Running Head: CUTTING CORNERS IN NURSING CARE 1

The Effect of Role-Modeling Cutting Corners in Nursing Care

Kendra Graham

James Madison University

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Introduction

Cutting corners in nursing care is an important and growing problem. In the healthcare

setting, The Journal of Clinical Nursing (2016) defines cutting corners as, “a violation

encompassing a deliberate and opportunistic deviation from safe operating practices, procedures

or rules” (Jones, Johnstone & Duke, 2016). One study regarding belongingness in nursing

suggests that students conform to clinical practices, even though it may not be best-practice, to

fit in with the nursing team, and to avoid “rocking the boat” (Jones & Lathlean, 2008). The same

article emphasizes that while students are aware that they are expected to adhere to professional

standards, they may comply to unacceptable practices to not endanger their belongingness (Jones

& Lathlean, 2008). This leads many students to feel guilty about not taking action and therefore

experience moral distress. Moral distress is a common finding among RNs and nursing students.

The Journal of Advanced Nursing says that according to a study conducted by Scanlon in 1994,

43% of nurses experience ethical issues daily (Ulrich et al., 2010). With the prevalence of ethical

issues in nursing, nurses must have a firm foundation and guideline to utilize when making

ethical decisions.

Background

During a clinical rotation I was in a patient’s room who had a Foley catheter inserted and

was incontinent of his rectum. I was helping change the patient’s brief as well as the soiled

linens. While I was getting the new brief, the nurse grabbed a wipe and began to perform

catheter care. I asked the nurse what she was using, and she replied that it was just a plain wipe.

She went on to say that technically they are supposed to use warm soap and water, but everyone

uses wipes since they are usually already in the room. Later I was holding the soiled sheets and

went to place them in the corner of the room so we could finish making the bed. I stopped and
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asked where I should put them since they are not supposed to go on the ground. The nurse

replied and said, “Just toss them over there. Technically they are not supposed to be set on the

ground or windowsill, but everyone does anyway.”

This scenario caused me moral distress. While it is not a major deal, I felt as though I

could not speak up about performing catheter care the correct way, or about following the

protocol for soiled linens. In order to fit in with the nursing team, and avoid being alienated by

the nurse, I conformed to what she was doing and made a mental note to perform the tasks

according to EBP when I do it alone. I set the soiled linens in the corner and I did not redo

catheter care. Alternatively, I could have spoken up and told the nurse that I would go and get the

soap and wash cloth to perform the catheter care the correct way.

Methods/ Findings

To further analyze my ethical distress, I will be utilizing James Madison University’s 8

Key Questions (Madison Collaborative, 2013). The 8 Key Questions is a set of guidelines that

encourages exploration of ethically challenging situations. It provides questions to ask regarding

fairness to those in the situation, the rights of the individuals involved, the potential outcomes of

the decision, what authority figures expect, what responsibilities I hold, and questions regarding

personal autonomy, empathy and character.

When applying fairness to this scenario, I have to be respectful to my nurse as she has

much more experience than I do. However, I also have to be fair to the patient who deserves the

best quality care even when it is inconvenient and time consuming. When thinking about

outcomes, I first analyze the short-term outcomes. If we continue working, we have more time to

care for other patients. This patient received some care, but not the best quality. Long-term, this

patient could contract a CAUTI. That is a sentinel event, harms the patient and costs the hospital
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money. If I re-did catheter care correctly, these long-term consequences could be avoided. Next,

what duties and obligations do I have? First and foremost, I have a duty to the patient to provide

the best quality of care according to EBP. Regarding character, what action reflects who I am

and the person I want to become? I want to be a nurse who always acts in the patient’s best

interest and provides the highest-quality of care that I can. The patient in this scenario was on

hospice care and unresponsive, so it is hard to analyze how liberty applies. The patient would no

doubt want the best care possible, and is trusting his health care team with that responsibility.

Next, what would I do if I cared deeply about those involved? If the patient in this scenario was

my family member, I would want the nurse to use the best technique, even if it took a few extra

minutes. It shows care and genuine concern for the patient. Lastly, what do authorities expect of

me, and what rights apply? One authority on nursing ethics is the American Nurses Association.

Provision 4.1 of the ANA Code of Ethics states that, “Nurses are responsible for their own

practice and the care that their patients receive” (American Nurses Association, 2015).

Regardless of what other employees are doing with their care, I have the duty to my patients to

perform care according to the best EBP. Furthermore, the patient has the right to receive high-

quality and appropriate care. While the ANA is the authority about patient care, and outlines the

rights the patient has, I also have to consider the authority my nurse had over me. The nurse has

many years of experience over me and is respected by her peers. Who was I, a second semester

nursing student, to question her ability to care for patients?

Conclusion

From utilizing the 8 Key Questions, it is clear that I should have advocated for my patient

and insisted that the catheter care be performed again, correctly. The questions about empathy,

character and rights helped me reach this conclusion. I feel as though the scenario described in
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this paper does not reflect who I am as a person, and what nurse I want to be. I do not want to cut

corners and provide less than optimal care for my patient just because it is convenient.

Furthermore, the 8 Key Questions taught me to really pause and think about what the short and

long-term outcomes of my actions are. In the moment, watching the nurse use flawed technique

for catheter care did not seem like a big deal. However, when I thought about the long-term

consequences that could harm the patient and get the hospital into trouble, it did.

In this instance, I should have insisted that catheter care be done correctly. I should have

finished making the bed with the nurse, and come back on my own with soap and a wash cloth to

clean the catheter the best way, according to hospital policy. Reflecting back, I wish I had the

moral courage to tell the nurse that we should perform the care according to EBP so that the

patient does not contract a CAUTI. This situation also taught me that in any position I hold in the

future, there will be people who cut corners and do not do the job the best way. It is easy to

conform to the culture of the unit or facility, and adhere to the norms because “everyone does it”.

However, if everyone does cut corners and acts in a manner that is task-oriented rather than

patient-centered, then the patients, employees and hospital all suffer. Furthermore, in the case

that nursing students are around, students can be taught improper technique in patient care that

they bring with them to their future employment sites.

In conclusion, when I am undoubtedly again faced with an ethically challenging situation,

I will utilize the 8 Key Questions and take into consideration my patient’s rights, the outcomes of

my decision making and what the ANA Code of Ethics expects of me as a nurse, as well as the

duties and obligations I have to my patients to deliver the best care that I possibly can.
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References

American Nurses Association. (2015). Code of ethics . Retrieved March 18 th, 2018 from

www.nursingworld.org/codeofethics.

Jones, A., Johnstone, M., & Duke, M. (2016). Recognising and responding to ‘cutting corners’

when providing nursing care: A qualitative study. Journal of Clinical Nursing, 25, 2126-

2133. doi: 10.1111/jocn.13352

Levett-Jones, T., & Lathlean, J. (2008). Don’t rock the boat: Nursing students’ experiences of

conformity and compliance. Nurse Education Today, 29, 342-349.

doi:10.1016/j.nedt.2008.10.009

The Madison Collaborative. (2013). The eight key questions handbook. Retrieved March 18th,

2018 from

https://www.jmu.edu/mc/Docs/131101%208KQ%20Handout%20Revision.pdf.

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010).

Everyday ethics: Ethical issues and stress in nursing practice. Journal of Advanced

Nursing, 66(11), 10.1111/j.1365–2648.2010.05425.x. http://doi.org/10.1111/j.1365-

2648.2010.05425.x