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Running head: BRIDGE TO PRACTICE ETHICS

Bridge to Practice Ethics

Kimberly Stoessel

James Madison University

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Introduction

Burnout leading to not treating patients with empathy in health care, especially nursing, is

a major problem because it can lead to neglect and take away from patient safety. A study titled

Nurse Burnout, Nurse-Reported Quality of Care, and Patient Outcomes in Thai Hospitals stated

that understaffed hospitals make it difficult for nurses to deliver care of the highest quality,

which might further increase stress and burnout (Nantsupawat, A., Nantsupawat, R.,

Kunaviktikul, Turale, & Poghosyan, 2016). Around thirty-two percent of nurses stated they felt

high levels of emotional exhaustion (Nantsupawat et al., 2016). While this study took place in

Thailand, the information still pertains to our local hospitals because they are not the only ones

that experience burnout leading to decreased patient care. A study by Ashley Hodgson, Dorothy

Morgan, and Ryan Peterson found a ratio that shows a higher number of secondary diagnoses

when there is a low patient-to-nurse ratio (2016). This is important because if the ratio of

nurse to patient is significant, then nurses, due to being overworked will be unable to focus on

non-immediate patient outcomes (Hodgson, Morgan, & Peterson, 2016). This means that

preventive treatments may not get the focus they deserve.

Background

I have seen nursing burnout lead to a variety of issues. In this paper I am going to talk

mainly about lack of empathy when dealing with patients. Just last clinical when we first arrived

in the morning and I went to check on my patient, I noticed that her telemetry on the monitor was

off. It said that she was in the shower even though I knew she was sleeping. I messed with the

leads with my clinical instructor but they all appeared to be in the correct position. We even

tried changing out the batteries which didnt seem to help. So we called down to telemetry and
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they told us this was a problem on our end and to make sure all the leads were attached, even

though I had already told him they were. I then noticed that the patient next to her had his

telemetry off as well, it said he was off the unit even though he too was sleeping in his bed. This

is when I went to grab the nurse, but she was entirely overwhelmed and huffed, telling me she

would look at it when she got the chance. I was able to get my clinical instructor and we were

able to figure out the problem.

I understand she was busy and I did not expect her to drop everything and help me. This

just brought to my attention how burnout can lead to decreased patient care. These patients were

on telemetry for a reason, it was an order put through by their doctors that was not being carried

out. If something were to happen, the telemetry would not be able to pick it up and the telemetry

technicians would not be able to see it on the screen. I hope the monitors had only been off for a

short time but they could have been off for a while. The techs were also able to see that the

monitors had been off and never said anything. This situation caused me moral distress. While

the situation turned out fine, and there was no imminent threat, something could have happened

to the patients in that time. I knew the right action, fixing their leads so it showed on the

telemetry, but needed the help of an expert. Luckily, I had a great clinical instructor and she was

able to help me.

Methods/Findings

We learned the Eight Key Questions our first week of orientation at James Madison

University. They are fairness, outcomes, responsibilities, character, liberty, empathy, authority,

and rights (James Madison University). They are a method of tackling problematic moral

dilemmas. Fairness asks how you can act in a way that most peoples interests are satisfied
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equally. Fairness pertains to my ethical situation in that you have to treat all of the patients

fairly, giving them your time. Outcomes looks at the short and long-term outcomes of the

situation and tried to gauge the plan of action based on that. This pertains to my situation

because the nurse may not think her exhaustion is a big deal but it could have long-term effects

on not only her health, but also the health of the patients. Responsibilities directly applies to my

situation because it asks what kind of obligation you have to carry out a certain action. Nurses

have a responsibility to carry out the doctors orders and to maintain patient safety. They need to

act in a way that promotes patient safety at all time because that is part of their responsibility.

Character and empathy go hand in hand because they ask you to look inward at yourself

and determine the type of person you want to become and how you want to treat others. In this

situation, the patient did not see the nurses reaction but many times I have been with a nurse

who has made a very similar remark right in front of the patient. I have been on psychiatric

units, where a patient was acting out and a nurse simply laughed and walked away to call for

extra help. This is not acting with empathy or promoting strong character. While often times

this comes with burnout, it shouldnt. We need to ask ourselves what type of person we want to

be and how we want to treat others. Liberty and right go hand in hand because they ask what we

can do to promote patient rights and in turn respect the patient bill of rights. This applies only in

the fact that the patient has a right to life, and the nurses and hospital staff need to not only

respect it, but promote it.

Authority asks you to look at legitimate authorities and their expectations of how the

situation plays out. The doctor in my situation expected the order to be carried out and for a

period of time, it was not. This could be detrimental to the patients health. Another authority in

nursing is the American Nurses Association. They created the nursing code of ethics, which also
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helps guide action in ethically difficult situations. I feel that the first provision applies to my

situation. It states that the nurse practices with compassion and respect for the inherent dignity,

worth, and unique attributes of every person (Fowler M. & Turner M., 2015). It is very

important for the nurse to treat the patient with dignity. That is what makes us different than

automated machines that pump out drugs or searching the internet for a diagnosis. It is important

for us to always keep this in mind.

Conclusion

While it would be easy to say the nurse should have handled the situation or that I will

never huff about a patient, its not true. Nursing is a difficult field to work in and burnout is

common. This is why nurses and other health care professionals need to check in with

themselves. Burnout often leads to patient neglect and not treating a patient with empathy which

is very important. I have seen just how much of a problem this is throughout my clinical and out

of clinical experiences. As we saw in the ANA Code of Ethics, it is our duty to treat patients

with compassion. It is our job to look out for their safety, that is why they come to us. It is

important for us to carry out doctors orders and to look out for patients. This entails hourly

rounds. This doesnt mean walking in, clicking the rounds button and walking back out. It

should entail a little more, like checking in with the patient, doing a quick head to toe or more

detailed assessment in regard to their chief complaint. As hopefully you saw throughout my

paper, telemetry is an important doctors order and tool that should be monitored. If you see that

a patients telemetry is not reading on the monitor for some reason, it would be important to see

why. This is a huge safety issue. Nurses are busy and they cant do everything. It is important

to do the best you can to promote patient safety in everything you do.
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References

Fowler, M., & Turner, M. (2015). Code of ethics for nursing with interpretive statements.

Retrieved October 17, 2016, from http://nursingworld.org/DocumentVault/Ethics-

1/Code-of-Ethics-for-Nurses.html

Hodgson, A., Morgan, D., & Peterson, R. (2016). Does better nurse staffing improve detection

of depression and anxiety as secondary conditions in hospitalized patients with

pneumonia?. Nursing Economic$, 34(3), 134-143.

James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in action.

Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml

Nantsupawat, A., Nantsupawat, R., Kunaviktikul, W., Turale, S., & Poghosyan, L. (2016). Nurse

burnout, nurse-reported quality of care, and patient outcomes in thai hospitals.

Journal Of Nursing Scholarship, 48(1), 83-90. doi:10.1111/jnu.12187