Introduction
Nurses are often overworked and underappreciated by society. People think of them either as exemplars of charity and selflessness, such as Florence Nightingale, or hardened, coercive figures, such as Nurse Ratched from the movie One Flew Over the Cuckoo’s Nest (Zaenst, Douglas & Forman, 1975). In reality, nurses usually fall in between, as devoted members of a profession whose mission is to “provide safe high-quality patient care based on a strong commitment to clinical expertise, education, evidence-based practice, research, shared governance, leadership and collaboration with multidisciplinary team members…improving the health and well-being” (Hospitals & Clinics, 2016) of all people. Likewise the vision of professional nurses is to a difference for all (Hospitals & Clinics, 2016). This is a caring group, yet driven by pragmatic and practical concerns. Among those concerns are adhering to the highest standards of ethical, moral, and legal behavior, and enabling the same in colleagues. In this paper, the writer will discuss a current situation at work that touches on all three of these categories, then present an analysis of how to handle it, true nursing standards and personal leadership style and temperament.
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Ethical, Moral and Legal Standards
The words ethics and morals are closely related and often used interchangeably. There is a distinction, however, between the two. Morals reflect personal behavior and beliefs shaped by religion, culture, or experience. Ethics, on the other hand, is a philosophical system that addresses right and wrong from a more objective viewpoint. In essence, individuals have morals while societies mirror ethical beliefs (Grammarist, 2016). In a way, ethics inform morals. Legal standards, on the other hand, are codified or regulatory edicts pronounced by governing institutions that must be followed; failure to do so can result in punitive consequences. Legal standards often derive from the ethical principles of a society or even the morals of leaders, but are enforceable against offenders. Nurses should be aware of their own morals, appreciate ethical standards of society, and be sure to follow all legal requirements their jobs entail.
Current Dilemma
The current dilemma the writer has observed at work involves moral neglect that runs counter to both ethical and legal standards. In this case, a co-worker has admitted allowing two patients under psychiatric treatment to engage in sexual activity when no one else was present to stop them. The colleague claimed that it did not bother him that the two patients were involved, since both were adults. This is a failure of not only personal morals, but the ethical precepts upon which nursing is based, to protect and care for the safety and well-being of patients. In this case, the patients are hospitalized for psychiatric treatment. Their ability to make informed and safe decisions is questionable; nor is it acceptable to allow such behavior that could result in physical or emotional harm to occur in what is supposed to be a safe setting. Hospitals have restrictions upon physical interaction between patients for a number of ethical and legal reasons—the potential for coercion, violation of vulnerable patients, rape—and subsequent liability of the institution for damage to the patients. Therefore, the nurses’ colleagues are not imposing their own moral standards by condemning this approach, but reflecting the ethical and legal requirements of their community and their profession.
Analysis
The writer’s role in this situation becomes active as soon as it is known. While an overly conciliatory person or leader might either let it go, in order to protect the colleague, such a position would be enabling an untenable act. Persons with democratic leadership styles might confront the fellow nurse and assume he will take proper steps to rectify the situation. Someone with a strong sense of affiliative leadership, working for a consensus that represents the best result for all, and who is motivated by adherence to rules, would most likely recognize the moral, ethical and legal failings present in this situation, and report the activity to higher authorities within the institution or even file a legal complaint.
In any event, it is clear that a responsible nurse will take action in this case. Allowing this activity to continue poses a risk to the patients, the hospital, and reinforces poor moral judgment on the part of the colleague. The ethical considerations of society’s leaders indicate that such conduct is not safe or healthy in such a setting and involving individuals who may not be able to make their own moral choices rationally. Therefore, legal prohibitions of such activity are in place and must be respected. The writer, and any other nurse, should report this activity for the sake of the patients, the institution, and the colleague, to prevent further incidents reflecting poor judgment.
Self-Assessment
Coercive leaders rule by fear—effective but not designed to develop loyal or satisfied workers. Authoritative leaders communicate knowledge and information, instilling confidence in their subordinates (Goleman, 2000). Affiliative leaders seek consensus and reason, to get the team on-board without considering opposing viewpoints. Democratic leaders believe that the majority should rule, regardless of the rights of the minority. Finally, transformational leaders lead by example and introduce new concepts and behaviors to inspire their workers (Goleman, 2000). The writer is an affiliative leader, seeking out counsel from others or guidance from legal and ethical constructs prior to making a reasoned, informed choice. This is consistent with the results of the Keirsey Temperament Sorter which indicated this writer to be a guardian (Keirsey, 2016).
Many nurses are guardians, indeed almost half of the population falls into that category. Guardians want to protect and preserve institutions, respect laws, and care for others. “Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for in the long run loyalty, discipline, and teamwork get the job done right” (Keirsey, 2016, 1). Therefore, although an affiliative leader might have consulted others prior to reporting the colleague’s behavior, for a guardian the choice was simple: the rules must be upheld, for the safety and well-being of all concerned. This position also reiterates some of the basic nursing mission and value rules of caring for all and protecting the well-being of everyone.
Conclusion
Everyone deals with situations in accordance to their own moral standards. Nurses are in a special position as guardians of the vulnerable and ill in society. Therefore, they have a duty to uphold ethical rules as well as laws and regulations developed to protect those who need protection, the community, institutions within the community, and society at large. An affiliative leader cares about the opinions of others and the settled ethical and legal directives within which he or she operates. An affiliative leader who is also a guardian is highly protective, and supportive of rules and regulations established to insure right over wrong. In the situation discussed herein, there is no way an affiliative guardian could fail to act, or even attempt to settle such a dilemma by talking to the colleague. This case demands action within the system, including filing a report and ensuring that the patients are safe and the colleague is dealt with in a constructive manner to prevent further moral negligence.
- Abudi, G. (2011). “The 5 Types of Power in Leadership,” The Fast Track. Retrieved from http://quickbase.intuit.com/blog/2011/08/26/the-5-types-of-power-in-leadership/
- Grammarist. (2016). Ethics versus Morals. The Grammarist. Retrieved from http://grammarist.com/usage/ethics-morals/
- Goleman, D. (2000). “Leadership that Gets Results,” Harvard Business Review 78(2): 78-90.
- Keirsey (2016). Keirsey Sorter. Keirsey.com. Retrieved from
http://www.keirsey.com/sorter/personal_page.aspx - Hospitals & Clinics. (2016). Nursing Mission and Vision. University of Iowa. Retrieved from
https://www.uihealthcare.org/content.aspx?id=236220 - Zaentz, S. & Douglas, M. (Producers) & Forman, M. (Director). (1975). One Flew over the
Cuckoo’s Nest. United States: United Artists.
