Running Head: BRIDGE TO PRACTICE ETHICS PAPER

Bridge to Practice Ethics Paper

Marissa V Mitrovic
James Madison University

Running Head: BRIDGE TO PRACTICE ETHICS PAPER

INTRODUCTION
Nurse to patient dishonesty is an extensive problem in the health care setting. According
to a USA Today article, many people have followed the advice that white lies are acceptable if
the lie was told to avoid hurting someone (Malloch, 2001). Even in the health care setting, health
care leaders have told their share of white lies over the years and the rationale has continually
been the same: avoid hurting others, avoid making anyone uncomfortable, or letting someone
else deliver an unpleasant message (Malloch, 2001). According to Mallach (2001), the need to be
liked often overshadows the importance of managing unacceptable behavior in the health care
setting, such as dishonesty. Nurses are viewed as individuals who have the highest of integrity
and moral standards (LaDuke, 2013). People trust nurses more than firefighters, policemen, and
doctors (LaDuke, 2013). When you lie in the workplace, your ethics, credibility, competence,
and who you are as a nurse and a person are questioned (Dishonesty, Deceit, and Deception,
2009). It is evident that if nurses are one of the most trusted professions, the dishonesty issue
needs to be resolved.
BACKGROUND
Starting as a second semester nursing student, I did not realize how much more I would
learn outside of the classroom, in the clinical setting. On my Labor and Delivery rotation in my
Womens Health clinical at Rockingham Memorial Hospital, I had a first hand experience to an
ethical dilemma. The night before I came in for clinical, a patient on the unit gave birth to a baby
girl. The patient was kept on the Labor and Delivery unit because of her post delivery severe
hypertension. The patient was 40 years old, with a 22-year-old son, and the father of the baby
had another family and was admitted to the Psychiatric unit that morning. On top of that the
patient had a positive drug screen, as well as no prenatal care. When the nurse that was with me

Running Head: BRIDGE TO PRACTICE ETHICS PAPER

was informing me about this patient and the situation, I asked about the drug screening protocol.
I figured that the drug screen was ordered for every woman admitted onto the unit, however, the
nurse answered differently. The nurse informed me that they only do drug screens on patients
that they think are suspicious, but they tell the patient that they perform the drug screen on
everyone as a protocol. Essentially, the patients who receive the drug screen are lied to by the
people they should trust the most: their nurse.
Going into nursing school and thinking so highly of the profession, it never crossed my
mind that there would be many ethical issues present on a day-to-day basis. This situation noted
above caused me such moral distress because I was conflicted with being dishonest with the
patient to not upset her versus being honest with the patient, since it is an important role in the
nursing profession. It was surprising that the nurse replied to my question in such a relaxed
manner, especially since it was not the answer that I expected. However, when I started to
explore both sides of the situation, I did not know what I would have done if I was the nurse of
this patient.
METHOD
James Madison University has eight key questions that reflect the best of humanitys
ethical reasoning traditions (Eight Key Questions, n.d.). They highlight the vital human values:
fairness, outcomes, responsibilities, character, liberty, empathy, authority, and rights (Eight Key
Questions, n.d.). These key questions were introduced to us in the beginning of our college
career to help us if we were in a situation that brought us moral distress.
FINDINGS
As I was analyzing the situation stated above, Provision Five stated in the ANA Code of
Ethics stuck out in my mind: The nurse owes the same duties to self as to others, including the

