Malpractice and Chain of Command

When one becomes a nurse, one must realize that there is a great deal of responsibility involved with that title. To be a nurse is being faced with many issues such as legal, moral, or ethical. A nurse must be able to differentiate between them and not let either interfere with their job yet still be protecting themselves from any backlash. I am faced with an issue that involves, I believe, all the issues presented. There is a patient with COPD, chronic obstructive pulmonary disorder, who is having difficult respirations, increased cyanosis, and increased anxiety. She cannot breathe and the nurse has done all the measures for which she has orders for. Still there is no relief. It is 2 in the morning and she calls the provider who orders Valium 10 mg IM now. Even though this is a new graduate nurse she is aware that Valium is contraindicated for this patient because of her respiratory status. After consulting with the nursing supervisor, who tells her that Dr. Jones is a good doctor and must know what he is doing, appears to not know what to do. It is obvious that there are legal issues in medical practice. Patients have legal rights as a person that have to be abided by in any situation. They have the right to life, liberty and freedom. The right to life is upheld by the medical professionals with the treatment that they give to them to either prolong or better their health. They also have the liberty to chose how they want to be treated. Patients can refuse to be seen or demand care. They also have the freedom to not do as the health professionals have advised. These are all their rights that we can not go against. The above patient has the right to life because at this point in her care she appears to be in grave danger without proper care. However, if she is given the medication she is also at risk of the same. This could become a more sever legal issue if the nurse does administer the medication and the patient codes. Therefore this action is illegal. Then there are the moral rights. Morality is individual to each person. It is a difference of belief and not a matter of preference. Here the supervising nurse feels that the doctor is very capable of making the appropriate medication order and should not be questioned. However, the nurse will feel a large amount of guilt for harming the patient if that happens. She will knowingly engage in an activity that is careless and caused intentional harm. Her moral compass has already made her question the order but now she must struggle with the fact that she is being told that this is what should be done. It is not fair or balanced in any way because as a new nurse she must feel she has no one to turn to and almost trapped into doing things that go against why she became a nurse. Then there is the ethical issues. Nurses have an ethical duty to not cause harm to their patients. We are to cause no harm or promote disease. Nurses are to be good and faithful in our profession. They also must be just in their practice. All patients should be treated with the same care and all persons are allotted medical care as necessary for the betterment of their health. The above patient is receiving treatment for her condition to the best of the nurses ability yet she has not able to achieve relief. At this point, the nurse has taken it to the next level by seeking further treatment by the doctor. However this treatment is not promoting wellness but perhaps may cause a more severe situation. It appears to me that this patient needs to have treatment but the doctor is obviously not completely aware of the severity of her specific situation. I think that the nurse should consult another provider or even another nurse for guidance. The fact that the doctor gave the orders is apparent that he is not completely aware of what is going on. The nurse may have to call the doctor back to clarify the situation and stress the fact that this patient is already in respiratory distress. I feel that even though she is a new nurse she still has the right to question the doctor because it is not just about the doctor or the patient it is about her and feeling right about what she is doing and protecting herself legally and morally. If this were me, I would definitely call the doctor back since the supervising nurse really was no help. I make my decisions based on my values in life. I believe that everyone should be treated the same and that includes doctors and other nurses. I don’t think anyone is above being questioned. I believe in honesty and fairness. This situation makes me frustrated and annoyed. The reason it makes me frustrated is that it seems that this nurse only has the supervising nurse to go to and does not know what else to do. It is annoying to think that even though the order appears to be wrong the supervisor does not question it or offer other solutions for the new nurse. I do not understand why it appears that no one but the new nurse cares about the situation. The above scenario could have a very bad outcome. There is a new nurse with a not so interested supervisor and a good doctor that is not taking into account the patients symptoms. This case could have the nurse being disciplined severely maybe even being sued or worse losing her license. All the issues, legal, moral, and ethical, should guide her into making and doing the right thing, at least I would hope so. I would also hope that this would be a learning experience for all to pay more attention to what is going on no matter what. To be a nurse is taking care of everyone and ensuring everyone does or gets the right thing.