ENG273 Ethics Case Analysis – ENG 273 Ethics and Policy in Nursing
Clark College Department of Nursing
ENG 273 Ethics and Policy in Nursing
Ethics Case Analysis Assignment
DESCRIPTION: Students will submit a paper in which a case study is reviewed and analyzed, and a course of action is determined using the MORAL model of ethical decision making. Students should cite at least one ethical principle and refer to at least one provision from the Code of Ethics for Nursing in this process.
PURPOSE: Students must demonstrate ability to synthesize information regarding principles of leadership, management, and ethical practice in nursing into their personal nursing practice. Students must model professionalism, practice ethically, and be accountable for their own practice, incorporating holistic nursing concepts in collaboration with patients, families and members of the health care team.
PROGRAM OUTCOME: Meets program outcomes of Knowledge, Clinical Judgment, Evidence-Based Practice, Caring, Teamwork, Interprofessional Collaboration, Professionalism, and Safety
GUIDELINES:
- Read the case study provided for this assignment.
- Assess the circumstances of the case to identify the relevant facts, the problem(s) and the ethical conflict or dilemma that is present.
- Use the MORAL model to ‘work through’ the process to identify what plan of action you believe should be taken to resolve the conflict/dilemma you have identified.
- Support your decision by referencing at least one ethical principle and at least one provision from the Code of Ethics for Nursing in this process. Be aware that more than one provision from the Code of Ethics may apply.
- Cite one specific Nursing Standard and one specific law/statute that provides support for the action you propose.
- Be sure to connect the standard/provision/law to the RN’s professional responsibility and obligation in this situation.
The completed paper should be no more than 5 pages in length and must meet professional, APA standards, with proper grammar, spelling, professional language and appearance.
Do not include a summary or copying of the case study as part of your paper content. Those who are grading the assignment will have a copy of the case study to refer to when grading.
You do not need to cite the case study in your references or in the content of your paper. This is considered ‘common knowledge’ and doesn’t need to be cited specifically. Instead, refer to the case study in discussing your analysis and recommendations. Example: ‘the case study notes that the patient does not have other relatives.’
You are writing this paper as someone looking at the situation from the outside, not as one of the characters.
GRADING:
The assignment will be graded according to the rubric criteria. Paper counts as 15% of final grade.
CASE STUDY (for Ethics Case Analysis Assignment)
Maria Hernandez, an 85-year-old resident of Riverbend Rehab and Convalescent Center, was sent to the emergency room at Plutoville Community Hospital five days ago after she complained of feeling very sick to her stomach, began vomiting, and spiked a fever of 102. Her daughter was called and went to the hospital to be with Maria and to interpret information for Maria, who speaks English as a second language and has some English comprehension challenges. The report from Maria’s daughter was that Maria had developed a kidney infection and was admitted for antibiotic treatment. The doctor who treated Maria in the ER was Dr. Reynolds, the newest member of the medical team. He had ordered urinalysis, blood cultures and other labs, had started an IV antibiotic empirically while they were waiting for the urine and blood culture results, and had handed off Maria’s hospital care to Dr. Hunter the next morning. Maria initially responded positively to fluids and the antibiotic, but yesterday she worsened, with increased fever of 104 and reduced urine output, suggesting kidney failure. She became unresponsive early last evening. Dr. Hunter was notified and he ordered medication to stimulate kidney function but Maria continued to deteriorate and this morning she passed away.
Maria’s daughter came to Riverbend to inform the staff of Maria’s passing and was obviously heartbroken at the sudden loss of her mother. She stated that Dr. Hunter was “not very sympathetic” about Maria’s death, that he acted as though this was to be expected given her age, and his only sympathetic comment was that he didn’t think she suffered because she was essentially comatose. The daughter, who knows Dr. Hunter’s reputation for being prejudiced against people of color, stated she wants to believe everything that could have been done for her mother was, in fact, done. She asked Kelly, the Riverbend DNS, to review the hospital records and give her opinion. Kelly told the daughter that, as a member of the health care community in Plutoville, Kelly was in an awkward position. Kelly said she wasn’t sure it would be a good idea for her to do this. The daughter pressed on, stating she knows Kelly is a “very smart nurse” and was only asking if Kelly would look at the records to see if she could assure the daughter that the treatment plan looked appropriate and appeared to indicate that Maria had received the right care. Kelly finally agreed to do this, to hopefully put the daughter’s mind at ease and allow her to feel better about Maria death.
