In today’s society working as a new registered nurse one can face many hurdles as they come upon their new work environment. While trying to grasp this major changeover nurses can often find themselves in the mist of ethical problems. There are in some cases policies of the healthcare institutions and the nurse’s personal professional ethics that can conflict with the clinical setting decision making.
Graduating from a Register Nurse program is a great accomplishment to many nurses. So once they start working, they need to know how to manage their time as well as organize. Without the instructions of the clinical instructor new nurses will develop their own patient and new nurse relationships. Finally, ethical and moral decision making is particularly essential for the new graduate nurse.
New nurses will be stressed with challenging environment. They will often have mixed emotions about the transition from the classroom to reality. Their thoughts can sometimes race and they have feelings of not being competent enough and lacking experience in many skills. New nurses may even have feelings of fear and insecurities of not being accepted by the patients. While that may be the case they do understand that trust is the foundation of a relationship.
Trust is mandatory for both nurse and patient. Patient must feel safe and confident about his or her nurse. In the beginning the patient and nurse relationship can be difficult to obtain due to lack of confidence. The new nurse has to establish trust with the patient by building a rapport with the client. Listen to what the patient has to say and learn to respect the patient wishes. All of this information is extremely important as a new nurse. Once the new graduate begins to gain that confidence then there are ethical issues to face.
In every nurse's career, the nurse is faced with many moral and ethical dilemmas such as autonomy. First we need to understand what is autonomy. According to Skår, R. (2010), “Autonomy is the freedom to make discretionary and binding decisions that are consistent within one’s scope of practice and the freedom to act on those decisions”.
It is important to know what types of issues that nurses may face during their careers and how they may have been dealt with in the past. It is also important for nurses to be aware of what unprofessional conduct is and how their personal ethics can conflict with the institutional policies.
As new nurses, they play a major role as advocates for the families as well as patients with decision making. The fact that nurses encounter clinical circumstances that require ethical judgment stresses the need for nursing staff to gain information and proficiency in delivering care in an ethical approach. The conflict with ethical dilemmas can occur as an example with doctor and nurse relationships. For example, the nurse can feel that the patient requires more therapy and the doctor may disagree with what the nurse suggests. The nurse can be right but because of the doctor being in charge it may down play the nurses decision.
As a nurse, truth telling versus deception is really important issue that nurses may have to deal with, especially when families want to deny telling the patient the truth about the medical condition. Many questions always ring in my mind about like, what should a nurse do when a family insists telling the patient the prognosis will cause harm? How can a nurse know if this is true? Does the patient have the right to know?
I really feel that patients have the rights to know their diagnosis. For example I have a personal experience with denial autonomy. My grandfather 85-year-old was admitted in Good Samaritan hospital 2003 complaining of increasing back pain. My grandfather had limited English skills. When the admitting hospitalists nurse entered the room, my grandfather was surrounded by his daughter and other relatives talking in Swahili.
After greeting the patient and us, the physician asked to speak to the patient in private about his condition. One of my aunts insists that she and her relatives stay in the room, as they have come “to help.” The doctor began to talk about my grandfather’s diagnosis, and my aunt interrupted, saying it is better if you do not say too much. The doctor then asked her if she and the patient understand how serious his conditions were. She said that she understands his condition and that grandfather “knows what he needs to know.” “It will hurt him,” she says, “if he knows too much.” The doctor began to say that the patient likely has cancer, and the aunt frantically asks him not to say any more. She stated emphatically, “Doctors in Kenya would never do such an unkind thing!”
The doctor emphasizes that the patient must know about his condition and asked that everyone to leave the room so he can talk to the patient privately. So the patient really has the right to know his or her diagnosis and as the nurse it’s your responsibility to let them know.
References
Skår, R. (2010). The meaning of autonomy in nursing practice. Journal Of Clinical Nursing, 19(15/16), 2226-2234. doi:10.1111/j.1365-2702.2009.02804.x
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