Nursing Ethics Paper

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Nursing Ethics Paper

Caitlin Prevette
James Madison University

Nursing Ethics Paper

Prevette

Introduction
Typically persons of authority are looked up to, respected and are trusted to not mislead
the people they are in charge of. The famous research study called the Milgram experiment
tested how people are more willing to compromise their moral values at the instructions of an
authority figure. The subjects believed the basis of this experiment was to test an individual in
their ability to learn while the experimenter supervised. When the learner made a mistake, the
experimenter instructed the subject to administer a shock, increasing voltage with every incorrect
answer. When the learner exclaimed he or she wanted to stop, the experimenter instructed the
subject to continue administering shocks, even when the learner stopped responding, and more
than half of the subjects continued until they reached the highest voltage (Velasquez, 2014). This
experiment exemplifies the compliance people display when authority figures instruct them to do
something immoral and the moral distress that results.
This basic framework can be applied to the clinical setting when a superior, or perceived
superior, orders you to act in a way that you consider morally wrong. In one European study,
lower autonomy was associated with increased frequency and intensity of moral distress and
lower levels of nurse-physician collaboration (Papathanassoglou, 2012, p. e41). This can lead to
inadequate patient care if not addressed in a timely manner.
Background
I experienced mistrust in authority during clinical when I was told by an instructor to
bring a flash drive with me to the hospital and put patient records onto it and take it home to
work on our assignments for clinical. This is clearly a violation of HIPAA, but she was our
instructor and I felt that we were supposed to trust her. I did not bring a flash drive with me to

Nursing Ethics Paper

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clinical that day and did not take patient records off of the computer. For me, this caused both a
moral distress and a moral dilemma.
Moral distress occurs when you know what is right, but you feel powerless to take action
(Epstein, 2010). I knew that what she was telling us to do was not only immoral but also illegal;
however, I felt scared to report her to someone else. I could have told her that she was wrong and
that she should stop telling students to do that, but I was scared to stand up to her. After all, she
was my superior.
Moral dilemma occurs when your options to take action both result in less than favorable
outcomes (Epstein, 2010). In this situation, if I were to listen to her and take patient records, I
could get in a lot of trouble. If I didnt take the records, but didnt report her, she would continue
instructing students to violate HIPAA laws and other people would get in trouble. Lastly, if I did
report her, she would get in trouble herself and it could ruin her career. All of these possible
outcomes caused me a lot of distress.
Methods and Findings
I will be using the JMU 8 key questions, found on the Madison Collaborative page, to
analyze the above situation. I will then use the ANA code of ethics provision 4 to develop an
action for this issue.
The first key question is fairness and asks, How can I act equitably and balance
legitimate interests? (James Madison University). This question does not apply to this situation
because there was no issue of inequality or unfairness.
The second key question is outcomes and asks, What achieves the best short- and longterm outcomes for me and all others? (James Madison University). To achieve the best shortterm outcomes, the students should not follow the instructors suggestions to avoid breaching

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HIPAA. To achieve best long-term outcomes, someone should report the instructor to keep her
from encouraging others to make questionable decisions and review her own moral beliefs.
The next key question is responsibilities and asks, What duties and/or obligations
apply? (James Madison University). The instructor had the obligation to serve as an example of
professional nursing for her students and everyone had the obligation to abide by HIPAA.
The next key question is character and asks, What action best reflects who I am and the
person I want to become? (James Madison University). The first action that reflects my
character would be to abide by HIPAA and not take patient records off the premises. The second
action that reflects my character would be to report the instructor for breaching HIPAA.
The next key question is liberty and asks, How does respect for freedom, personal
autonomy, or consent apply? (James Madison University). Liberty was a big issue in this
situation because the patients consent was not given to take their records off the property, which
violates their autonomy.
The next key question is empathy and asks, What would I do if I cared deeply about
those involved? (James Madison University). I would be upset if this happened to one of my
loved ones, although I would like to think that after being on this side of the situation, I would be
understanding of the situation. However, I would expect disciplinary action to be taken because
this is a serious offence.
The next key question is authority and asks, What do legitimate authorities expect of
me? (James Madison University). In this situation my authority asked me to do something
immoral and illegal. However, other authorities expect that I abide by the law and be honest
about the situation.

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The last question is rights and asks, What rights apply? (James Madison University).
The patients rights of privacy and autonomy were violated in this situation. Taking patient
information without consent of the patient is a serious violation of HIPAA.
Provision 4 of the ANA code of ethics focuses on nurses duty to act responsibly
and accountably in her individual nursing practice. This includes being accountable and taking
responsibility for her judgments and actions (ANA, 2001). In this case, the instructor needs to
take responsibility for encouraging students to violate HIPAA. The students should also
recognize that it is their duty under this provision to take action to make this injustice right.
Conclusion
In this situation, it was hard for me to act. I was worried about what would happen if I
told on my instructor and if she would retaliate had she stayed. Looking back, I think that I acted
according to my position. My clinical group asked about HIPAA to see if that would caution her
and I chose not to take the records without consent. I dont think that it was my place as a student
to tell my instructor that she was wrong or to dispute the matter with her. However, I do feel that
I have the ability to talk to another authority. In the future, if I were involved in a similar
situation, I would stay true to my values and seek support from other superiors.
The struggle of authority over morality is unfortunately still very prevalent in the
healthcare field. As a nurse, I will be faced with situations where other professionals cut corners
or break rules. As I continue towards my nursing career it is important to remember that while
moral dilemmas and moral distress can be inevitable, standing firm in my moral conviction will
aide me to avoid burnout.

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References:
American Nurses Association, (2001) (2 Code of Ethics for Nurses with Interpretive Statements,
Washington, D.C.: American Nurses Publishing.
Epstein, E.G., Delgado, S., (Sept 30, 2010) "Understanding and Addressing Moral Distress"
OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 1. DOI:
10.3912/OJIN.Vol15No03Man01
James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in action.
Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml
Papathanassoglou, E., Karanikola, M., Kalafati, M., Giannakopoulou, M., Lemonidou, C., &
Albarran, J. (2012). Professional Autonomy, Collaboration With Physicians, and Moral
Distress Among European Intensive Care Nurses. American Journal of Critical
Care, 21(2), E41-E52. doi:10.4037/ajcc2012205
Velasquez, M., Andre, C., Shanks, T., & Meyer, M. (2014). Conscience and Authority. Retrieved
2015.