Nursing Essay Example

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3Ethical Dilemmas in Nursing


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Ethical Dilemmas in Nursing

Nursing has evolved into one of the top disciplines with critical link to the wellness of individuals and societies. Since its inception by Florence Nightingale and other theorists, the profession has continued to evolve, with more codes and standards being introduced with the fundamental aim of improving patient care. However, there are also scenarios when nursing profession has been cited as a high-risk career, prompting focuses on strategic solutions to the existent stalemates. Some theorists have since compared nursing to humanitarianism, outlining that both scenarios call for selflessness and valuation of other people’s welfare beyond egocentric goals. To ensure adherence to these set codes, nurses have since founded their practice on some guiding frameworks that seek to balance the risks and the rewards for the practice.

Worryingly though, there are scenarios when healthcare facilities and individual nurses have been sued for negligence. In the wake of such progressions in the industry, it calls for a clear understanding of the specific obligations of the nurses, and their strategic rights during patient care. This case, therefore, reviews the concept of nursing care. A specific focus is directed to the degree of professional accountability of the nurses and the codes of conduct that they should prioritize when dealing with specific patients. Also, the paper analyzes the scenarios under which nurses are at liberty to make specific decisions that may otherwise be viewed as negligence of their professional obligations.

Rejecting Patient Allocation

Patient safety and privacy is a primary goal in any medical setup. It is the role of the nurses to stay close to the patients and to interpret their healthcare needs. In the modern setups, the nurses have also the duty to implement policies and strategies that would guarantee sound healthcare of the patients. It is thus concerning when the nurses are not empowered to provide the vital patient care services. Further, it is instrumental for the nurses to affect their duties in line with the critical provisions of the law. Therefore, the balance between the expected outcomes and the restrictive frameworks are vital considerations in nursing care. Based on this ground, the nurses are entitled to rights and privileges which are all aimed at improving the quality of care available for patients in the Australian medical facilities (Aston & Strouther, 2012).

Staffing is a major issue in most hospitals. The challenge of understaffing has led to significantly high shortage of patient to nurse ratios in some hospitals. Overcoming the challenge remains an oblique hope, but one that the Australian medical facilities hope to achieve in the future. In line with the concept of staffing, the number of patients allocated to a specific nurses, and subsequently the quality of care that the nurse can provide is insufficient (Nursing and Midwifery Board of Australia, 2007). In many instances, registered nurses strive to provide the critical care to the patient populations, but equally become overwhelmed in the process. The result is a jeopardized quality of care which may pose health risks to the patients. Under the Australian codes, the nurse can be considered to have neglected their codes of conduct by not adhering to the quality provisions stipulated under the professional codes (Guido, 2010). When a patient encounters healthcare complications due to such negligence, the nurse can be sued and subjected to professional scrutiny which not only impacts on their reputation, but also limits their ability to scale the professional ladder (Gorton, 2005).

Therefore, closer review of the understaffing challenge means the nurses must be able to work comfortably. They have the right to demand equitable staffing to limit the load and hence be in a position to align with nursing professional codes. The secondary implication of the observed trend is the ability of the nurses to refuse patient allocation when they feel that such new allocation will make them overwhelmed and unable to provide the required quality care. During such a refusal, nurses will be complying with the professional policy that empowers them to practice in a way that aligns with their duties to the society and the patients under their care. Failure of a nurse to refuse allocation under such scenario may prove challenging and deleterious to their professionalism.

Another critical situation relates to the environment in which the nurses should discharge their duties. Contemporary healthcare facilities have created platforms for collaborative working, with some institutions training multi-tasked nurses with integrated knowledge on some other critical fields. The approach in such facilities has been vital in the quest to implement evidence-based practice which is proving to be the future of healthcare. However, nurses may face challenges in aligning with the codes of evidence-based practice if they are not fully equipped with the necessary skills. Consequently, the ethical and professional codes in nursing empower the RNs to practice in familiar environments (Fenton, 2015). Also, the RNs are mandated to act within their scope of practice in line with their specific lines of training. A major worry, therefore, is whether understaffed medical facilities can be in a position to promote the implementation of these basic protective guidelines.

