nursing (health leadership case study)

Case Studies - Ethics in Nursing Leadership

Please choose one of the following situations and answer the questions that follow it. Please incorporate at least two additional sources from the literature/websites when providing your responses.

1. You are the nurse manager on a busy telemetry unit at a teaching hospital. You have a very varied skills/experience mix among your staff members, which allows them the potential to be good resources for each other. Even though care is provided in a thorough and timely manner, your staff is not always kind and supportive toward one another. This troubles you as a manager, as you realize that this has the potential to turn into a safety issue, as well as having the potential to affect patient satisfaction.

One of your nurses comes to you and tells you that a more senior nurse was acting in a rude and condescending way toward one of the new graduate orientees on your unit. The new graduate that was involved has not come to you to mention this, and you did not hear the exchange for yourself- it was only reported to you by the concerned nurse. Please consider the following questions and note your responses.

a. Which ethical principles have been violated here? How? b. As the manager, what would your next steps be? c. As the manager, how would you go about creating a more positive culture on your unit, so

this does not happen again? d. What type of leadership/management style would be most effective in dealing with this

situation?

2. You are the nurse manager on a Labor and Delivery unit at a Level III hospital. A new neonatologist has recently come on staff with a plan to resuscitate preterm babies born at 22 weeks and above, if the parents wish for that to be the course of treatment. Previously, the cutoff for resuscitation had been 24 weeks and above. The staff has expressed many concerns over this policy change, but the neonatologist has been very dismissive of their concerns and will not sit down for a meeting with the staff to discuss this.

You have had a patient admitted in pre term labor who is 22 weeks and on the edge of viability. The patient and her husband have noted that they want everything done for the baby. The nurse who has been assigned to care for this patient comes to you and notes that she is having moral distress around the fact that the patient wants to resuscitate a neonate who will likely have many medical problems if resuscitated, and will quite likely die, despite the heroic measures employed to save his/her life. She also notes that as the guidelines have been shifting around gestational age and resuscitation efforts, many of the staff are becoming uneasy as to their roles and responsibilities in these cases and are considering refusing to accept responsibility for these patients.

a. Which ethical principles should be considered in providing care to this patient? b. What advice would you give this nurse in providing care to this patient? c. What can you do to foster more of a cooperative, team environment on your unit?

d. What type of leadership/management style would be most effective in this situation?

3. You are the manager on a med/surg unit where there are many elderly and confused patients with various different diagnoses. There are often times where you need to schedule sitters to sit with these patients overnight so they do not fall and injure themselves. Many times, they are your own unlicensed assistive personnel (UAP), doing overtime to make some extra money.

When you get to work one morning, you notice that the night shift charge nurse has left you an incident report regarding a fall that happened on that shift. The sitter assigned to the patient had fallen asleep, and as a result, the patient climbed out of bed and fell trying to get to the bathroom. The patient is complaining about severe pain in the right leg and is being evaluated for a fractured hip. The UAP involved has worked on your unit for 10 years. She has always been a hard worker that prides herself on a job well done. She is distraught and tearful over what has happened to this patient. Please consider the following questions and note your responses.

a. Which legal and/or ethical principles have been violated here by the staff? How? b. As the manager, what action would you take with the sitter? c. As the manager, what action would you take with the charge nurse? d. What type of leadership/management style would be most effective in this

situation?