When she received the hospital records from Maria’s daughter, Kelly began to read through them. She noted that Maria was promptly evaluated upon her arrival at the hospital, had a number of appropriate diagnostic tests done, including urine and blood cultures, and was started on IV Rocephin to begin to address the urinary infection. She was not allergic to this medication, so there was no problem there. The records appeared to be in good order, reflecting accurate and timely administration of ordered medications and IV fluids, documented the initial improvement in her condition and the downturn that occurred the afternoon and evening before she died. When Kelly looked through the lab work to review the results, she saw the culture results from the urine and blood, both of which showed the predominant bacteria to be one that was resistant to Rocephin. The culture results were dated and timed for 8 a.m. on the day before Maria died, several hours before Maria began showing signs of deterioration. There were two IV antibiotics noted to which the bacteria was sensitive. Signature on the culture result sheet indicated it had been reviewed by Dr. Hunter and there was a nursing note documenting that the culture results had been received and reviewed by the MD. Kelly found no order to change the antibiotic orders – Maria had continued to receive IV Rocephin up until her death.
Kelly looked up both of the ‘indicated’ antibiotics to see if there was a reason they might not have been indicated or safe to use for Maria. She could find none. She called a pharmacy in another town and spoke to the pharmacist there about the two antibiotics and any contraindications. Other than that they both are very costly, nothing she learned from these sources identified a rationale for not giving one of the antibiotics to Maria. As her last step, Kelly contacted PCH to see if either of the antibiotics were available, explaining that she had been reading a professional journal article about them and wanted to see if they were part of standard pharmacy stock or something that needed to be specially ordered. The hospital had one of the medications in stock.
Kelly must decide what to do with this information and consider her professional and ethical obligations and responsibilities.
Use the MORAL model to determine possible outcomes for this very interesting scenario.
S/2020
Clark College Nursing
N261 and ENG273
Virtual Scenario IV – Plutoville
Plutoville
- A small, rural town in Washington state, population approximately 5,000. Plutoville relies on farming, logging, orchards, wineries, and tourism/outdoor recreation for its financial income/livelihood.
- Around 35% of the community’s population consists of first and second generation Mexican immigrants. (This is an increase from 10% 20 years ago.) About 15% of the population is Native American. 40% of the population is Caucasian (a decrease from 80% 20 years ago). The remaining 10% are African American or of Southeast Asian heritage. English and Spanish are the predominant languages in the community. Medical services in Plutoville serve several surrounding small communities.
- A north-south highway (AA-1) to and from Canada passes through part of Plutoville. This highway is regularly used by tractor-trailer rigs hauling produce/logs/livestock, and by travelers with recreational vehicles. Traffic on AA-1 tends to be heavy all year, due to nearby winter recreation resorts and many lakes and rivers in the area that draw watersports and fishing enthusiasts in the spring and summer. Also, the AA-1 highway is the only viable route for tractor-trailer rigs – there are minimal, narrow alternate roads. Not surprisingly, there are frequent vehicle accidents on the highway because it is only 2-lanes wide, beginning 5 miles south of Plutoville and extending 8 miles north of Plutoville. This stretch of highway crosses a county line; the necessary improvements must be agreed upon and funded by two separate governing entities who have, so far, been unable to identify a realistic way to fund the road improvements. Plutoville is not a wealthy community and has no connections to large corporations that might be willing to help invest in the road improvements. Real estate development in the area is minimal, with little growth projected.
- Plutoville has a small community hospital, one medical clinic, and one SNF/long term care facility. A similar-sized community hospital, a SNF, and two private medical clinics are located in Truman, about 35 miles north of Plutoville. Comprehensive medical services are available in Verbena, a city of about 100,000 population, 70 miles south of Plutoville. A major medical center with affiliated clinics, specialty services, and Level 1 trauma care is located in Mansen, about 150 miles east of Plutoville.
