Running Head: CONSISTENCY OF RESPECT IN A NURSE’S PROFESSIONAL ROLE

Consistency of Respect in a Nurse’s Professional Role: An Ethics Review

Jordyn M. Hursh

James Madison University

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Introduction: Professionalism in nursing begins the moment you walk into the hospital

doors until the moment you leave. This includes the words you say to the patient and about the

patient. A patient with Crohn’s disease wrote about an experience in the hospital when she

overheard her nurse practitioner in the hallway talking about her, saying: “‘Gosh…she was just

in the ER, and was just here a couple weeks ago! What does this woman want from me?!’ At that

moment, my heart sank and I lost faith in my trust team of medical gladiators” (Carter, 2015).

The number one thing a patient should feel towards their healthcare provider, faith and trust,

immediately dissolved with this apathetic comment. “[Trust] builds when the client is confident

in the nurse and when the nurse’s presence conveys integrity and reliability, also it develops

when the client believes the nurse will be consistent in his or her own words and actions and can

be relied on to do what he or she says” (Said, 2) both in and out of the patient’s room.

Background: While having clinical in the labor and delivery unit, I was sitting in the

nurse’s station when another nurse sitting in the station hung up the phone and was clearly

frustrated. She turned to me and described the conversation she just had: a twenty-year old

primipara woman’s water had broken, yet she refused to come in to the hospital. On top of that,

she was also positive for Group Beta Streptococcus so she needed immediate treatment. Still

early in the morning, the future mother argued that she had not been sleeping well so she wanted

to get more rest before coming. The nurse explained to the young woman the importance of

coming to the hospital promptly, but the young mother refused and was short with the nurse.

As the nurse described the situation to me, her tone of voice appeared upset and offended.

She used profane language to describe the young pregnant woman and embellished the

conversation by including her unfiltered thoughts in manner contradictory to hospital standards.

As a nursing student listening to the nurse vent, I experienced an ethical dilemma. I

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acknowledged that the nurse had every right to be upset because she was disrespected by the

pregnant woman and she worried for the health of the mother and fetus, but she responded

inappropriately. Sitting there quietly and listening, I contemplated speaking up about

professionalism and the importance of respecting the patient, but I decided that this was not my

authoritative place. I struggled to find a way to respect the nurse’s authority while also

advocating for respect of the patient.

The nurse was doing her job by prioritizing the health of the mother and fetus and she

became frustrated by the young woman’s rude responses. Although the nurse conveyed

professionalism on the phone with the patient, this quickly dissolved as soon as the phone call

ended. Nurses should always act respectful, appropriate, and professional whether the patient can

hear them or not.

Methods/Findings: In analyzing the ethics of this situation, I will use the JMU 8 Key

Questions. These questions create an open framework for helping individuals utilize critical

ethical reasoning in times of moral distress or ethical dilemmas. The first of these questions

focuses on fairness followed by outcomes. As I considered how the nurse could “act equitably

and balance legitimate interests”, fairness could have been achieved by prioritizing

professionalism in the words chosen concerning the patient. Whether the nurse talked

unprofessionally about the patient or not, the outcome for the patient would most likely be the

same in both cases. The patient’s outcome of care should be objectively separate to the attitude

of the caregivers, but that does not take away from the influence a negative perspective can have

on the compassionate care of the patient.

Respectfully advocating for the patient leads into the question of responsibility by

answering what duties and obligations apply in the situation. As a nurse and a nursing student, I
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have a responsibility to patients and even though I did not know this patient, I still hold the duty

to protect her rights as evidenced by Provision 3 on the ANA Code of Ethics. In this case,

allowing the nurse to use profane language to describe the patient was not protecting the

patient’s rights.

Character follows responsibility and asks the question, “What action best reflects who I

am and the person I want to become?”. For the nurse, to act one way when talking to the patient

and another with other staff members shows an inconsistency and inauthenticity in character.

Noble character in this scenario would be the ability of the nurse to express her frustrations in a

professional manner without devaluing the patient through her words.

The 8 Key Question on liberty looks at the “respect for freedom, personal autonomy, or

consent”. Liberty was applied in this situation because the patient had the authority to make and

carry out her own decision with the hospital educating her on the best decision and allowing her

to come to her own conclusion. Even though the nurse did not agree with the patient’s decision

and did not value it, personal autonomy was carried out and the patient was able to assert her

liberty by not coming in to the hospital. Liberty for the nurse was also implemented because she

had the freedom to have her own thoughts and feelings regarding the situation even if she came

about it in an unprofessional manner.

Empathy plays a big role in JMU’s 8 Key Questions in relation to the conversation

between the nurse and the patient as well as the nurse and me as the nursing student. While on

the phone with the patient, the nurse exemplified empathy by clearly presenting her concern for

the mother and fetus’ health in an educated and caring manner. Even when she got off the phone,

I would argue that the nurse showed empathy because of how passionate she was in her
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frustrations. She may have disagreed with the patient and not responded appropriately but deeply

cared nonetheless.

The last two 8 Key Questions involved include authority and rights. The hospital stands

as the ultimate authority and expects both the nurse and the nursing student to be respectful to

the patient at all times both in and out the patient’s presence. The nurse-patient relationship

cannot be built on trust when patients can overhear inconsistencies in the nurse’s care and

attitude. When considering rights, the patient had the legal right to refuse care and this was

implemented through the patient’s decision to stay at home despite the nurse’s encouragement to

come in to the hospital.

Conclusion: As I reflect on this situation, I view it as a learning experience. While I learn

from the nurse’s behavior, I also learn from my own response as well. I am disappointed by my

silence because silence argues affirmation of the nurse and her words. I was so concerned with

respecting my authority that disregarded respecting the patient. In retrospect, I would have

validated the nurse’s feelings and concerns in the situation while also advocating the patient’s

rights of value. Respect applied to the nurse in her choice of words about the patient and respect

applied to me in the way I can choose to speak up for the patient while being mindful of

authority.

This situation opened my eyes to the fact that advocating for the patient not only includes

healthcare but also the innate values of the patient. Using profane language to describe a patient

is never acceptable and the patient needed me to stand up for her when she was not present to do

so herself. I am positive that this will not be the last time I hear someone in authority talk poorly

about a patient and this experience has shown me that I need to be prepared to handle these

situations and conversations in a respectful and caring manner.

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References

American Nurses Association. (2015). Code of ethics for nursing. Silver Spring, MD: American

Nurses Association.

Carter, M. (2017). IT HAPPENED TO ME: I heard the Nurse Practitioner Trash Talk Me from

the Hallway. Retrieved March 15, 2018, from https://www.xojane.com/it-happened-to-

me/nurse-practitioner-trash-talk

Madison Collaborative. (2018). The Eight Key Questions (8KQ). Retrieved March 15, 2018,

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

Said, N. (2013). Nurse-Patient Trust Relationship [Review]. Retrieved March 15, 2018, from

https://staff-old.najah.edu/sites/default/files/Nurse_Patient_Trust_Relationship.pdf.