in Hayward, California, and 78 registered nurses at John Muir Behavioral Health Center in Concord, California
Reason: The strike was in response to:
- Hazardous staffing levels
- Poor working conditions
- Inadequate pay
- Management’s refusal to respond to nurses’ requests for fair contracts
Outcome: At the last minute, a two-day nurses’ strike at St. Rose Hospital in Hayward was called off due to progress in contract negotiations. The contract negotiated by the John Muir nurses and the union after 30 bargaining sessions may be put to a vote if the union leaders agree or permit a vote.
May: PIH Health Good Samaritan Hospital (PIH GSH) in Los Angeles, California
Who: Registered nurses at PIH Health-Good Samaritan Hospital in Los Angeles, California
Reason: The registered nurses at PIH Health-Good Samaritan Hospital in Los Angeles, California had concerns regarding patient safety due to management actions, including:
- Understaffing
- Inadequate supervision of safe meals and rest breaks by RNs
- Poor patient outcomes
Outcome: Strike averted
- A one-day strike scheduled to start on May 11 was avoided.
- Registered nurses reached a tentative deal on May 6, 2023.
- The agreement will be in effect until November 2025.
May 22, 2023: HCA Healthcare
Who: 3,000 healthcare workers at HCA Healthcare
Reason: The healthcare workers at HCA Healthcare had concerns regarding:
- Staff shortage
- Nurse retention
- Poor working conditions
Outcome: Strike averted
- Five HCA hospitals in California were at risk of being impacted by the strike.
- Negotiations between the parties resulted in the cancellation of the strike.
- A tentative agreement was reached on the new contract.
- The agreement includes significant investments in the workforce and salary increases to retain experienced healthcare workers.
- Over a period of three years, a raise of 15% will be implemented.
- The agreement also ensures the protection of healthcare and education benefits for workers.
June 12, 2023: St. Charles Health System’s Bend in Central Oregon
Who: Nearly 1,000 nurses represented by the Oregon Nurses Association at St. Charles Health System’s Bend in Central Oregon
Reason: The nurses at St. Charles Health System’s Bend had concerns regarding:
- Inadequate staffing to meet patient demand
- Better pay
- Nurse retention issues
Outcome: Strike averted
- After over 40 hours of negotiations, the Oregon Nurses Association and St. Charles Bend reached a tentative contract early on Thursday.
- The tentative agreement addresses several key issues, including:
- Guaranteed meal breaks
- Increased compensation
- Security of employment in the event of a change in hospital ownership
- The agreement is subject to the approval of the nearly 1,000 nurses represented by the nurses’ union, who must vote on the tentative agreement.
June 12, 2023: NewYork-Presbyterian Brooklyn Methodist Hospital
Who: About 1,250 nurses at NewYork-Presbyterian Brooklyn Methodist Hospital
Reason: The nurses at NewYork-Presbyterian Brooklyn Methodist Hospital had concerns regarding:
- Staffing cuts leading to unsafe patient care
Outcome: Strike averted
- Nurses were initially scheduled to go on an indefinite strike on June 12.
- However, a new contract has been approved by members of the New York State Nurses Association, allowing them to avoid the strike.
- The agreement includes the following provisions:
- Full retroactive pay for the nurses
- Three years’ worth of pay increases totaling 18%.
- These terms ensure that nurses will receive fair compensation for their work.
June 19, 2023, Providence Portland Medical Center, Providence Seaside Hospital, and Providence Home Health and Hospice
Who: Roughly 1,800 nurses at Providence Portland Medical Center, Providence Seaside Hospital, and Providence Home Health and Hospice
Reason: The nurses at these facilities have raised concerns about:
- Unfair labor practices
- Failing practice standards
- Overuse of temporary nurses
- Unsafe nurse-to-patient ratios
- Failed nurse retention
- In late May and early June, union members voted to approve strikes.
- Contract talks between nurses, clinicians, and management began in the fall of 2022.
- The most recent contract expired in 2022.
Outcome: Current negotiations and bargaining are ongoing.
Looking at the financials for Providence in Oregon
1st quarter numbers of 2023
- Total hospital value of assets: $28,806,511,000
- Net assets (assets – liabilities): $17,224,530,000
- Cash and Cash equivalents on hand: $1,233,382,000
- From 2019-2022 total salaries and benefits went up 15%
- This doesn’t mean RNs got paid 15% more, the total of all employees, CEOs, Managers, administrators, and benefits
- Operating expenses Q1 2023: -$345,000,000 (-$510,000,000 in 2022)
- Keep in mind hospitals lost millions to billions of dollars in 2021 and 2022 but it looks like they are slowly making it back
https://www.providence.org/about/financial-statements
June 27, 2023: Ascension Seton Medical Center Austin (ASMCA)
Who: 900 registered nurses at Ascension Seton Medical Center Austin (ASMCA)
Reason: The registered nurses at ASMCA have cited concerns related to:
- Unsafe staffing levels
- Alleged mismanagement of resources by hospital administrators
Outcome: Current negotiations and bargaining are ongoing. Historic one-day strike at Ascension Seton Medical Center in Austin (ASMCA), the largest nurse strike in Texas history.
- Nurses were locked out until July 1st as the hospital hired temp nurses to fill the strike.
- Nurses will not be sharing details of negotiations publicly, out of respect for the process and to ensure Ascension will settle strong contracts as soon as possible.
https://www.nursetogether.com/nurse-strikes/
Watch the full episode: https://youtu.be/250grmnCPXM
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