Plutoville Community Hospital (PCH)
- PCH has changed in its services over 60 years. Up until 10 years ago it was a full-service hospital, with complete medical, surgical, and intensive care/cardiac care services. At that time, in order to better serve the widespread population and to control costs, PCH created a reciprocity agreement with the hospital in Truman, so that most hospital services are provided between the two facilities. PCH currently has 40 in-patient beds; primary services include medical, general surgical (especially orthopedic surgeries), labor/delivery, stable newborn care, and emergency care/trauma stabilization. Truman’s hospital handles cardiac patients, basic cancer care, in-patient rehabilitation, respiratory specialty care, acute psychiatric care, and basic emergency services. PCH has an associated family medical clinic 1/2 mile from the hospital (see separate description). A privately owned 50-bed skilled and long term care nursing facility, Riverbend, is four blocks from PCH. (see separate description)
- PCH has been remodeled over the years. There is adequate space for the medical and surgical services. The previous 10-bed intensive care unit was converted to a labor and delivery suite and nursery, which is routinely busy. However, the Emergency Department is quite undersized for the needs, with only one trauma room and three smaller exam rooms. It has been suggested that the former therapy wing could be remodeled to add more emergency room treatment space, due to a steady influx of emergency patients. PCH is the first stop for trauma patients, in order to stabilize them adequately so they can be transported to Verbena by ambulance, or sent by life flight service to Mansen. While the PCH emergency services are adequate for routine emergencies, there have been repeated occasions when the ED was overwhelmed with multiple trauma patients. In those instances, protocols and coordination broke down, highlighting a need for additional training and practice for nursing staff. Further, during those events the hospital staff had to create makeshift trauma rooms to handle the sudden influx of seriously injured patients. Everyone agrees the emergency department needs to be expanded and more emergency care training is needed. Funding and lack of a clear plan and time frame are preventing any forward progress.
- Hospital management staff includes an Administrator, Chief Financial Officer, Director of Nursing Services (Jan), a part-time Assistant DNS/Staff Development Director/Infection Control Nurse (Mickey), Medical Director (Dr. Hunter), Housekeeping/Maintenance Director, and Director of Pharmacy and Central Supply.
- The Medical Director, Dr. Hunter, also acts as primary hospitalist and Chief Surgeon. Although he also works at the medical clinic, he has an office at the hospital. Three other MDs and an orthopedic P.A. provide hospital coverage and services through the medical clinic.
- Hunter considers the hospital his own. He is a native of Plutoville and returned there several years after obtaining his license to practice medicine. He plans to remain in the community until he retires in a few years. He is a competent surgeon and the best choice of the four physicians when trauma situations occur. While he is felt to be a very good medical doctor, he has not stayed current on new approaches to treatment, tending to rely on his many years of experience when making clinical decisions. He is regarded by most people in the community as a hard-working, dedicated family man who keeps long hours at the hospital and who often sees patients at his hospital-based office as well as at the clinic. People describe him as a dedicated and compassionate doctor, a happy family man, and a wonderful person. In fact, Dr. Hunter’s marriage is strained, due to his long work hours and minimal time spent at home. There are rumors that he has been unfaithful to his wife. Dr. Hunter also has some strong personal prejudices against “people of color” and especially against the immigrants from Mexico and other countries in Central America. He believes the increased population of Mexican immigrants in Plutoville is the fault of the local orchardists and vineyard owners, who recruited laborers for their crops. Dr. Hunter privately says Plutoville’s culture has changed for the worse because of this. While he doesn’t refuse to treat anyone, he does not participate in the clinic’s wellness and prevention outreach programs that were established for the Mexican/Latino population, and he refuses to learn Spanish or request translators for patients who don’t speak English.
- Hunter’s views are not shared by the other three doctors on staff, but they have chosen not to challenge him on his opinions because he is such a powerful force in the community. Instead, they just try to work around his biases. Unfortunately, there are indications that PCH patients who are non-Caucasian do not always get the same quality of medical care, depending on which doctor is their primary physician. There have also been indications of higher rates of infection/reinfection, surgical complications, and exacerbations of chronic conditions in the non-Caucasian patient population. This trend has contributed to the mixed-reviews about the hospital. Because of the fear of reprisal and lawsuits, the doctors tend to “back each other up” when complaints about medical care arise.
