Chapter 5 : Nursing and Ethics

Section 3. Presentation of Issues

Collective Responsibility

Consider a case focusing on the role of the nurse:

1.Whistle Blowing

Dr. D: surgeon

Nurse N: scrub Nurse in OR

Dr. D is about to perform a surgery. Nurse N observes Dr. D with a dirty gown and about to enter the OR with the same surgical gloves as were worn in a surgery preceding the surgery that was about to take place.

Nurse N: Doctor don't you want to change those gloves?

Dr. D: Who are you to tell me what to do?

Should N continue to assist D in the surgical procedure? Should this event be reported? If so, by whom and to whom? What should be done then? Now the nurse is responsible for maintaining aseptic conditions in the OR. What can she do, particularly, if the surgeon is on the board of directors of the hospital?

Nurses are sometime in the middle of a conflict between various groups involved in health care and the recipient of health care. Nurses are educated in their role as patient advocates and protectors and yet they often have little authority with which to carry out their responsibilities. They are often given responsibilities but with little authority to effectively carry out those responsibilities. The individual nurse involved in the case above might be powerless to effectuate change or even to protect the recipient of care from harm. However, nurses as a collective might have the power to do so.

There is the notion of Collective Responsibility which is realized in cases such as that above. The nurse as an individual is caught by the tension between the directives given by administrators and superiors and the best judgments of the nurse based on training , experience and assigned responsibilities. The nurse is to act in the interest of the recipient of the care. What if this means acting against other health care providers, such as physicians who are operating under the influence of drugs, have contaminated clothing on, or are prescribing the wrong dosage of a medication?

Conditions for Collective Responsibility :  by James Muyskens

see:  Muyskens, James L. Moral Problems in Nursing: A Philosophical Investigation. Totowa, NJ: Rowman and Littlefield, 1982.

1. Members of a group perform undesirable acts.

2. They act in accord with the group's way of life or culture.

3. The aspects of the undesirable acts are below the general standards set by the group.

4. It is not necessarily the case that the individuals are falling below those standards, least wise not of their own accord.

Nursing is a career which is also a profession. It is chosen by its members. They are recognized by government. They are licensed and given control over their membership through an educational and certification process. Nurses can use their collective control over their profession, who enters it, the standards it sets for conduct in order to produce changes that conform to the highest level of behavior and standards of care.

Nurses who individually may not have the authority to observe their own standards might possess that authority collectively and are collectively responsible to act to preserve and protect the health of those they serve.

Consider the case above as an example of the application of the concept of collective responsibility. If the nurses at the health care facility which has Dr. D on its Board of Directors acting collectively were to issue a statement that insisted that there must be more effective measures to insure aseptic conditions to protect the health of staff and recipients of care that might lead to an effective change. If that were not successful then specific requests could be made and then a work stoppage or job action. In taking these measures collectively they are more powerful and effective than the actions of an individual nurse. In acting in this manner they would be exercising the collective responsibility that the profession has towards those they serve.

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Copyright Philip A. Pecorino 2002. All Rights reserved.

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