When the environment factor is taken into consideration, then it can be affirmed that the nurses have the freedom to advocate for safe environments, and to refuse patient allocation when such a move leads to advanced healthcare risks. For instance, a nurse may refuse patient allocation if they ascertain that the conditions that the patients are suffering from are not within their scope of practice (Gorton, 2005). A case example is when a general practice RN who is trained in dealing with chronic conditions is allocated a patient suffering from critical lethal acute states that require intensive care. Since the nurse may not be familiar with the healthcare procedures involved in dealing with such patients, they are at liberty to refuse patient allocation under the Australian nursing codes.

Another case example is when the patient is suffering from highly infectious and communicable conditions such as the Ebola Virus. The nurse should be able to refuse patient allocation on the premise that they lack the critical knowhow on how to manage and deal with such patients. In addition, the acceptance of such a patient involves risks of infections of the nurse. Based on the safety first policy, the nurses can argue against being allocated the patient unless they are given all the essential protective gears. The limitation of the protective gears in some institutions is thus a concern, and explains why some patients have to be subjected to advanced professional care which may necessitate transfer from one facility to another (Guido, 2010).

Beside the above grounds, the nurse can also reject patient allocation based on conscientious grounds. These refer to the inborn properties that influence the values and beliefs of different individuals. The conscientious beliefs can be founded on moral or personal principles, and may significantly deviate from the standard codes for nurses. One fundamental property noted in conscientious nursing is the prospect of the individual nurse developing a feeling of lowered integrity and impaired personality if they fail to align with the conscientious codes. For instance, a nurse may refuse a patient allocation if they believe that discharging their duties to the specified patient would contradict their innermost beliefs and values. Parental and social norms within a given society could also be grounds for conscientious decision to reject patient allocation. Further analysis of this concept shows that three basic characteristics of conscientious claims. These property include; inner sense, internalization of beliefs, and reflection on integrity implications (McLeod, 2013).

While this ground has significantly grown and has severally been adopted by nurses to reject patient allocations, there are numerous moral grounds that have since been cited against such a move. The belief of nursing as a humanitarian discipline indicates the need for non-discrimination and inclusive approach to care. Therefore, rejection of assigned patients may amount to abandonment of the humanitarian aspect of nursing, and may thus deviate from Nightingale’s vision for nurses (Merner, 2009).

However, the ANA handbook for nurses outline the need to respect the moral beliefs of the different nurses as a way of giving them an appropriate environment to discharge their mandates. The association supports the need to live in line with internal feelings and beliefs. This is evident in the 2001 code of ethics in which ANA submits that nurses should exhibit consistency in their professional and personal values. While the professional facet is guided by the predefined codes of practice for the RNs, the personal principles vary from one nurse to another and are rarely documented. It is thus the duty of the specific nurses to communicate their innermost beliefs and values to their employers, and to remain consistent in observing the values. The consistency will enable them to object to patient allocation when they believe that it contradicts one or several of their long held personal values. It also accords them protection under the nursing codes of ethics (McMillan, 2009).

A worrying trend, however, is the tendency of some nurses to express cowardice as conscientious objections. Besides, some nurses may develop prejudice towards defined patients, and thus use the established dislike to refuse allocation. This contradicts the ANA policies and also contradicts the founding principles of nursing care (Aston & Strouther, 2012). Therefore, it is necessary for filed cases of conscientious objections to be critically analyzed and evaluated in line with the guiding codes for nurses. Under no circumstance should conscientious objections be founded on the retrogressive concepts of discrimination, prejudice, and egocentrism. Nurses must also understand their stipulated obligations to respect patient privacy and to protect their dignity (McMillan, 2009). Moreover, ANA directions dictate professional obligation of the nurses to protect patients from harm and to enhance their autonomy. When conscientious objection to patient allocation threatens to jeopardize the defined professional obligations, the nurse should reconsider their stance and adopt a more liberal approach to patient care.

