Legal and Ethical Issues in Nursing


Ethical codes are important in every institution as they govern the behavioral patterns of individuals at the work place by ensuring that such behaviors are in line with the institutions’ goals and reputation. Breaching rules that form part of an institution’s code of conducts can have serious consequences on the reputation of a firm and the continued employment of the individual causing such breaches. The law ensures the protection of institutions, including their integrity and their property. However, it is also the law’s duty to ensure that individuals working for the institution benefit from protection as well so that institutions do not take advantage of them. A case study in Ginny Wacker’s book, Legal and Ethical Issues in Nursing, reveals the extent of the impact that suspicion of breach of a code of conduct can have on individuals and the legal complications that arise. This paper seeks to establish the role of the law in determining matters regarding to such breaches and the responsibilities, which individuals and institutions assume when a breach of ethics occurs.

You be the judge: Case analysis

Regarding the case, the hospital had insufficient evidence to facilitate the suspension of the nurse. However, the suspension of the nurse was a necessary measure to ensure fairness and thoroughness in investigations regarding the issues. The case creates an understandable dilemma for the hospital’s management, as it has to protect its patients but at the same time ensure that the nurse gets fair treatment. The hospital can do both by ensuring that the nurse gets payment while awaiting the court to determine whether the nurse is indeed guilty or not. The outcome of the trial is an important determinant of whether the hospital takes further legal action against her or reinstates her. Most of the evidence given at the trial was circumstantial and thus it needed further corroboration (Earley, 1995). None of the nurses saw the accused nurse filling in misleading information in the paper records and thus their testimonies did not apply as evidence against her. The testimonies mainly comprised admissions of faults on the part of the other nurses creating instances of questionable conduct and putting the viability of their testimonies against the accused nurse under a microscope. The testimony of the nurses in the unit should apply only as indications that other possibilities could have resulted in the errors on the paper report. For instance, it is possible that another nurse, who is responsible for the same patients as the accused nurse, filled in the paper reports before the accused nurse was through with her shift. It is also possible that the misrepresentation in information was the result of faulty recording after a long shift by the accused nurse, as opposed to the possibility of her taking the narcotics for her own personal use, as was the assumption that led to her suspension. Additional questions such as what measures the hospital had in place to counter malpractices and provide surveillance over operations in the unit are important for the company to answer before the court makes a ruling on the case. The hospital should also rule out any other possibilities or reasonably prove the accusations it levels against the nurse failure to which it would risk a counter suit for wrongful dismissal from the nurse.

The most appropriate ruling in the case would be to uphold the nurse’s grievances. This assertion holds for the evidence against the nurse is purely circumstantial and thus it needs further corroboration through reliable testimonies or the presentation of irrefutable evidence such as matching the nurse’s handwriting to the faulty paper records or surveillance footage of the nurse committing the malpractices for which the hospital has accused her. Possibly, another nurse or nurses are responsible for diverting the narcotics and creating the suspicions to divert attention. The current practice of medical administration makes this aspect possible by failing to allocate specific nurses to the task or stipulating a clear procedure for the determination of the nurse with the authority to create the paper records for each patient. Therefore, perhaps the accusations against the suspended nurse are false; a situation that would grant the accused nurse an opportunity to seek legal redress against the hospital for her suspension. The standard of proof in criminal cases requires that the hospital prove, beyond reasonable doubt, that the nurse did in fact divert the narcotics for personal use. Due to the gravity of the offense and the penalties that apply in case she is found guilty; it is the duty of the hospital to seek certainty of the facts they present or risk a counter suit.

Policy and procedure manuals form part of a hospital’s tools of governance. Accrediting and licensing institutions such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and state licensing boards consider them mandatory for the licensing and accreditation of a healthcare facility. The manuals are legal documents and as such ensure compliance of the employer and the employee to the company code of conduct. Good policies are flexible enough to accommodate change according to evolving needs at an institution. However, before effecting such change, hospital authorities such as the senior management and personnel governed by the policies in the manual need to be involved. A representative of the doctors and nurses would be essential in establishing the right changes to some of the crucial hospital policies, such as the number of nurses that must attend to patients at all times.

