Nurses are altruistic, caring, and competent practitioners. Nurses are often considered “angels” by the public. The most recent Gallup pole reveals that 79% of the public view nurses as “high” or “very high” on ethical standards. Nursing, as a profession, is held to high ethical standards of care and the ANA Code of Ethics for nursing, provision 3, states “The nurse promotes, advocates for, and protects, the rights, and safety of the patient.” What happens when our compassion for others clashes with the ethical standards by which we are held? This one unfortunate story about a nurse who found herself in such a dilemma. The nurse was reported to the employer by a colleague for patient-nurse boundary violations and HIPPA violations.
A registered nurse, who adopted the child of a former patient, was sanctioned by the Iowa Board of Nursing for violating state regulations “that prohibit nurses from attempting to initiate an emotional, social , or business relationship with a patient for personal gain regardless of the patient’s consent. In addition, the board has charged Simon with violating patient confidentiality regulations” according to an article by the Iowa Capital Dispatch. Another factor in the case of ethical dilemma is one of position and power. The nurse as the professional, has a greater position to influence the relationship as she possess the “expert nursing knowledge” to provide care and the critical information need for the patient. The nurse has the greater “power” as the nurse in the position to make life or death decisions that the patient cannot do for his or herself. For example, the nurse has the information related to the medication schedule, dosage, administration technique to deliver insulin to a new diabetic. The nurse takes the blood sample for the monitoring test and had the results. The nurse is the keeper of the knowledge and therefore, has a higher responsibility as a professional. The patient may ask the number, The patient was in the country on a visa and had to stay in school or face deportation. The patient could not care for her son and attend school, creating an ethical dilemma for the patient. One could argue that the nurse had “power” over the patient as if she did not adopt the child, the patient would be deported. I cannot say that the nurse was cognizant of this nuance, but it is one to consider in this case, as ethical dilemmas often need to balance the power dynamic. The nurse was ordered to complete 30 hours of continuing education on patient privacy and take a 3 day course on professional ethics.
The nurse, in this case, was employed as a labor and delivery nurse and took care of the patient and her newborn son. The state alleges that the nurse discussed the option of adoption while the patient was in the hospital. The nurse reports that the patient contacted her after she was discharged from the hospital through Facebook. The nurse, who already has children, says she did not want to adopt another child initially. This is where things can get sticky. What are your employers’ rules about communicating with patients via social media? What is in your nurse practice act about maintaining a relationship with a patient outside of the professional relationship? Nurses should review the nurse practice act of the state in which they reside. There may be specific guidelines regarding the relationships between nurse and patient. As a general rule, if there was no prior relationship, it is unethical for a nurse to enter into social relationship with a patient, even though the patient may give consent and/or initiate the relationship, under the assumption that patient could conceivably be a repeat patient of the nurse. This restriction may also extend to the family members of the patient. For example, an elderly patient is in the hospital. Her son comes to visit and he asks out the nurse. Should the nurse go on a date with him? This is where it can be difficult to discern if enough time has passed and if there are ethical boundaries that may be crossed. A nurse should ask her state of board of nursing for clarification, ask her employer about the hospital policy, and in some cases, consult an attorney.
Unfortunately for this nurse, the board sanction was not the only consequence. The nurse had secured employment with a new hospital. In a subsequent story by the Iowa Capital Dispatch, the nurse was “fired” after the board mistakenly listed her as “financially exploiting” the patient. The hospital reviewed the erroneous information on the website and subsequently, fired the nurse. The nurse’s attorney contacted the board and had the information corrected. The nurse at the time of the article has not been rehired.
The nurse and the patient may have both had the best intentions. The child in question is reported to be doing well in his new home and the patient has continued school. This is not an indictment against the nurse. It is how, despite our best intentions, when we do not understand ethical boundaries, we can fall victim to a breach in the standard of care.
This article is for general education and discussion. It is not intended to serve as legal advice nor to serve as an expert opinion on this case on breaches on the standard of care.
References
https://news.gallup.com/poll/467804/nurses-retain-top-ethics-rating-below-2020-high.aspx
https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
https://iowacapitaldispatch.com/2023/02/17/nurse-who-adopted-patients-baby-is-sanctioned-by-the-state/
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