Marisa received her BSN nine months ago and has been working in an eight-bed ICU in a small rural hospital for the past three months. Initially thrilled to be offered this position, she is beginning to regret coming onboard. As the latest hire, she frequently works the night shift, 7 p.m. to 7 a.m., and often has been asked to pick up extra shifts. The differential for nights and overtime pay is welcome because Marisa has large college debts. She rarely is finished with her work at the end of the shift and routinely stays late to finish her documentation. Moreover, she learned the hospital is losing money and tightening expenses, which has resulted in a decision not to replace the two critical care nurses who left the hospital last month. Marisa is thinking about leaving but doesn't want to make conditions worse for the nurses who remain. Each night nurse has three critically ill patients to care for, and Marisa knows this patient-staff ratio is unsafe. Marisa originally thought working nights would be great and would give her lots of time for being with family, working out during the day and running errands. Now she only wants to sleep, has no energy and realized she gained seven pounds as a result of ordering fast food at work and using food as a coping mechanism.
Guidance from the ANA Code of Ethics
Provision 5 of the ANA Code of Ethics for Nurses states, "The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth." This provision first appeared in the 2001 revision of the code of ethics. Members of that writing group explained their careful use of duty versus rights language, "One can choose whether or not to exercise a right, but duties are non-negotiable." Provision 3 of the ANA Code of Ethics for Nurses states, "The nurse promotes, advocates for, and protects, the rights, health and safety of the patient." The interpretive statements make clear that nurses have a role in developing, implementing and reviewing adherence to policies that promote patient health and safety, reduce errors and waste, and establish and sustain a culture of safety.
Scenario 1
Marisa confers with one of the senior nurses who always seems to get her work done on time. Jane shares with her that "It gets easier with time ... be patient. All we can do is to give an honest day's work for a day's pay. What doesn't get done doesn't get done. I stopped letting this bother me." Somehow Marisa doesn't think she will ever be able to adopt Jane's laissez-faire attitude - especially with patient safety and her own professional integrity at stake.
Scenario 2
Marisa knows her concerns are not unique and she asks the charge nurse if she can explore her concerns at the next staff meeting. She begins to research the literature on safe staffing and also finds articles demonstrating improved patient outcomes with appropriate nurse staffing. She is hopeful that senior nurses can help her make the case for improved staffing with senior leadership. She also wants to voice her concerns about staff health and wellness and is hopeful that a group wellness initiative might be beneficial to everyone on the unit. The unit culture supports unhealthy self-care behaviors. The Code of Ethics makes clear that eating a healthy diet, exercise, rest, maintaining family and personal relationships, engaging in adequate leisure and recreational activities, and attending to spiritual needs are the responsibilities of each nurse to counter fatigue and compassion fatigue. Nurse leaders are charged with helping nurses in their organizations to balance self-care and work to promote health and well-being.
