Ethical Dilemma Safe Staffing
Ethical Dilemma Safe Staffing
Safe staffing involves making sure that nurses are placed in positions where their knowledge and competence are undeniable. Pandemics like the COVID-19, however, have forced nursing unit managers to put underqualified nurses in positions where their expertise is limited. This has exposed patients to unfavorable outcomes while bringing up the morality of such choices from the perspectives of the management and nurses. Based on ethical considerations, the unsafe staffing situation at the COVID-19 unit needs to be addressed. As a result, other nursing professions, such as educators and administrators, will approach this issue in light of their unique responsibilities for ensuring safe staffing. In addition, the nurse will base her choice on the nursing ethical standards, including beneficence, as well as the laws and rules of New York State pertaining to dangerous staffing. The REST Model of ethical decision-making will be used to guide the aforementioned choice. Therefore, these choices are essential to ensuring that nursing decisions are safe.
Moral Conundrum: Safe Staffing Situation
County General, New York City, Brooklyn
Conversion of the Rapid Respiratory Weaning Unit (RRWU) to the COVID-19 ICU
The ratio of nurses to patients is calculated by dividing the number of patients’ beds by the number of nurses working in a shift. In an
intensive care unit, the nurse to patient ratio is either one nurse to one patient or one nurse to two patients. On the (RRWU), there are one nurses for every four patients. The Rapid Weaning Unit had a 24-bed capacity during the COVID-19 pandemic, and there were five regular med-surg registered nurses, two patient care associates, one receptionist, and two ICU float nurses in all. The two critical care ICU nurses were given the go-ahead to submit a report on the entire unit because they were responsible for managing and documenting ventilators, titrating vasopressors, managing central venous catheters, starting and maintaining continuous venovenous hemofiltration therapy (CVVH), and serving as a resource nurse for the medical surgical nurses. The report received approval and an SBAR noting it.
There were 24 patients in the COVID-19 ICU overall census. Six patients were on a quick weaning pathway, four patients were using a CPAP machine while switching to a high flow nasal cannula, and six patients were using vasopressors and required high-level ICU care. There were also eight patients on vent support who needed total care. Continuous Renal Replacement Therapy was being used in one patient (CVVH).
Background: One ICU nurse has twenty years of experience, while the other has only one. The five medical-surgical nurses have one to five years of experience. RN to patient ratio of 1 to 4 (RRWU).
Assessment: There are six patients taking vasoactive medications and one patient on CVVH. ICU nurses are the clinical and resource nurses. The staffing ratio exceeds the policy’s recommended staffing grid. Six medical-surgical nurses are required for staffing, and four intensive care nurses are required.
The risky staffing condition on COVID-19 unit was reported to administrator Chantel Francois, who also contacted union member Frances Thomas. The assignment was filled out in protest of the dangerous procedure in the intensive care unit.
Introduction
Due to the ethical conundrum presented by this circumstance, the inexperienced nurse in issue is unable to provide good care to patients in the intensive care unit without official education and training. For optimal patient outcomes, it is crucial to match the nurse’s skill set and educational background to the patient’s level of acuity. The patient’s care and the nurse’s license are put at risk when the nurse is given multiple patients and their skill level does not match their level of acuity. When this happens, the death rate of the patients goes up and the nurse faces legal action. As a result, the nurse must decide which patient should receive care first, which puts her in a moral bind. A facility’s ability to provide patients with safe treatment with nurses who are adequately trained in intensive care units is crucial from a legal perspective.
A registered nurse is what?
A registered nurse (RN) has fulfilled all licensure requirements set forth by the state nursing board, holds a nursing diploma, an Associate degree (ADN), or a Bachelor’s degree in nursing, and has successfully passed the NCLEX-RN exam given by the NCSBN (GraduateNursingEDU.org, 2020). According to the National Council of State Boards of Nursing (NCSBN), an RN’s scope of practice covers the following:
Clinical Care Management, Safety and Infection Control, Psychosocial Integrity, Health Promotion and Maintenance, Pharmacological and Parenteral Therapies, Basic Care and Comfort, Physiological Adaptation, and Reduction of Risk Potential
Medical-surgical nurses’ areas of expertise
A registered nurse (RN) who has chosen to focus on providing inpatient care for surgical and nonsurgical diseases is known as a medical-surgical nurse (Springer Publishing Company, 2020). They work with people suffering from a wide range of illnesses. A medical-surgical unit typically has a ratio of 1 nurse to 6 patients. The following are just a few of the fundamental qualifications and competencies needed for employment as a medical-surgical nurse (Springer Publishing Company, 2020):
Planning, developing, implementing, managing, evaluating, and documenting nursing care; administering medications via oral, intravenous, topical, etc.; educating patients and their families; having excellent observation and assessment skills; administering medical examinations and treatments; and, finally, being able to encourage and assist people to become better at what they do.
Therefore, based on scientific nursing principles, med-surg nurses offer tailored and direct nursing care (General Healthcare Resources, 2014).
The practice areas for ICU/critical care nurses
Registered nurses who have received specific training in caring for seriously ill patients whose lives are in danger as a result of their medical conditions are known as critical care nurses (Jacksonville University, 2020). These nurses frequently care for patients in the intensive care unit (ICU) who have heart problems, brain injuries, complex surgical cases, and accident victims (Mona, 2018). They acquire further training for this higher, more intricate degree of nursing. ICU nurses and medical surgical nurses must collaborate closely with patients, their families, doctors, and other members of the healthcare team (Mona, 2018).
A nursing degree as well as a diploma, Associate or Bachelor’s, in any of the social and behavioral sciences are prerequisites for becoming an ICU/critical care nurse (Nurse Journal, 2020). The following are some fundamental qualifications and competencies for an ICU nurse’s position:
Hemodynamic monitoring, management of vasoactive drugs, empathy and interpersonal communication abilities, critical thinking and decision-making abilities, management of complex medication doses, ventilator and anesthesia support, identification of complications and provision of critical care, administration of medication via all routes (PO, IV, etc.), administration of medication via all routes of administration, management of vasoactive drugs, and care for pre-operative and post-operative patients with complications.
Offer assistance and information to patients and their families.
Personal Challenges and Restrictions
I received my training as a medical-surgical nurse, and for the past five years, I have worked on the medical Surg unit. I was floated from the med-surg unit to the ICU to care for more complex patients due to the healthcare emergency posed by the COVID19 pandemic, even though I had no formal training. Given that the duties, education requirements, and job profile for each of these nursing roles are entirely different from one another, it was a very unprofessional and careless move. We frequently upgrade a patient’s care status and move them from the medical-surgical unit to a monitored unit, such as telemonitoring or the intensive care unit (ICU), because we are not prepared to handle such instances while working as a med-surgical nurse. I was expected to care for the seriously ill patients in the ICU when I was floated there. These patients were in serious condition; some had intubations, ventilators, and/or high flow oxygen. As a medical-surgical nurse, you do not administer many of the drugs that the patients were receiving on our wards.
Because I had to consult the ICU nurse who was designated as a resource nurse for everything, I felt inept. Not only was it demanding and physically taxing, but it was also intellectually and emotionally draining. I lived in continual anxiety that my lack of expertise in this nursing field might endanger someone’s life. I am aware of the pressing need created by the sudden scarcity of nurses brought on by the COVID 19 outbreak. It is dangerous for both the nurse and the patients to place a nurse in an intensive care unit without professional training or education. unethical. I voiced my concern about the risky situation to my union representative. After contacting with the nursing director and informing the nurse education department that the employees must receive the necessary instruction and training, the union representative took action to fix the situation.