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Running head: ETHICAL DILEMMA CASE #4

Ethical Dilemma Case #4: Fidelity and Friendship


Asherly Silva
Kristen Nii-Jensen
Sandy Van
Sun-Young Helmer
Natalie Wong
Kapiolani Community College
NURS 360

Running head: ETHICAL DILEMMA CASE #4

The ethical dilemma faced by Nurse A is whether to betray the confidence of her
childhood friend (Nurse B) by informing their workplace that she (Nurse B) has admitted to
taking narcotics from the facilities Pyxis. Nurse B states that she is seeking help for her admitted
addiction and if Nurse A were to betray her and inform anyone, she (Nurse A) would be
violating HIPAA and cause her to lose her job, medical insurance, and go bankrupt. The threat
issued by Nurse B concerning HIPAA is a non-factor in this ethical dilemma. HIPAAs privacy
rule does not apply to workers of health care facilities subject to the rules of HIPAA, but to the
facilities patients (U.S. Department of Health and Human Services, n.d.).
Though we have three alternative actions, the first two involve not saying anything, or
warning Nurse B that she will turned in if she steals medication again. This action preserves
Nurse As ethic of fidelity, keeping commitments, to Nurse B, and beneficence, promoting good,
in allowing her to continue her work. However, this choice violates the ethical principle of
veracity, or telling the truth, fidelity to the facility they work at, and nonmaleficence, which is to
do no harm. This action can harm Nurse B if her addiction persist, and Nurse B may harm her
patients while impaired.
The third option is to turn Nurse B in but also encourage and assist her in finding help for
her addiction. This promotes beneficence to Nurse B, in that it directs her towards help for her
addiction, nonmaleficence to Nurse Bs patients, veracity to the truth, and fidelity to the facility
both nurses work at. On the other hand, this violates the fidelity Nurse A has to Nurse B.
The best course of action will be determined by analyzing the evidence through two
ethical theories. Through the utilitarianism prism, which posits the right choice as one that
promotes the best outcome for the most people would be option three. This is supported by a
2009 journal article by Copp that reveals nurses with addiction have impaired judgment, slower

Running head: ETHICAL DILEMMA CASE #4

reaction times, greater incidence of mistakes, and neglect for patients. In addition, Hawaii state
law mandates that, Theft or loss of any substance discovered by any person regulated by this
part shall be reports to the departments of public safety within three days of receipt of actual
knowledge of the discrepancy (Hawaii Revised Statutes Chapter 329, 2013). This action
protects the patients, Nurse A, and the facility the nurses work at, thus promoting the most good
(Cherry & Jacob, 2011, p. 198-199).
A deontological approach of making decisions based on what is morally right also
supports option three. If the right course of action is defined by the nurse code of ethics,
provision 3.6 of the American Nurse Associations code of ethics asserts that its a nurse duty to
take action, protection patients, and follow legal processes if another nurse may be impaired.
Morality from the rule of law also supports this option (Cherry & Jacob, 2011, p. 199).
Despite the threats from Nurse B, Nurse A has a moral and ethical obligation to facility,
patients, and herself to report Nurse B. The consequences of not reporting her would cause harm
to numerous individuals, break ANA code of ethics, and Hawaii state law. The fidelity and
friendship to Nurse B cannot win out over these concerns.

Running head: ETHICAL DILEMMA CASE #4

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