Doing What is Easy or Doing What is Right

Guest Blog by Angela Prestia PhD RN NE-BC

Angela Prestia is the Corporate Chief Nurse for the Geo Group. Her responsibilities include the alignment of system-wide elements of nursing including quality improvement, infection prevention, education, competencies, and leadership development.

It may happen daily and sometimes in clusters. Sometimes it happens when you least expect it. Inevitably it happens and the nurse leader is faced with doing what’s right or doing what’s easy.

The nurse leader works to create and sustain a culture of care and safety for staff and patients. There are periods of time when impressions are favorable; no sentinel events occur, patient satisfaction is high, staffs appear to take pride in their contributions to the established vision.

Calm erodes when least expected, taking the form this time as an incomprehensible medication error. The nurse leader’s world is turned upside down as the patient, family, state, accrediting bodies, governing boards and corporations all want answers. The nurse leader often stands alone, wondering in the recesses of the mind, what happened, what now, and what if…?

Doing what is easy

In times of chaos it is easy to accept a simplistic explanation of nurse error. Our overloaded minds need to expediently seek resolution to move on to the next 10 priorities. How convenient to channel the Queen of Hearts, “Off with their heads” (Carroll, 1865). The leader may justify terminating the employee because, “the organization is safer without them”. The pressure nurse leaders are under to out-perform and be metrically superior may explain an unethical quick fix (Squazzo, 2012). Reporting yet another sentinel event may threaten even the most experienced nurse leader. A short sighted reaction will not serve to benefit the leader, staff member or the organization as a whole.

Doing what is right

Nurse leaders are bound to lead their organizations in an ethical manner. The American Nurses Association (ANA) Code of Ethics contains a foundational provision for individual efforts to create ethical environments conducive to safe quality healthcare (ANA Code of Ethics). This takes strength of conviction and courage.

Modeling ethical behavior when stressful challenges strike, involves the investment of time, resources; both human and financial, energy, support, and rumination. This expenditure is required of the nurse leader. Conducting a root cause analysis is a prime example of exhaustive resources, yet the prudent course of action.

In our scenario of the medication error, the nurse leader simultaneously ponders the disruption decisions will create. The nurse in question may be suspended pending further investigation. This may create a hardship for the nurse’s family. It also may create a staffing issue for the unit and the patient’s served. Swift action may not be timely enough for the patient’s family, and the generalization of negative publicity can jade community perception which may affect the reputation of other employees as well as the medical facility. Gathering the interprofessional team i.e. pharmacists, nurse managers, associated staff, physician, risk, safety and supply representatives can be time consuming and costly.

It is at this juncture however, when the virtue of patience in assuring an ethical culture is recognized. The benefit of the exercise outweighs the costs associated, and the return on the ethical and monetary investment comes to fruition. When due diligence is paid to evaluating the environment, equipment, communication, procedures, and the role of leadership with respect to the medication error, an learning environment is fostered, and the dignity of the leader, staff member, and organization is upheld.

Sharing lessons learned within the nursing profession helps inform our practice. Policy or procedural changes can help shape future care delivery. Treating a staff member with dignity and courtesy strengthens us as caring professionals.

Doing what is right is never easy.

Read to Lead

Carroll, L. (1865). Alice’s Adventures in Wonderland. MacMillan & Co: London.

ANA Code of Ethics. Nursingworld.org/DocumentValut/Ethics-1/Code-of-Ehtics-for-Nurses.html. Accessed 1/6/17.

Squazzo, JD. (2012). Ethical challenges and responsibilities of leaders. https://www.ache.org/abt_ache/JF12_F3_reprint.pdf. Accessed Jan. 6, 2017.