- The hospital staff is comprised of RNs, LPNs, CNAs, and ancillary staff (unit secretaries, UAPs, housekeeping/laundry/dietary staff.) Some of the RNs are clinically strong, with good knowledge and skills, and professional integrity. Others are less reliable and less consistent. Because Plutoville is in a rural area, there is not a great ‘pool’ of nurses to draw from when hiring, and they must compete with Truman for those available nurses. Continuing education opportunities are very limited and many of the ‘classes’ offered at PCH are taught by Dr. Hunter, who is not current on medical best practice and has even more limited knowledge of evidence-based nursing practice. The budget for staff training is inadequate. Jan, the DNS, is not very invested in continuing education for the nursing staff. The Assistant DNS, Mickie, feels it is vitally important, but with her multiple duties and limited work hours she is not able to make much of an impact.
- The primary night shift nurse, Bobby, occasionally calls in at the last minute for her shift and frequently arrives late, claiming car trouble or emergency situations that came up. Two of the doctors have expressed reservations about Bobby to the evening charge nurse, Evan. Because the doctors lack confidence in Bobby, they often ask Evan to stay over to help them with their patients who are in active labor or need emergency care. These concerns have been brought to Jan, who refuses to address the problem, citing the difficulty in finding night shift nurses. Jan’s solution has been to tell Evan to keep the doctors happy and reassure Evan that overtime hours will not be questioned. Evan has stated she doesn’t want or need the overtime and would rather have a reliable, competent nurse for night shift. Evan is also concerned about Jan’s practice of asking nurses from the convalescent center to cover nurse shortages at the hospital. Evan believes these nurses are not adequately familiar with hospital protocols and may be jeopardizing their own licenses by trying to practice in an unfamiliar environment with minimal to no orientation.
- The nursing director at the nursing facility has requested a meeting with Jan to discuss this ‘borrowing a nurse’ practice, but Jan is avoiding such a meeting, saying her schedule is too full at the present time and the meeting will need to be delayed. Evan, however, has talked with the nursing facility DNS and they agree that a better solution is needed as soon as possible. Evan has been tracking Bobby’s absentee problem, along with her performance issues, and realizes the best solution is to replace her. Evan has been talking with Mickie about ways to recruit a possible replacement for Bobby.
- The hospital administrator has been in his position for many years. He is very settled in his job and is not a dynamic leader. He and Jan have known each other a long time. He takes most of his ‘decision cues’ from the doctors, especially Dr. Hunter. The administrator is seldom seen in patient care areas and tends to remain in his office. He is involved in the community somewhat (Elks Club, Rotary), has very high regard for Dr. Hunter, and does whatever he can to keep Dr. Hunter happy.
- Jan is also a staunch supporter of Dr. Hunter. Mickie audited patient charts and found a clear correlation between increased complications or secondary infections and the treatment courses prescribed by Dr. Hunter, particularly in non-Caucasian patients. She showed this evidence to Jan, who openly blamed the nursing staff for the complications and has refused to hear any criticism of Dr. Hunter. Even when Bobby pointed out Dr. Hunter’s failure to order cultures or lab work in response to nursing reports of wound changes, fever, or other symptoms, Jan has strongly defended Dr. Hunter.
- Mickie hopes to obtain the support of the youngest – and newest – hospital MD for a plan that includes written, detailed treatment protocols based on best-practice research, and related, specific training for the nursing staff. Mickie recognizes she needs support of at least one doctor in order to make any progress in addressing the higher incidences of nosocomial infections, surgical complications and readmissions cited on the hospital’s last inspection. She knows if she pushes too hard she risks alienating Jan and Dr. Hunter, which will certainly mean the loss of her job. She also knows that if negative outcomes continue to rise, the consequences for the hospital are likely to be reductions in reimbursement or refusal of payments due to hospital-acquired problems and chronic condition readmissions. That will lead to decreased patient census and, thus, loss of jobs. Mickie is asking for support in this effort from some of the staff nurses, particularly Evan, who shares many of the same viewpoints and concerns.