Grounds for Defense

Refusal to accept patient allocation may lead to petitions against a nurse, and may thus present a series of professional and ethical questions (Fenton, 2015). However, the nurse should be in a position to defend their refusal to be allocated patients and must support their positions with different valid reasons that are strong enough to convince the association. For instance, the patient can cite the professional codes in the organization’s statutes that dictate the allowable freedoms of choice for the nurses (Hughes & Common, 2015). A case example is the ability of the nurses to cite the need for adequate staffing. The nurse can convince the organization about the probable impact of the patient allocation of the patient on the quality of care deliverable. It is the uttermost obligation of the nurse to defend the welfare of the patient. Therefore, the RN is at a position of decision making, and is required by law to make decisions that contribute to the welfare of their patients.

In addition, the nurse is mandated to uphold key values of privacy and quality care. In instances when the nurse is dealing with excess patients, they are likely to confuse treatments and can thus jeopardize safety, privacy, and quality of care given to the patient. Therefore, the RN can use this ground to convince the board about their decision to decline the allocation. The RN will be able to show that the fundamental issues relating to the welfare of the patient would best be satisfied with other nurses in charge (Hughes & Common, 2015).

Another ground for convincing the body involves citing the strategic personal beliefs. When the nurse adopts the conscientious rejection approach, they must be able to provide evidential support to their position. Often, the nurse should have filed values and principles that they believe in with their employers (Stringer, 2009). They must also be in a position to prove their consistency in observing the values and beliefs so that it is not assumed that their actions are a result of prejudice or other aspects of self-centeredness. More importantly, the nurse should be able to point out how their approaches align with the nursing principles (Merner, 2009).

Another important defense tools is the provision of exhibits detailing the reasons for allocation rejection and supporting the validity of the position. In line with this need, the RN is often required to fill in the rejection form to explain the patient details and the reasons why they have rejected the calls to help the patients. In addition, the RN should be able to weigh on the possible consequences of their actions and gauge the relativity of the risks against benefits of rejecting the allocation (Nursing and Midwifery Board of Australia, 2007). This approach is also fundamental in decision making process. For the RN to reject the allocation, they must be able to ascertain that the risks outweigh the benefits. Consequently, they can share their detailed assessment of the scenario with the board hence convincing the body to support their approaches (Stringer, 2009).


In conclusion, RNs are required to provide quality patient care and to protect the fundamental rights of the patients. Such concepts as privacy and quality care should never be compromised. Therefore, the nurse should be in a strategic position to make decisions based on what is best for the patient. On the other hand, the nurses are at liberty to reject patient allocation under different grounds. Generally, such cases of rejection must be supported by valid grounds and detailed explanation of how the move contributes towards the general welfare of the patient. The Nursing body protects the nurses but also encourages them to focus on patient care. The nurses must show readiness to promote the humanitarian aspect of nursing.


Aston, L. & Strouther, L. (2012). The student nurse handbook. Maidenhead: Open University Press.

Fenton, K. (2015). Ethical Dilemmas at the Bedside: How Do We Decide?. The Thoracic And Cardiovascular Surgeon64(01), 015-016.

Gorton, M. (2005). Guide to complaint handling in health care services. [Melbourne]: Dept of Human Services.

Guido, G. (2010). Legal & ethical issues in nursing. Boston: Pearson.

Hughes, J. & Common, J. (2015). Ethical issues in caring for patients with dementia. Nursing Standard,29(49), 42-47.

McLeod, M. (2013). Work health and safety essentials for nurses and midwives. NSW Nurses and Midwives’ Association.

McMillan, J. (2009). Better practice guide to complaint handling. Canberra: Commonwealth Ombudsman.

Merner, B. (2009). Health Practitioner Regulation National Law (Victoria) Bill 2009. Melbourne: Parliamentary Library Research Service, Dept. of Parliamentary Services.

Nursing and Midwifery Board of Australia,. (2007). A national framework for the development of decision-making tools for nursing and midwifery practice. Dickson, ACT: Australian Nursing and Midwifery Council.

Stringer, S. (2009). Ethical issues involved in patient refusal of life-saving treatment. Cancer Nursing Practice8(3), 30-33.