Ethical Issues and

Impairment in the
Workplace
Adriana Blanco & Kayla Wallace
 Ethics
Ethics is the part of philosophy that deals with the
rightness or wrongness of human behavior. The motives
behind behaviors are also of concern.

Bioethics is the application of ethics that pertains to

life and death. Judgements can then be made about the
rightness of health-care practices.
 Ethical theories
Deontological theories
➢ Immanuel Kant
➢ Norms and rules are taken from
duties that are owed. It
considers the intention of the
action and not the consequence
of the action. It is the
individual’s good intention or
goodwill that determines the
worthiness of the action
Teleological theories
(Utilitarianism)
➢ David Hume
➢ Norms and rules for behavior
are taken from the consequences
of the action. Usefulness (the
amount of happiness) is what
makes an action right or wrong.
“Right” equals good outcomes
and “wrong” equals bad
outcomes.
Ethical Theories and Principles
Principalism integrates existing Ethical Principles
ethical principles and tries to
resolve conflicts by relating one ➢ Autonomy
or more of these principles to a ➢ Nonmaleficence
given situation. Ethical principles ➢ Beneficence
influences professional decision ➢ Justice
making more than ethical theories. ➢ Fidelity
Ethical principles are basis for ➢ Confidentiality
laws. ➢ Veracity
➢ accountability
 Personal & Professional Ethics
Is there a difference between personal ethics and professional
ethics?

Personal ethics is a category of philosophy that determines what

an individual believes about morality and right and wrong.

Professional ethics encompass the personal, and corporate

standards of behavior expected by professionals.

Professional and personal ethics may clash in some cases and

cause a moral conflict.
 Ethical Issues in Nursing
What is a code of Ethics?

A code of ethics is a formal statement of the rules of ethical

behavior for a particular group of individuals. A code of ethics
is one of the hallmarks of a profession. This code makes clear
the behavior expected of its members.
American Nurses Association Code of Ethics for nurses
The nurse, in all professional relationships, practices with
compassion and respect for the inherent dignity, worth, and
uniqueness of every individual, unrestricted by considerations
of social or economic status, personal attributes, or the nature
of health problems.
The nurse’s primary commitment is to the patient, whether an
individual, family, group, or community.
The nurse promotes, advocates for, and strives to protect the
health, safety, and rights of the patient.
The nurse is responsible and accountable for individual
nursing practice and determines the appropriate delegation of
tasks consistent with the nurse’s obligation to provide
optimum patient care.
The nurse owes the same duties to self as to others, including
the responsibility to preserve integrity and safety, to maintain
competence, and to continue personal and professional
growth.
The nurse participates in establishing, maintaining, and
improving health care environments and conditions of
employment conducive to the provision of quality health care
and consistent with the values of the profession through
individual and collective action.
The nurse participates in the advancement of the profession
through contributions to practice, education, administration,
and knowledge development.
The nurse collaborates with other health professionals and the
public in promoting community, national, and international
efforts to meet health needs.
The profession of nursing, as represented by associations and
their members, is responsible for articulating nursing values,
for maintaining the integrity of the profession and its practice,
and for shaping social policy.
 Ethical Dilemma
What is an Ethical Dilemma?

An ethical dilemma or ethical paradox is a decision-making problem

between two possible moral imperatives, neither of which is
unambiguously acceptable or preferable.
 How are they solved?
How are ethical dilemmas resolved in Nursing? Assessment: You should ask yourself 4 Questions:

● What are the medical facts?: Find out how the physicians, physical and occupational
therapists, dietitians, and nurses view the patient’s condition and the treatment options.
Speak with the patient, if possible, and determine his or her understanding of the situation.
● What are the psychosocial facts?: In what emotional state is the patient in right now? The
patient’s family? What kind of relationship exists between the patient and his or her family?
What are the patient’s living conditions? Who are the individual who form the patient’s
support system? How are they involved in the patient’s care? Do financial considerations
need to taken into account?
● What are the patient's wishes?: With very few exceptions, if the patient is competent, his or her
decisions take precedence. Too often, the family’s or physician’s worldview and belief system
overshadow those of the patient. Nurses can assist by maintaining the focus on the patient.
● What values are in conflict?: To assess values begin by listing each person involved in the
situation. Then identify the values presented by each person. As such questions ass “What do
you feel is the most pressing issue here?” and “Tell me more about your feelings regarding
this situation.”
 How are they solved?
Planning: Determine the goals of the treatment; identify the
decision makers and make a list ranking all options.

Implementation: A mutually acceptable decision is made

between the patient or surrogate decision makers and members
of the healthcare team. As a nurse one needs to ensure that
there is no break down of communication.