- Jan often misses work due to “migraine headaches”, most often on Mondays and on the day after a holiday. Jan developed a dependence on alcohol some years ago, and she tends to drink heavily on weekends. Jan plans to retire in a few years and is trying to keep her job until then. She knows she could not be successful in a staff nursing position, or even as a clinic nurse. The DNS job has allowed her to avoid close scrutiny, and she developed the cover story of the migraine headaches a few years ago when she recognized she could not stop drinking so much. She believes this is not a serious problem, since she is able to do her job and has never been inebriated at work. After a particularly big ‘celebration’ two years ago, she had a very bad hangover and needed to attend some important meetings the next day. She confided in Dr. Hunter that she had “overdone it” and he obliged with some prescription medication that helped relieve the worst of her symptoms, assuring her he understood. From time to time, since that day, Jan has needed to ask for ‘headache medicine’ and Dr. Hunter has readily obliged, telling her he is invested in her remaining in her job because she is so “perfect” for the role and “a huge help” to him. Jan is certain that once she retires and no longer has all the stress of her job, she will not feel the need or desire to drink alcohol, except on special occasions. In the meantime, she realizes she needs to do anything she can to protect and support Dr. Hunter.
Plutoville Ambulatory Care (PAC)
Key Personnel at PAC: Pat (senior RN), Glenn (Relief RN).
PAC is a local clinic owned and operated by Plutoville Community Hospital (PCH), and is located ½ mile from the hospital. Patients are seen by Dr. Hunter, the three other hospital doctors, and the orthopedic PA. The clinic is open Monday-Friday from 8 am to 6 pm. Two full-time RNs, two medical assistants, and two office staff provide support services for the doctors. One of the RNs, Pat, coordinates the wellness and preventive care program for the Hispanic/Latino community members.
- PAC is very busy. The doctors tend to rely heavily on the nurses, especially Pat. Pat is scheduled to work Monday – Friday, supposedly from 7am to 4pm. She directs one of the medical assistants in scheduling and preparing patient visits for the day, orders needed supplies, and works on the never-ending mounds of paperwork related to patient billing, documentation, insurance claims, and follow-up. She assists the doctors with any procedures requiring RN level skill. She also coordinates services related to the wellness program. Pat is supposed to take an hour lunch break – she never does; in fact, she works right through lunch and typically stays well past the 6 pm closing time. She often comes in on weekends to do paperwork or other tasks.
- Glenn is scheduled to work Monday – Friday from 1pm to 6 pm. She is efficient and organized. She is concerned about Pat and the doctors’ heavy reliance on her. Glenn feels the clinic needs another nurse and probably another staff member to help with all the paperwork, so that Pat can concentrate on the wellness/prevention program, which they both feel is very important for the growing Hispanic/Latino population. Glenn is unhappy because Dr. Hunter often calls patients and tells them to come in to the clinic to be seen, without asking Pat or Glenn if there are any open time slots (there rarely are.) Even if the patient schedule is full, Dr. Hunter expects Pat and Glenn to stay past closing time so these added patients can be seen. He doesn’t seem to be concerned about this and often says “We are here for them because that’s what we do.” This happens at least twice a week. Glenn is not sure how long she will be able to tolerate this, but she is afraid to leave Pat without another nurse to help her. Glenn used to receive calls from Jan, the DNS at the hospital, asking if Glenn would come work a shift at the hospital because they were short of staff. Glenn told Jan that the clinic is chronically short of staff and Jan would have to find some other way to resolve her staffing problem. Jan expressed shock at Glenn’s refusal, but has since stopped calling.