Running Head: BRIDGE TO PRACTICE ETHICS PAPER

responsibility to promote health and safety, preserve wholeness of character and integrity,
maintain competence, and continue personal and professional growth (Code of Ethics, 2015).
This provision stuck out to me because of the importance of maintaining a wholeness of
character and integrity, which was not being followed in this particular situation. I also utilized
James Madison Universitys Eight Key Questions to help give me a more in depth examination
of the situation at hand. In regard to fairness of the situation, I was tremendously torn because I
was capable of providing rationale for each side. If the truth was told that the staff on the unit
gave this patient a drug screen because there was suspicion, the patient could react in a manner
that would not be ideal. However, I also did not think it was morally correct to hold back
integrity and honesty from the patient as a professional that the patient trusts. I then thought
about the short and long-term outcomes that could result. Lying to the patient would provide
good short- and long-term outcomes because the nurse-patient relationship would remain healthy
and trustworthy. Also, since the patients blood pressure was already exceptionally high,
withholding the truth about drug screening could prevent the rise in blood pressure from anger
and stress. I then thought about my responsibilities at hand in this situation. Since I am a nursing
student and cannot implement any measures, since I am technically observing in a clinical
setting. However, if I were a registered nurse, my responsibility would be to provide my patient
with integrity and honesty, as noted in provision five of the ANA Code of Ethics. In terms of my
character in the situation, integrity is something that has been exceedingly important to me
throughout my life. I can understand why the miniscule white lie of drug screening has
benefits that are seen as good, but in my opinion, being truthful and maintaining integrity with
the patient is more important. Next, I considered the liberty in the situation, which involves the
respect for personal autonomy. In my opinion, the nurse disrespected the personal autonomy of

Running Head: BRIDGE TO PRACTICE ETHICS PAPER

the patient. If I were the patient, I would want my nurse to be honest with me, regardless of what
information was presented. I then considered my empathy for this patient and if the patient were
someone I cared about. If this were the case, the dishonesty of the nurse would truly bother me
and I would want my loved one to be told the truth. However, if it were a concern for the high
blood pressure, I would want the nurse to refrain from informing my loved one about drug
screening. Next, I considered the authority that would be involved in this situation. Since I am a
student nurse and was not the actual registered nurse for this patient, nothing is expected of me
from authorities since I cannot implement anything. Finally, I reflected on the rights that the
patient possesses in this situation. The patient has rights to be informed of everything that is
involved in their care at the hospital, which in my opinion includes being truthful about hospital
policies, unless it interferes with the health and well being of the patient. Analyzing both sides of
this situation allowed me to investigate my options if I was a nurse in a similar ethical dilemma.
CONCLUSION
This particular situation at hand truly brought me moral distress because at first, I was
conflicted as to what I would do if I was the nurse for this patient. Although I went about
analyzing the situation in the correct manner, I could have asked the nurse more questions as to
why the patient was lied to because the result might have had more beneficial aspects that what I
expected. However, already being uncomfortable with the nurses response to my question in the
situation noted above, there was not much more I could have done. Despite the moral distress
this situation caused me, it has taught me that nursing is not a cookie-cutter profession.
Awareness of the complexity of the nursing profession at large, whether it is good or bad, is an
important attribute to have. I think that possessing this awareness can help to properly manage
any ethically challenging situation that I, as a nurse, might encounter in my future.

Running Head: BRIDGE TO PRACTICE ETHICS PAPER

REFERENCES
Code of Ethics. (2011, January 1). Retrieved April 16, 2015, from
http://www.nursingworld.org/Mobile/Code-of-Ethics
Dishonesty, Deceit, and Deception. (2009, January 1). Retrieved April 16, 2015, from
http://advocatefornurses.typepad.com/my2cents/2009/07/dishonesty-deceit-anddeception-my-name-is-a-i-am-a-nurse-and-i-am-a-liar-.html
Eight Key Questions. (n.d.). Retrieved April 16, 2015, from https://www.jmu.edu/mc/8-keyquestions.shtml
LaDuke, R. D. (2013). ACADEMIC DISHONESTY TODAY, UNETHICAL PRACTICES
TOMORROW?. Journal Of Professional Nursing, 29(6), 402-406. DOI:
10.1016/j.profnurs.2012.10.009
Malloch, K. (2001). The White Lies of Leadership: Caring Dishonesty?. Nursing Administration
Quarterly, 25(3), 61-68.