Ethical

Dilemmas in
Nursing
NURS 362
Kristen Nii-Jensen
Natalie Wong
Asherly Silver
Sun-Young Helmer
Sandy Van

Case Study #4
Natalie (Asherlys best friend since grade school) and Asherly work in the ICU as nurses. Natalie had a work related back
injury and was receiving treatment for the past few months. Natalie has recently returned back to work after being
cleared by employee health and workman compensation program but remains on pain medication. Although Natalie is
able to keep up with the demands of the job, Asherly notices that Natalie is calling in sick more often than usual and
having less social interactions. One day Asherly stops by to see how Natalie is doing and sees her in a great deal of pain
and feeling depressed. She suggests to Natalie that she must go see the doctor but she states that she just did. The doctor
felt that Natalie was dependent on the meds and that it was time to come off the meds and utilize other pain
management strategies. One month later after doing a narcotics count in the Pixis, Asherly notices that there are some
narcotics missing. She follows procedure and notify the manager and pharmacy but she is suspicious Natalie might be
involved. Asherly asks Natalie who denies taking the narcotics and says that she is no longer on pain medications. Over
the next few months Asherly is aware of another incident of missing narcotics. Again shes says something to Natalie
who then states, "I am telling you only on the grounds of the strictest confidence that I did it just once but I know I have
a problem and I am getting help. You cannot say anything because of HIPPA and you know if I lose my job I will lose
medical insurance and will be bankrupt from all my medical bills."

HIPAA
1. Enacted in 1996
a.

Privacy Act- compliance period begins 2003

i.

Protects individual identifiable health information

2. The HIPAA Privacy Rule does not apply to disclosures to employer

including managers or supervisors.
a. If you work for a covered health care provider the rule does not apply
apply to your employment, but does protect your medical and health
plan records if you are a patient of the provider or a member of the
health plan

U.S. Department of Health and Human Services. (n.d.) Health Information Privacy. Retrieved from
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/employers.html

Ethical Theory
Utilitarianism
The approach in the assumption that an action or practice is right if it leads to the greatest possible
balance of good consequences or to the least possible balance of bad consequences (Cherry & Jacob,
2011, p. 198).
-The needs of the many outweigh the needs of the few

Deontology
The approach that is rooted in the assumption that humans are rational and act of principles that are
consistent and objective and compel them to what is right (Cherry & Jacob, 2011, p. 199). Right is
the sense of universal principle to act on way.
-The end does not justify the means

Cherry, B. & Jacob, S. (2014). Contemporary nursing: Issues, trends and management (6th ed). St. Louis: Elsevier

Code of Ethics
Purpose: ethical obligations and duties for every individual in the
nursing profession; nonnegotiable ethical standard; nursings own
understanding of its commitment to society

Provision 3.6 Addressing impaired practice

If a nurse suspects anothers practice may be impaired
-Nurses duty to take action
-Follow guidelines for fair institutional and legal processes
-Protect patients
-Assure impaired individual receives assistance and support

The American Nursing Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Ethical Principles
Beneficence: promote goodness, kindness and charity
Nonmaleficence: duty not to inflict harm

Veracity: obligation to tell the truth

Fidelity: act of keeping a commitment or promise

Cherry, B. & Jacob, S. (2014). Contemporary nursing: Issues, trends and management (6th ed). St. Louis: Elsevier

Solution: Option #1
Turn a blind eye to the situation because you dont want to
destroy your friendship
Ethical Principle: + Fidelity
BENEFITS:
- Asherly will withhold her loyalty and maintain the friendship with Natalie
DISADVANTAGES:
- Natalie will continue to have addiction enabled which poses a risk to her
own health and risk to patients who would receive care from opioid
sedated nurse
- Agencys policies and protocols will not be adhered to, displaying nursing
negligence

