When Patients Suffer from Lack of Nursing Care

Tim, an RN, works weekends on the skilled nursing unit of a small rural hospital.Recently purchased by a large corporation, the hospital was forced to dismissnearly one-third of the staff of the skilled nursing unit. Lately, when Tim comes towork, he feels totally overwhelmed. Although he always considered himself effi­cient, Tim is distressed because he rarely has enough time to complete his work.He knows that many of the patients suffer because of lack of attention. Those whoare bedfast are not turned on a regular schedule, they often wait for assistancewith eating until their food is cold, and medications are rarely given on time. Suf­fering from expressive aphasia and hemiplegia secondary to a CVA, Mrs. Wallacewas admitted to the skilled nursing unit after two weeks in the intensive care unit.

Mrs. Wallace has been on the skilled nursing unit for three weeks when her daugh­ter, Nina, notices a large reddened area surrounding a small gray ulcer over hermother's coccyx. Concerned, Nina asks Tim what caused this problem. Eventhough Mrs. Wallace's nursing care plan calls for attention to activity including fre­quent turning and sitting in a chair twice daily. Tim suspects that this was not con­sistently done the previous week. He recognizes that the reddened area is the begin­ning of a large pressure ulcer, a problem that might have been prevented withproper attention to activity and good nutrition. Tim hesitates to tell Nina that theproblem is a potentially serious one that might have been prevented by good nurs­ing care measures. He believes she has a right to know but is hesitant to implicatehimself or the other nurses, and he is afraid that he will lose his job if he complains.

1.What are the ethical principles implicit in this situation?

2.What are Tim's conflicting loyalties?

3.The staff on the unit is efficient and hard-working—skipping lunch and staying overtime to complete their work. Do you believe the staff isresponsible for the apparently poor nursing care that Mrs. Wallace isgetting?

4.Do you believe Tim should tell Nina the truth about the pressure sore?

5.Should Tim risk losing his job by whistle-blowing?

6. What harm can result from either option?What would you do?