- The clinic is financially in good standing. The patient volume has steadily increased over the years – most patients don’t want to travel to Truman for medical care and like the idea that Dr. Hunter will let them come into the clinic practically any time. Glenn has tried to talk to Pat about the fact that the funds are there to pay for additional help. However, Pat feels that if Dr. Hunter is willing to sacrifice his personal time for the welfare of their patients, she should do the same. Pat has no life outside the clinic – she was married briefly years ago but has long been divorced, has no children, does not socialize, has no pets, and no hobbies. The clinic has become her second home and she feels ‘special’. She loves receiving thanks from the doctors and the cards and gifts from the patients. Because she works so much, she has not done a very good job of self-care. She eats erratically, mostly frozen, processed foods that are quick to heat up. She doesn’t exercise and has gained a fair amount of weight, in spite of being so busy at the clinic. Glenn is very concerned Pat is at risk for a health crisis. Glenn is married and has two young children – it is not in her plan to increase her hours. Her work/life balance is good, her home life happy. She feels Pat is being used by the doctors and can’t see what it is doing to her.
Riverbend Rehab and Convalescent Center
A 50-bed skilled rehabilitation and long term care nursing facility located four blocks from the hospital. Riverbend is privately owned but is considered a collaborative partner with the hospital and clinic in meeting the healthcare needs of the community. Riverbend has an administrator, nursing director, therapy director, activities coordinator, physical plant/maintenance manager, and social services/admissions director. The facility is staffed with RNs, LPNs, CNAs, therapy staff, dietary and housekeeping personnel, and office staff.
While the nursing staff are employees of Riverbend, the RNs and LPNs have been asked, when there is a staffing shortage at the hospital, to help out by working a shift at the hospital. This is a very sore point with the facility nursing director, Kelly, who has expressed concern to Jan about this several times. Although Jan repeatedly says she is working on a plan to cover hospital staffing shortages, nothing has been done and the “borrowing” issue remains active and unresolved.
Mobile residents of Riverbend are taken to Plutoville Ambulatory Center (PAC) for medical appointments, although physician/PA visits to Riverbend are arranged for non-mobile residents who are unable to be transported to the clinic.
- The previous Director of Nursing at Riverbend was not a strong manager and allowed staff, particularly the CNAs, to ‘run the show’. He did not consistently support the licensed staff and did not address obvious performance issues. The new Director of Nursing, Kelly, has been on the job 6 months. She has launched a new nursing care philosophy and mission statement, “Residents First”, that she is using to update and strengthen care policies and protocols and as a focus of staff meetings and training sessions. Kelly also has been holding ‘family night’ events to encourage residents’ families and friends to visit and spend time with them. This has been very popular with both residents and families.
- Under the previous DON, the CNAs had become very independent and self-directed, often making their own resident assignments, deciding which tasks they would do, and documenting tasks as being done when they weren’t. The CNAs routinely cut corners to save time by doing such things as reporting that residents had “refused to eat” instead of taking the time to encourage/cue/assist them to eat meals. As a result, a number of residents lost weight, developed skin problems, and became depressed because of lack of care and lack of investment in their welfare. Newly-hired CNAs who did not show respect for the CNAs who had seniority would be assigned all the heavy-care patients and not offered any help from the long term CNAs. As a result, these new CNAs would quit in frustration. Kelly is aware of these behaviors and is changing things — to the obvious displeasure of the long term CNAs.
- Kelly has begun evaluating each staff member, citing both strengths and areas of needed improvement, with associated plans of correction that will be the basis for bonuses, raises, and continued employment. Some staff members have chosen to leave rather than adjust to these new expectations, but in the six months Kelly has been there, noticeable improvements have already occurred. There is resentment of her by some of the long time staff who don’t want things to change, and they continue to talk privately about ways to sabotage Kelly and all these new policies.
- Riverbend’s administrator has been in his position a long time, has not been a strong leader historically, and personally dislikes Kelly, whom he feels is too forceful. He grudgingly admits that the facility smells better and that patients and their families have been more positive about the care quality since Kelly came on board, but he feels bullied by her and thinks she is too hard on the staff, some of whom have worked at the facility a long time. The administrator feels loyal to the longer-term employees and wants to keep them around, partly because he is concerned that Kelly wants his job or wants him to be replaced. He would like to find another nurse who would be more agreeable with his views, but it is very difficult to recruit nurses in this small town – he was lucky to get Kelly.
