Nurses all over the world face ethical challenges when it comes to patient care. Today’s healthcare system is characterized by the critical staff shortage and the lack of time to meet all the patients needs. The nature of nurse care becomes increasingly exhausting and stressful through the prism of ethical decisions. Therefore, an ethical issue might arise in any healthcare case where a basic moral understanding of “rightness” and “wrongness” underlie the patient’s beneficial care and professional decision-making. Moreover, one of the significant problems in the U.S. healthcare system is the heavy workload of nurses due to several factors. They include the increase in nurses demand, inadequate staff supply, increased overtime, and reduction in patient time of stay.
Patient Autonomy and Working Under the Time Pressure
It is predicted that “the number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group’s share of the total population will rise from 16 percent to 23 percent” (Mather et al., 2019). Hence, today’s hospital nurses have to take care of patients with worse health state than in the past. Respectively, the workload and shortage in time are more intensive.
The four levels of nursing workload measures are as follows: unit level, patient level, job level, and situation level. All of them might be structured into a specific hierarchy. Still, the clinical patient’s condition is a primary determinant in this chain. Nursing lack of time negatively affects the quality of various tasks directly influencing the patient’s state and autonomy. For example, heavy nursing workload often influences the healthcare staff’s decision to perform a specific procedure. Hard working is also able to reduce the quality of communication between nurses and both physicians and patients. Moreover, the workload in the time-pressure form directly causes medical errors, especially those resulting from the reduced attention paid to safety-critical tasks. These circumstances might reduce the patient’s autonomy and lead to unsafe patient care.
Additionally, healthcare expectations and system factors, along with the staff shortage, contribute to the workload increase. For instance, nurses are likely to perform nonprofessional and indirect tasks. They include, but are not limited to, food trays delivering and retrieving, transporting patients, housekeeping duties, performing or coordinating ancillary services. Caring for patients with dementia might be a vivid example of an ethical dilemma. A nurse should respect and support a patient’s autonomy in every possible way. In terms of time pressure, healthcare staff is more likely to be forced to balance between the patient’s wellbeing and safety and his or her autonomy.
Hence, there is a conflict between the circumstances and the nurse’s moral positions. It is not a secret that in terms of elderly care the ethics research resulted in ageist attitudes and insufficient attention (Smebye et al., 2015. Additionally, when it comes to older people, the scope and size of ethical challenges are underestimated by many nurses. Whereas “nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of. Care must be fairly, justly, and equitably distributed among a group of patients” (“Ethical practice,” n.d.). They often tend to trivialize the complaints of elderly and do not always provide them with autonomy or at least an opportunity to affect their daily activities. (Smebye et al., 2015). Nevertheless, patient participation should never be addressed to as a losing principle in nursing care.
For a nurse facing time pressure, it is essential to manage it accurately. There are several steps that might help save time and direct it to the defense of patient autonomy and safety care. First of all, it is necessary to examine and prioritize the nurse’s assignments. It requires the activities categorization into low, medium, and high priority. Hence, it is better to start with high-priority tasks such as critical interventions and assignments. In turn, medium priority duties include educating the patients. Finally, it is rational to delegate the rest to UAPs (unlicensed assistive personnel), volunteers, or family members. This step can also be characterized as being a team player instead of carrying the whole responsibility and workload alone. For example, when the family members are visiting, a nurse can ask them in a friendly way whether they would like to help without mentioning the lack of staff.
The workload should be duly organized. For instance, before entering the patient’s room, all the supplies and equipment should be already gathered. It would be appropriate to involve and inform the nursing administration regarding inadequate staffing cases. For each nurse, it is essential to take care of him- or herself for staving off burnout. Finally, nothing seems to be possible without a positive attitude. Negative outlooks result in the decrease in performance and morale of the whole team, whereas the positive mood help to thrive and survive in the most challenging situations.
Autonomy and Ethical Nursing
One of the main challenges for any nurse is the respect of the patient’s right to autonomy in different situations. A nurse should always keep in mind that “a fundamental principle that underlies all nursing practice is respect for the inherent worth, dignity, and human rights of every individual” (“Code of ethics,” n.d.). Nursing ethics states that the patients autonomy as well as self-determination might be limited or outweighed by the health, welfare, and rights of others in terms of public health (“Code of ethics,” n.d.). Simultaneously, any limitation of autonomy is a severe deviation from the care standards. Hence, it may be justified only in cases when less strict means are unable to preserve the laws demands and the other peoples rights. A nurse is entitled to advise or suggest, but not coerce or persuade the patients in making a particular choice. Basically, personal autonomy is the right of a patient to make own decisions and actions. Therefore, “the patient has the right to decide what happens to their own body” (“Module 4,” n.d.). A patient has the legitimate right to act for his interests sake independently.
Nevertheless, autonomy should be limited when it is likely to cause harm. In such cases, healthcare professionals have the right to disregard the autonomous decisions of a patient. Additionally, they need to determine whether the patient is able to appreciate the consequences of the decision made adequately. One of the examples is a patient’s willingness to treat the virus with antibiotics. In most cases, patient autonomy and wellbeing are interrelated definitions but not always in a positive sense.
The main implication should be considered as follows: once the treatment data is made available for the patient capable of producing adequate treatment decisions, a healthcare professional can propose treatment without preventing the patient’s choice. The only exclusion relates to the situations when the patients wishes are likely to harm their wellbeing or others. Hence, the central ethical dilemma nurses frequently face is the incompatibility between beneficence and autonomy.
“Ethical Practice: NCLEX-RN.” (2020). Registered Nursing.
Mather, M., Scommegna, P., & Kilduff, L. (2019). Fact sheet: Aging in the United States. PRB.
Smebye, K. L., Kirkevold, M., & Engedal, K. (2015). Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC Health Serv Res., 16(21). doi: 10.1186/s12913-015-1217-1.