Evaluation: Determine whether the desired outcomes have

occured.
 The Moral Model
M: Massage the dilemma

O: Outline the options

R: Resolve the dilemma

A: Act by applying the chosen option

L: Look back and evaluate the complete process, including

actions taken
 Current Ethical Issues
Stem cell research Genetic engineering

Storage of DNA (The Human Genome Gene therapy

Project)
Termination of life support
Genetic screening
Neonatal care for the preterm
Abortion infant

Euthanasia/Assisted suicide Life vs living

Allocation of organs and medication

Common Ethical Issues faced by nurses
● Patient Freedom vs. Nurse Control – What happens when a patient decides to make a personal choice about their
treatment which is in direct conflict with established medical practices?
● Honesty vs. Selective Information – In some cases, families choose to withhold information about a patient’s
medical condition to avoid causing them emotional distress. How does a nurse decide what information to give the
patient?
● Dilemmas surrounding Minors – Nurses have to consider the best interests of the minor patient and they also have
to respect the wishes and beliefs of the child’s parents.
● Patients’ Personal Beliefs – The personal or religious beliefs of a patient may disagree with scientific evidence
● Reproductive-rights – Nurses must deal with choices surrounding abortion.
 Ethical Issue
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 Impairment in the Workplace
➢ An ethical issue that goes against the ethical principle of
nonmaleficence.
➢ Demonstrated by diminished cognitive functioning and memory,
altered motor skills, decreased alertness, difficulty in decision
making , compromised judgment, and the inability to cope with
stressful situations.
➢ Substance abuse and dependence, physical conditions,
psychological problems, and psychiatric illness can all impair a
nurse’s ability to practice safely
➢ The ANA estimates that 6-8% of nurses use alcohol or drugs to an
extent that impairs professional performance
 Signs of Impairment
Behavioral Signs Physical Signs

● Inappropriate and/or ● Bloodshot eyes

unprofessional behavior ● Poor hygiene
● Difficulty getting along with others ● Track marks
● Resenting authority ● Chronic rhinorrhea and/or frequent
● Frequent absences nosebleeds
● Smelling of alcohol or marijuana ● Hand tremors
● Appearing impaired ● Slurred speech, rapid speech
● Deteriorating appearance and job ● Pupils dilated or constricted
performance ● Insomnia
● Poor judgment ● Drowsiness
● Wearing long sleeves all the time ● Confusion or memory loss
● Refusing Drug tests ● Unsteady gait
 Diversional Signs
● Administers more narcotics than
any other nurse
● Volunteers to give other nurses
medications for them
● Takes frequent bathroom breaks
● Reports wasting excessive amounts
of drugs
● Failure to document wasting of
drugs or have witness sign off
● Narcotic don’t reconcile
● Patients do not appear to have
adequate pain relief
● Drug choice or amount is not
appropriate
● Medications are missing
● Medications appear to be
tampered with
● Carrying medications in pockets
 Intervention Project for Nurses (IPN)
● IPN is Florida’s state approved
alternative to a discipline program
for nurses. It functions under
contract with the Florida Department
of Health. Making a referral of a
nurse for impairment to the IPN
meets the mandatory reporting
requirement.
● IPN’s mission is to enhance public
safety by assisting nurses and CNAs
whose practice has been or may be
compromised due to substance abuse,
psychiatric, psychological, or
physical conditions.
● IPN uses evidence-based practice to
provide an avenue for affected
nurses to be rehabilitated in a
therapeutic, non-punitive, and
confidential process
● Nurses and CNAs are required to
complete formal evaluations by
DOH/IPN approved physicians,
successfully complete recommended
treatment, provide negative random
toxicology screens, and have their
practice monitored at the workplace
● IPN/DOH reports demonstrate a 75-80%
successful completion rate and
retention in the nursing profession
is 78%. The relapse rate is 9%
● https://youtu.be/_YIKhttc_1c
Employers
➢ Employers are moving away from
firing nurses
○ This may result in further
issues; treatment is not sought
and nurses may be hired
elsewhere and the problem
persists
➢ The goal is to prevent
impairment and diversion
activity before it occurs as
well as to help nurse recover
and keep practicing
➢ Employee Assistance programs
○ Comprehensive assistance
programs such as counseling,
support groups, and education
○ Referrals and resources
➢ Wellness programs
○ Exercise, smoking cessation,
support groups, nutrition...
 Treatment Options
➢ Mental health evaluations and treatment
➢ Methadone and Buprenorphine
➢ Support groups
➢ Inpatient Rehabilitation
➢ Cognitive behavioral therapy
➢ Motivational interviewing
➢ Relapse prevention