- Like the hospital administrator, the Riverbend administrator is seldom seen in patient care areas. He works in his office, goes to meetings in the community and at the hospital, and is often out of town at conferences and meetings. He makes a very good income and has been rewarded by the owner (who lives on the other side of the state) for maintaining the facility within the budget allowed. He isn’t really interested or invested in the nursing department – he considers that the nursing director’s job. He sees his duty as keeping the beds full, the bills paid, the building and the grounds looking good, and keeping the owner happy. He plans to retire in this job and has cultivated positive relationships with the owner, the local doctors, and the hospital administrator to assure his job security.
- The Riverbend nursing staff includes some strong RNs, particularly the day shift charge nurse and the evening shift charge nurse, who both like and support Kelly. However, other nurses on staff are less strong and two of them have been identified as not being safe to perform their duties. One is 80 years old, very hard of hearing, and demonstrating signs of significant memory loss. Her name is Mable. She works part-time, passing medications and doing treatments. Mable doesn’t attempt to direct or correct the CNAs, who openly make fun of her. Kelly has told the administrator that Mable must be replaced immediately. He cites age discrimination as his reason for not agreeing to do this. Kelly knows there is plenty of evidence to support terminating Mable and has informed the administrator that if he does not agree, Kelly will be forced to report her concerns to the board of nursing and the owner. The administrator has asked for some time to think about it, so he can try to come up with an alternate plan that will save the Mable’s job. Kelly, in the meantime, relieved Mable of medication duty and assigned her to doing simple treatments and other tasks that Kelly feels are ‘safe’ for Mable to perform. Kelly has temporarily given med pass and complex treatment duty to the primary evening shift nurse, who agrees with this action and is willing to help Kelly in this process. Mable is secretly relieved not to have to pass meds, but has told the administrator that she feels she is “being picked on”. That makes him worried that she might sue him. He has assured her he will save her job and will even create a new job for her if he must.
- The other identified ‘compromised’ nurse is the primary night shift RN, who appears to have many personal stresses — especially depression, which Kelly feels has been worsened by the fact that the hospital often begs this nurse to work night shifts at the hospital with little or no advanced notice. This nurse usually agrees to do this, and she is chronically sleep-deprived as a result. Kelly is very angry about this practice. She has told the night nurse there is no requirement to accept any hospital shifts and that Kelly will support a decision to refuse them. However, Kelly learned that the Riverbend administrator is encouraging this nurse (and other nurses) to ‘help out the hospital’ in order to maintain a positive relationship with them. His expectation is that Kelly will arrange coverage at Riverbend whenever a nurse is “needed” at the hospital. He believes hospital patients have higher priority than patients/residents at Riverbend. Kelly has informed the administrator that this practice must stop and, again, has threatened to take the issue “as far as needed” to get a satisfactory resolution. Most of the nurses at Riverbend do not feel comfortable being called to work at the hospital, but they don’t want to tell the administrator and risk his disapproval. On this particular issue, even the staff who don’t like Kelly are hoping she can make something happen to stop this practice.
2020
ENG273 Ethics Case Analysis Rubric
Student Name: ___________________________
| TRAIT | Value:4.00
Exceeds Standard |
Value: 3.0
Meets Standard |
Value: 2.0
Minimally Meets Standard |
Value: 1.0
Below Standard |
Value: 0
Unacceptable |
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| Clarity of Response, Organization and Ease of Understandabilty | Evidence of professional appearance, format, and language – extremely neat, clear, with skillful clarify of responses. | Work reflects neat appearance, requires minor revision of professional language/format. Responses adequately detailed. | Work is inconsistent in appearance, format, and/or language. Clarity, organization and understandability meet minimum standard. | Work is unsatisfactory in professional appearance, format or language. Organization and understandability not evident or weak. Requires major revision. | Work is of very poos quality with unprofessional format and language. No organization of thoughts or logical sequence of discussion. Requires total revision |
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S/2020 /40 |
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| Accuracy of Mechanics (grammar, punctuation, spelling) | Absence of readily detectable errors | Presence of few minor errors; no major errors | Presence of 1 or 2 major and numerous minor errors interfering with clarity | More than 2 major errors and many minor errors, disrupting meaning or flow. | Extensive errors in gramma, punctuation and/or spelling that make comprehension very difficult |