Nursing negligence: definitions, standards, and legal implications

Nursing Negligence

Ethical Reasoning Cooperative Tool: Drug Abuse and Nursing Negligence

Facts:

The ethical reasoning assessment here will concern the hypothetical case of a veteran nurse who begins to demonstrate signs of a potential drug dependency issue. Particularly, there have been reports that a 46-year-old female nursing professional with 12 years of experience at the medical facility in question has been repeatedly late for work, has missed work with increasing regularity and has shown signs of potential cocaine abuse during work hours. It is incumbent upon the Director of Nurses (DON) in this situation to make a number of decisions, largely based on initial observations from co-workers, with the imperatives of protecting all parties involved. The DON must therefore make fair and lawful evaluation of what is known and what is not known in the case.

Most of what is known comes from reports of fellow workers. However, at this juncture, a number of reports from different parties concur on such details as the nurse's attendant nervousness at work, her lack of focus and an appearance which suggests to those with medical training that she is dealing with a cocaine addiction. These reports combine with our knowledge of her declining performance to suggest that the subject is undergoing some difficulty that warrants further exploration. It is necessary therefore to engage the subject in a manner which is at once respectful of her privacy and sufficient for uncovering the relevant facts in the case. This will require the administering of a drug test, which, it is expected in the present case, will yield positive evidence of a chemic addiction.

Issues:

The overarching issue at hand is the safety, health and well-being of the patients in the medical facility. As noted in an article by Weber & Ornstein (2009), nurses who may be under the influence of drugs represent a genuine threat to health outcomes on a variety of levels. First and foremost is the degree to which drug abuse can inhibit reasoning, focus and proficiency. In the area of medical care, such inhibitions can be downright deadly for patients. According to Weber & Ornstein, "these healthcare professionals may be in the operating room. They may be serving you when you're sick,' said George A. Kenna, an addiction researcher at Brown University. 'You just don't want that sort of person who's impaired' at the bedside." (Weber & Ornstein, p. 1)

This concern is compounded by additional issues such as the threat that such addicts represent to themselves and others through the specialized access to drugs afforded by their status as medical professionals. Weber & Ornstein indicate that it is a common matter for concern that nursing professionals with recurrent drug addiction issues often remain in a position to access and pilfer drugs directly from hospital facilities or even from patients.

An additional issue which is due for consideration is the ethical treatment of the nursing professional, including the respect for her privacy and adherence to legal responsibilities relating to the treatment of drug addiction in employees. There is a need to find balance between decisive action and the troubling code of silence which sometimes persists in medical facilities. According to the text by Dunn (2005), "many nurses choose to remain silent about a colleague who may have a substance-abuse problem because of loyalty, fear of being a hypocrite, guilt, or fear of jeopardizing a colleague's license to practices. Addiction must be accepted as an illness so that nurses can help one another recognize and seek treatment for the problem." (Dunn, p. 1)

Options:

This assertion in the section above denotes that dismissal is not an appropriate action even in the face of some of the conduct problems shown in the subject's lateness and missed work. Termination is not an option where drug addiction is concerned. And the acts of misconduct cited above are to be considered symptoms of the disease of addiction. Thus, it is necessary instead to enroll the subject in a rehabilitation program. Because this is the subject's first known offense, the variables and alternatives will be largely based on the evaluation of a professional drug counselor.

Duties and Decisions: