Ethics in perioperative practice—duty to foster an ethical environment

AORN Journal,  Sept, 2002  by Patricia C. Seifert

• E-mail
• Print
• Link

The formation and maintenance of an ethical environment is a shared responsibility that requires the effort of all individuals in the workplace. Roles may differ, resource allocation may vary, and formal power arrangements may be unequal, but each individual carries the same moral weight and retains the same obligation to serve as an advocate for an ethical environment.

CASE STUDY ONE

A nurse employee of an ambulatory surgical center went to the facility for a breast biopsy. Upon her return to work, the nurse was approached by colleagues who expressed their concern and sympathy for her confirmed diagnosis of breast cancer. The nurse was disturbed that her coworkers, who were not involved in her care, were aware of her diagnosis.

Patient confidentiality represents an important ethical principle that applies to patients who are unknown previously to caregivers and to patients who are professional colleagues and coworkers. Although coworkers may be well-meaning in their expressions of concern, they have breached an ethical, regulatory, and, possibly, a legal standard that permits access to a person's health information only by health care workers directly involved in the care of that patient. Only the individual patient should disclose such information to those not involved in his or her care.

In a setting where confidential information is not respected and protected, it is difficult to establish an environment of trust or maintain fidelity to patients who should be able to expect that personal information will be kept private and confidential. There is potential harm to the patient, as well as the entire workforce whose members may question whether they themselves will be respected. Employee trust and loyalty may be threatened, which in turn can jeopardize the effectiveness of the health care team. Patients and staff members have a right to expect that private information, thoughts, and beliefs will be kept confidential. (30)

CASE STUDY TWO

A clinical educator developed an extensive perioperative internship program that was to be offered in several institutions of a large health care system. The program was to be copyrighted and published by the employing institution. The nurse author submitted the program to her supervisor for final review. Two months later, the educator saw her program and noticed that the supervisor's name was listed as the author of the work. The educator's name was not listed. The educator went to the supervisor and questioned her about the change; the supervisor replied that, as the department head, she had the right to be credited with all work done within the department. The educator questioned the propriety of such a directive and was told by the supervisor that the educator had agreed to this as a condition of employment. When the educator denied having made such an agreement, the supervisor retorted that the educator would have to resign if she did not agree to the condition. (31)

A number of issues are raised in this example. Neither an employer nor an employee can unilaterally change the agreed upon conditions for employment. When an employer does change the employee's working conditions without the employee's knowledge or consent, the principles of veracity, justice, fidelity, beneficence, nonmaleficence, and autonomy are compromised. The supervisor was dishonest to claim the work as her own. The employee had a right to seek recourse through the institution's grievance process or through legal action.