Solution: Option #2
Inform Natalie that what she is doing is a crime and the
next time she does it, you will turn her in
Ethical Principles: +Beneficence. tenuous+nonmaleficence, veracity, fidelity
BENEFITS:
- Asherly allows Natalie to become responsible for her actions and stop
further criminal acts
- Given a warning, turning Natalie in would not pose as much impairment to
the friendship than turning her in without a warning
DISADVANTAGES:
- Delay in stopping/addressing narcotic theft on unit if Natalie continues, as
well as a delay in help for her addiction
- Explanation of past missing narcotics will go unreported if Natalie stops

Solution: Option #3
Report to your supervisor that Natalie has admitted to
stealing narcotics and encourage Natalie to continue to
receive help and/or assist her in finding other help options
Ethical Principles: +Beneficence, +nonmaleficence, +veracity, +fidelity
BENEFITS:
- Asherly is following agency procedure and protocol
- Natalie will no longer have her addition enabled through work
- Patients will not be put at risk by receiving care from opioid sedated nurse
DISADVANTAGES:
- Natalie may resent Asherly for turning her in, thus risking the loss of the
childhood friendship

Hawaii Law
-

According to the Uniform Controlled Substance Act

in Hawaii (Chapter 329), it is unlawful to obtain
any controlled substances by misapply or divert to
the persons own use or other unauthorized illegal
use.
A person who prohibits act shall be fined up to
$100,000 or imprisoned up to five years, or
both.
Theft or loss of any substance discovered by any
person regulated by this part shall be reported to
the department of public safety within three days of
the receipt of actual knowledge of the discrepancy
(Hawaii Revised Statutes Chapter 329, 2013)

Journal Findings

Approximately 1 in 10 or 10% of nurse in the United States are dependent on drugs

Nurse with untreated addiction can jeopardize patient safety because of:
Impaired judgment, slower reaction time
Failing to recognize changes in patient assessments
Medication errors
Diverting drugs
Neglecting patients
Drug abuse is usually noted first by fellow staff members, but many are reluctant to report a colleagues drug abuse
Those who remain quiet about a colleagues drug abuse risk:
Patient care and safety
Facilitys reputation
Colleagues life
New York State Nurses Associations Model Drug Policy:
Employers have an ethical obligation and most have a legal mandate to report an impaired nurse to the
appropriate legal and regulatory authorities in order to safeguard consumers.
Nurses have an ethical obligation to address impairment of a colleague.

Copp, M. B. (2009, April 1). Drug addiction among nurses: Confronting a quiet epidemic. Retrieved from http://www.modernmedicine.com/modernmedicine/news/modernmedicine/modern-medicine-feature-articles/drug-addiction-among-nurses-con?id=&sk=&date=&pageID=2

BEST Solution
Option #3: Report to your supervisor that Natalie has admitted to stealing
narcotics and encourage Natalie to continue to receive help and/or assist her in
finding other help options
Deontological: Moral rightness as defined by ANA code of ethic, obliges
Asherly to report Natalie regardless of consequences. Hawaii state law as
moral rule also supports this position.
Utilitarian: The most good for the most people supports this view.
Asherly is following ANA ethics and Hawaii state law, patients are
protected from a possible impaired nurse as supported by Copp, the facility
is protected from further theft, and Natalie may receive support for her
addiction.

Works Cited
The American Nursing Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Cherry, B. & Jacob, S. (2014). Contemporary nursing: Issues, Trends and Management (6th ed). St. Louis: Elsevier

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Copp, M. B. (2009, April 1). Drug addiction among nurses: Confronting a quiet epidemic. Retrieved from
http://www.modernmedicine.com/modern-medicine/news/modernmedicine/modern-medicine-feature-articles/drugaddiction-among-nurses-con?id=&sk=&date=&pageID=2
State of Hawaii: Department of Public Safety. (January 18, 2013). Hawaii revised statutes chapter 329 - Uniform
controlled substances act. Retrieved from http://hawaii.gov/dcca/pvl/hrs/hrs_pvl_329.pdf.
U.S. Department of Health and Human Services. (n.d.) Health Information Privacy. Retrieved from
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/employers.html