The hospital ought to look at procedural alternatives that create precise methodology for the administration of medication. This move would benefit the hospital in the prevention of future incidents and wastage of IV bags that is persistent in the unit now due to malpractice (Wacker, 2009). This step would create financial relief in the hospital budget and optimize on its profitability. One such alternative is the restriction of the number of nurses that work on the electronic and paper records at any one time to ensure credibility of records and accountability by the responsible individuals. It would also be prudent for the hospital to station nurse assistants with the responsibility of creating immediate records, as this move would prevent faulty recording and reduce the chances of misdiagnosis by the physician for the patients, thus helping in saving lives. Installation of surveillance cameras would also be a critical alternative as it has numerous advantages. One of the advantages is that it is discrete and provides it 24-hour surveillance over the hospital staff and their operations in the presence and absence of further supervision. It also allows for supervision of patients in the unit during both day and night and records any progress or deterioration of a patient’s health. The importance of this aspect is that the footage is reviewable, thus providing an avenue for assessment and development of better methods of treatment where applicable.

In respect of the other nurses in the unit, the hospital should take appropriate disciplinary measures against them based on their individual testimonies. Their behavior goes against the hospital’s ethical code of conduct and the repetitive violation of the code causes financial loss to the hospital, which is very likely to lead to loss of lives, especially with regard to their disregard of express instructions by the physician (Stern, 2005). The nurses need to find ways of ensuring that they record information on medication immediately after administration to ensure that instances of faulty recording are minimal or non-existent. The nurses also should ensure that they follow the physician’s instructions on injection of medication to the letter, which is crucial in ensuring that patients get the right treatment and avoiding mishaps caused by negligent behavior (Wacker, 2009).

Other than suspension from her job, in the unlikely event that the court finds the nurse guilty, she is likely to face other serious charges, such as the misuse of hospital facilities, breaching the hospital’s code of conduct, and risking the lives of patients due to her negligent behavior. The latter is a criminal charge that has serious implications on her freedom and future career opportunities. It is criminal for a medical professional to put the life of a patient in danger knowingly for personal gain (Stern, 2005). The people and the profession allow nurses and physicians to hold the lives of their patients in trust and they must thus do everything within their abilities to ensure that the lives of their patients are safe. If, for instance, a patient dies in the hospital due to wrongful administration of medication through actions such as using IV injections to administer medicine in disregard of the physician’s orders, the nurse would be responsible for the crime of manslaughter and would serve a lengthy period in prison or even face life imprisonment. It is therefore important for the court to ensure that the evidence proves guilt beyond reasonable doubt.

The hospital should look at appropriate measures to discipline rest of the nurses in the critical care unit. The nurses were fully aware of the risks that their actions pose to patients yet continually acted in breach of the code of conduct. Ignoring their actions after such confessions would be an injustice, both to the suspended nurse and to patients in the hospital who possibly suffer in silence due to the nurses’ ignorance of what happens around them daily. The hospital should ensure that it has a concise code of conduct put in writing and distributed to all hospital employees for signing so as to ensure that they are fully aware of the implications that their actions have for the hospital and for them individually. The reviewing process is also likely to reveal the nurses responsible for malpractices and the full extent of the damage that their actions have caused to the hospital. This information is useful, should the hospital decide to take disciplinary action against the nurses.


Codes of conduct play a crucial role in ensuring that employees in any institution act according to standards set by an institution. As the case study portrays, the breach of ethical conduct at work has serious legal implications, which have substantial effects on the individuals working in an organization and the entire organization as a whole. Therefore, every individual has the duty to guard against malpractices and the institution to ensure that proper oversight is established on the operations that take place in the work place.

Reference List

Earley, P. (1995). Circumstantial Evidence: Death, Life and Justice in a Southern Town. New York, NY: Bantam Books.

Stern, T. (2005).Measuring Medical Professionalism. New York, NY: Oxford University Press.

Wacker, J. (2009).Legal and Ethical Issues in Nursing (5thed.). New Jersey, NJ: Prentice Hall.

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