Editor’s Letter
Happy spring everyone! The daffodils are blooming, the snow has melted and baseball has started up again, a sure sign of better weather to come. Here in New England we just witnessed the 113th running of the Boston Marathon. If you didn't get a chance to see it, the women's division showcased an amazing race, which was literally neck and neck down to the last second, in which the first place runner won by a mere .01 second. It was amazing to witness such focus and determination, and also served as a reminder I may need to get out and exercise a little more. Enjoy and see you next month.
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Ethical Dilemma in Nursing and Moral Distress
There has never been a time where there exists so many advances in medicine and technology which allow healthcare professionals including nurse RNs and travel nurses the ability to offer a wide range of treatment options. At the same time insurance and administrative restraints, rising healthcare costs, and scarce resources can lead to ethical issues and conflicts. As cultures become more diverse, a difference in beliefs about treatments may exist between providers and patients which in turn leads to ethical dilemmas.
Moral distress occurs when a provider struggles between what is an ethically appropriate treatment for a patient and the inability to discuss their views. Many healthcare facilities have ethical committees and consultants to address this issue. Even nursing and medical schools are addressing ethics in their programs, recognizing the need to provide professionals with the skills to address these conflicts.
Yet many nursing professionals still feel this is a reoccurring issue. Many responded to a nytimes.com article about moral distress agreeing that is was a big concern and that the threat of malpractice and insurance requirements are contributing factors. Some suggested having patients fill out a treatment directive would help in alleviating this problem. Clearly many professionals had left or were thinking about leaving the nursing profession due to the strain of dealing with moral distress. Several critical care nurses had witnessed family members, who were facing a family crises and, desperate not to lose a loved one, would make decisions in the family's interest and not necessarily the patient's. The occurrence of a situation where the patients best interests or wishes are not always respected during end-of-life care due to families insistence on prolonging the inevitable only grows each day with advances in medicine coupled with an increasing rise in an older population. In addition, many voiced the opinion that today's medicine is not about prolonging life but rather about improving quality of life and some even agreed that euthanasia should be legalized.
In regards to this issue, the Hospice Foundation of America will be presenting a program live via satellite and webcast on "Diversity and End-of-Life Care". The program aims to discuss challenges faced by healthcare professionals whose cultural values may differ with those of patients and families and how we can respect and support each other even though our beliefs and preferences may differ. "Our goal in hosting this teleconference is to increase sensitivity by helping professionals in our community acknowledge how their own cultural values and assumptions influence the delivery of care. There are many times when cultural considerations may cause ethical concerns or moral distress and this program will discuss those challenges," Community Relations Director for Heart To Heart Hospice Tiwana O'Rear said. The teleconference will be broadcast Wednesday, April 29. More information can be found at http://www.hospicefoundation.org/teleconference .
Nurses On The Go
Seven months ago my husband announced that he was just laid off from his marine construction job. I looked around our dream home, one block from our beloved ocean...the Olympic-sized pool in the backyard and an upstairs deck for our teenagers to hang with their friends. There was, I admit, in a brief moment of panic, but then the reality set in.
"I can go back to nursing," I reminded Dave. We smiled at each other. I'd had a couple of years off, to work on my writing, but both of us had always known that someday I'd go back. "Someday just came a little sooner, honey," I added, giving his arm a squeeze as I Googled nursing jobs in our area.
My nursing career of two-plus decades has provided a steady and certain ability to support my family, regardless of economic well-being or instability. Wherever we've lived, when I was married, when I was a single mom, I have been able to find work. People get sick wherever you live, and no matter how tough times are, patients always need their nurses.
So here I am, sitting at my desk, writing. From time to time, I gaze out my window at waves crashing and seagulls diving in the ocean, and I smile, content in my life, and the lessons I have learned along the way. I am a nurse, and after 26 years of giving of myself and my talents to those for whom I care, I realize more and more what nursing has meant to me.
Nursing has benefited me in more ways than one. Inherently restless, never one to sit still or in one place for long, I have taken full advantage of the varied opportunities to do wildly different kinds of nursing jobs. I've happily traded pediatric scrubs for street clothes and a lab coat when I went from pediatric med-surgery to psychiatric nursing, and just as easily transitioned back into scrubs when I tried out home healthcare in a rural area. I fed my lust for travel as a missionary nurse in the Philippines, as I learned Tagalog, the local dialect and struggled to adjust to a culture that was so much more grateful and so much less materialistic than my own.
When I had a temporary burn-out in my early 40's, I went to work as a health reporter at a newspaper. I stayed there for two years, and garnered that year's Georgia Nurses Association's Media Award, reminding me that I was truly, a nurse at heart and I returned to the field.
The variety of my experiences, as myriad in color and shape as the pieces of a complicated puzzle, somehow fit together in one exciting, adventurous whole. I believe true, real nursing encompasses so much more than the physical realm. Caring for patients requires attention to three other, just as important, if less obvious, areas: the mental, the emotional and the spiritual arenas.
This was brought home to me early on, in my first year as an R.N. A pediatric nurse at a large teaching facility, I had a patient with priapism. Only 12 years old, he was in fairly constant discomfort and rang his call bell often. One evening, less than 15 minutes before it was time for me to give my report to the night nurse, I stopped by to answer his call. He was lying there, pain contorting his face, with big tears rolling down his cheeks. I realized that it wasn't all about the physical pain. A few minutes talking to him revealed that he missed his mother terribly and wanted to call her, but he didn't know how to use the phone card she'd left for him. "She can't come see me because there's nobody to take care of my little brothers and sisters," he explained, sobbing by this point. "And we don't have a car." I glanced down at my watch. I had just enough time to sign out his Demerol and give it to him. I would be late with my report, no matter what the night nurse said. I showed him how to access an outside line and how to use the card. By the time he took his pill, he was talking to his mother, tears dried and a little smile on his face.
That moment has stayed with me, crystal clear. From the pediatric floor to the psych unit, from my stint as an occupational nurse to my most recent job as a school nurse, in all my "faces" as a nurse, holistic care remains my trademark, my unofficial calling card.
Thanks to Donna for her wonderful submission to this month's Nurses On The Go segment. If you would like to have the chance to get published in our monthly newsletter and be eligible to win a $50 VISA gift card, we would welcome your submission. All submittals should be between 500 and 800 words. To submit a story, send an email with the subject line Nurses On The Go story submission to info@nurse-recruiter.com.
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