Ethical and Legal Dilemma Nurses come into the profession with personal values and

morals that guide them daily. However, sometimes they are presented with situations that

conflict with what they believe is right; in this case the nurse faces an ethical dilemma.

Regardless of the ethical issues they face, nurses must act in the best interest of their clients.

According to Canadian Nurses Association (2017), “Code of ethics will be an ethical basis from

which nurses can advocate quality work environments that support the delivery of safe,

compassionate, competent and ethical care” (p. 2).

For the purpose of this assignment, I will present a case study, in which the nurse faces

an ethical dilemma in the workplace. First, I will summarize the content of the case. Next I will

use Catalano (2009) as (cited in Blais & Hayes, 2015) 13 step Bioethical DecisionMaking Model

Algorithm to analyze the case. Then, I will provide a discussion of the case from a nursing view,

outlining nursing actions and interventions. I will finalize the paper by briefly summarizing what

steps were taken to resolve the dilemma present in the case.

Summary of Case Study

This scenario is based on case study number two retrieved from Athabasca University,

NURS 250 study guide, (n.d.). In the following case, the writer will assume the nurse manager

role on a 25-bed, medical-surgical unit in a hospital. The writer is also responsible for the

supervision of 26 staff members. It was brought to the writer’s attention that a senior nurse staff

is stealing cash and other valuables from patients and staff members. The writer is very morally

distressed about the situation because this senior nurse has a very good reputation on the unit.

She is very supportive to the writer, and her competency has contributed well to the team. The

writer knows the appropriate action to take but is worried that no one will believe her if she does.

Application of the Ethical Decision-Making Algorithm The Bioethical decision-making

algorithm by Catalano (2009), as (cited in Blais & Hayes, 2015), is one model that is used to

guide nurses in resolving ethical dilemmas throughout their practice. The thirteen steps of this

model are as follows: (1) Identifying the moral aspects, (2) Gather relevant facts related to the

issue, (3) Determine ownership of the decision, (4) Clarify and apply personal values, (5)

Identify ethical theories and principles (6) Identify applicable laws and agency policies, (7) Use

competent interdisciplinary resources, (8) Develop alternative actions and project their outcomes

on the client and family, (9) Apply nursing codes of ethics to help guide actions, (10) For each

alternative action, identify risk and seriousness of consequences for the nurse, (11) Participate

actively in resolving the issue, (12) Implement the action, and (13) Evaluate the action taken.

These steps will be outline in the table that follows.

Table 1 Clinical Application of Bioethical Decision-Making Model – Catalano (2009)

Clinical Application of Bioethical Decision-Making Model Nursing Action Considerations Step

1. Identify the moral aspects In this situation, the ethical dilemma is either to report the senior

nurse’s behavior to the appropriate authority or condone her behavior. There is conflict between

veracity and loyalty. The nurse manager knows what the senior nurse did is wrong but is worried

about what the negative implications, such as lost of trust by colleagues and patients will be. Step

2. Gather relevant facts related to the issue The manager should ensure the information received

about the senior nurse staff member is accurate prior to taking any measures Gather all the

information about the theft; the patients and staff members affected, and witnesses of the events

should be questioned. Find out what might cause this staff member to commit such offence.

Does she have a motive? Is she mentally ill? Step 3. Determine ownership of the decision In this

case, the senior nurse clinician does not have a say in whether the manager should report what

she did. The manager is making the decision for patients and staff members who were 4 affected
by the theft. The persons affected by the theft should be the owner of the decision. Step 4.

Clarify and apply personal values The Nurse manager needs to clarify her morals and values and

ensure that she follows the code of ethics set out by her profession. It can be inferred that she

values honesty and loyalty, so she is in moral distress Step 5. Identify ethical theories and

principles If the nurse manager reports the act of the senior nurse clinician, she is applying the

principle of veracity (telling the truth).

The moral principles of fidelity (being faithful), respect for person, justice (fairness and

equality), and beneficence (to do good) are also seen in this scenario. Step 6. Identify applicable

laws or agency policies The nurse manager should refer to the hospital policies, nursing practice

acts, nursing code of ethics, provincial criminal laws, regarding professional misconduct, to

guide her next course of action Step 7. Use competent interdisciplinary resources Consultation

with hospital management and the nurse licensing body Step 8. Develop alternative actions and

project their outcomes on the client and family. 1. Further Investigate the matter at hand.

Confront the senior nurse clinician about the possible allegation of theft, report her to the

appropriate authority. Possible outcomes maybe (a) She denies the allegation or accept. The

nurse manager loose relationship with staff and clients because they might not believe she is

telling the truth or (b) the staff and clients is thankful and appreciate the nurse manager for

reporting the act of the senior nurse 2. The nurse manager, do not further investigate the matter,

and condole what the senior nurse did. Possible outcomes maybe (a) the senior nurse continues

to commit theft from staff members and patients (b) staff members and patients may become

angry, and loose respect and trust for the manager if they found out she was aware of the senior

nurse clinician’s professional misconduct and did not take the necessary step to stop her Step 9.

