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Ethical and Legal Courses of Action - Case Studies

In each case, answer the questions at the end of the case and also give researched references to support your assertions and explain what would be the ethical course of action and the legal requirements for action in the case.

Case One

Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of six months, she noticed that all patients admitted from the shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis. There appeared to be patient abuse in the nursing home. Mrs. Lewis investigated discreetly and found no explanation possible except abuse. In accord with the obligations of the law in her state, she reported the matter to the Department of Welfare Bureau of Inspection.
The Welfare Department investigated immediately, found proof of abuse, and threatened to close down Shady Rest if there were any more recurrences. Mrs. Lewis was overjoyed until her hospital administrator, bypassing the director of nursing, called her in and warned her that she would be fired if she reported any other instances of abuse. Shady Rest sent the hospital a lot of business, and good relations had to be maintained.

Mrs. Lewis was even more shocked when she discovered that the administrator was a golf partner of the owner of Shady Rest and was doing an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a lawyer, who threatened the hospital with exposure and with penalties that would follow if one of its employees failed to follow the reporting provisions of the law on abuse in nursing homes.

Did Mrs. Lewis act correctly? What should she have done if she could not have afforded to consult with a lawyer? In what ways can whistle-blowers protect themselves? Must the art of intimidation be part of the toolbox of health care professionals in order to protect their patients? Is power an appropriate consideration in health care ethics?

Case Two

On a July weekend, Mrs. Allesfertig, nursing supervisor of the whole hospital, discovered that the intensive care unit was seriously understaffed. She pulled two nurses with previous ICU experience off other floors to bring the unit up to strength in view of the extreme level of acute care needed. On the following Monday, Dr. Bestknabe, who has overall responsibility for the ICU unit, closed the unit for further admissions until the staffing had been worked out on a permanent basis.

Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU nurses?

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Case One

Mrs. Lewis acted correct in this manner by contacting the proper authorities. It is always an obligation of the law to report any type of abuse in a vulnerable population such as elderly or children. Shady Rest was given the proper recourse by a warning to have no more reports of abuse or they would be closed. Having Mrs. Lewis' administrator use his authority to chastise her was a blatant use of power of his position to over step the legal laws of the state. He is in a position to be removed from his own job as an administrator or the chance of being ...

Solution Summary

The ethical and legal courses of action case studies are examined. Nurses authority to refuse to admit patients when the staff is not sufficient to handle them is determined.