Apply nursing codes of ethics to help guide actions Two ethical responsibilities set out by CNA
code of ethics for nurses can be applied to this case. (1) Being Accountable- Nurses are

accountable for their actions and answerable for their practice. (2) Promoting Justice- Nurses

uphold principles of justice by safeguarding human rights, equity and fairness and by promoting

the public good. These codes should guide the manager’s decision. For each alternative action,

identify risk and seriousness of consequences for the nurse If the nurse manager does not report

the senior nurse’s act, the manager would be going against her personal morals and values and

against the standard and code of ethics set out by the nursing profession. She could be held

accountable for not acting in the best interest of the client and the profession If she takes the

necessary steps to stop the senior nurses from stealing, she would be protecting the client and

staff members, and acting in the best interest of the profession. She will lose a valid member of

her team, and risk having staff and clients being angry at her telling the truth Step 11. Participate

actively in resolving the issue The nurse manager has a professional obligation to try and resolve

this matter. She can approach the senior nurse clinician to talk about the issue Report her to the

appropriate authority Step 12. Implement the action The nurse manager will now implement the

necessary measures to seek justice for the staff members and clients affected by the professional

misconduct of the senior nurse clinician Step 13. Evaluate the action taken Reflecting on the

situation, the manager can begin by asking, “Did I do the right thing?” She can involve the

clients, staff members and other members of the healthcare team in the evaluation, if possible.

She can ask herself whether she would make the same decision again if the situation (in this case

report the senior nurse professional misconduct) were repeated. If she is not satisfied, with the

outcome, she can review other alternatives and work through the steps of this ethical decision

model again. Discussion Identification of the Ethical Issues from Nursing Perspective In the

above case study, the nurse manager is experiencing an ethical dilemma in the workplace.
According to the Canadian Nurses Association (2017) Code of Ethics, Ethical dilemmas, “arise

when there are equally compelling reasons for and against two or more possible courses of

action, and where choosing one course of action means that something else is relinquished or let

go” (p. 6). The dilemma here is either to report the senior nurse to the appropriate authority or

condone her act of stealing. The manager is faced with an action-focused problem. As noted in

Blais & Hayes (2015), “in action-focused problems, the difficulty lies not in making the

decision, but in implementing it” (p. 63). There is a conflict between veracity and loyalty, moral

principles that the manager values. She knows the theft committed by the clinical nurse manager

is wrong, but she is morally distressed about taking the appropriate action because of factors,

such as worrying about being disloyal to the nurse clinician, or about how other members of the

team, and patients will react to her if she tells the truth. To guide her decision making about this

issue, the manager will need to rely on her personal morals and values, consult the code of ethics

set by the nursing profession, and civil laws. There is no doubt the act of theft is a professional

misconduct on the nurse clinician’s part, and she should be held accountable for what she has

done. According to Canadian Nurses Association (2017),” being passive about the situation and

not reporting or intervening the unethical behavior means tolerating this act” (p.12). Therefore,

the nurse manager need be proactive, and get justice for all who have being affected by the theft.

Recommended Nursing Actions and Interventions The goal of settling moral conflict is to ensure

that the conflicting values of all parties are respected, and sometimes concessions are made

(Blais & Hayes, 2015, p. 65). The first step in resolving this dilemma is the nurse manager will

need to clarify her personal values, to ensure that they are congruent with the ethical and moral

principles of the nursing profession. (Blais &Hayes, 2015, p. 65). The manager should ensure to

consult institutional polices about theft before proceeding to take any action. After consultation
with the necessary resources, the nurse can investigate the matter. During this process, if

compromises are possible, the nurse should ensure preservation of each person’s integrity, with

no one forced to give up values, principles, or moral integrity (Blais & Hayes, 2015, p. 65).

Adhering to the principles of veracity (telling the truth), fidelity (being faithful) , respect for

person, justice (fairness and equality) and beneficence (to do good), the manager will need to

address the nurse clinician about her professional misconduct and report her to the appropriate

authority so that appropriate measures can be taken. In the end, the nurse manager will probably

question herself about if she had made the right decision and what would she do differently if she

was confronted with the same situation again. She can find the answers to these questions by

actively evaluating the process she used in solving the problem and involving other team

members in this evaluation process. Whatever the outcome of the decision, the health and well-

being of the patients and family members in the nurse manager's care should be the priority.

Conclusion In summary, Ethical and legal issues are inevitable in healthcare, but with utilizing

and applying fundamental nursing theories and principles, nurses can ensure that they are making

the appropriate decision. In this paper, I have presented a case study, in which a nurse manager

was faced with an ethical dilemma. Catalano's (2009), Ethical Decision-Making Model was used

to help the nurse in resolving this case. Using this model, the nurse was able use her personal

values and morals, ethical and moral principles of the nursing profession to make the appropriate

nursing recommendations and actions. In this process, the nurse must ensure, the decisions made,

reflects the best interest of the patients and their family.

 References

Athabasca University (n.d). NURS 250: Exploration of Professional Nursing Practice. Unit 7:

Ethical and Legal Foundations.

http://charon.athabascau.ca/cnhsundergrad/250c6/assessment.htm Blais, K. K., & Hayes,

J.S. (2015).

Professional nursing practice: Concepts and perspectives (7th ed.). Julie Levin Alexander.

https://online.vitalsource.com/#/books/9780133595581/cfi/6/10!/4/2/2/4@0:0

Canadian Nurses Association. (2017). Code of ethics for registered nurses. Ottawa, ON:

Canadian

Nurses Association. https://www.cna-aiic.ca/~/media/cna/page-content/pdfen/code-of-

ethics-2017-edition-secure-interactive Catalano, J. (2009). Nursing now: Today’s issues,

tomorrow’s trends. (2nd ed.). Philadelphia: F.A. Davis.