A nursing ethical situation

SCENARIO - Youâ??re the manager of a brain injury rehab unit

Even though this situation involves a nurse, I think the non-nurses in our class will see the ethical issues...

You are the nurse-manager of a brain injury rehab unit. Many of your patients are ambulatory â??wanderersâ? who need to be protected, but itâ??s NOT a locked unit. Staff re-direct wandering patients back to the unit. Your unit has a security system using ankle bands that alarm when a patient tries to leave, but some of the higher-functioning patients learn to remove the bands. These patients are very vulnerable if they leave the facility, since their judgment is typically very impaired. Thus, assuring patient safety and security is a major nursing priority.

After a hard week, youâ??re heading out for a weekend getaway. At 5:30 pm, on your way out, you overhear one of the nurses asking if anyone has seen Mr. Jones yet. You inquire, and learn that this nurse hasnâ??t seen her patient since the shift started at 3:00 pm. You question her further, and she dismisses your concerns by saying â??his wife probably took him to the cafeteriaâ?

A quick check of his room reveals that all his clothes and his suitcase are gone. Mr. Jones is nowhere to be found, and the nurse hasnâ??t even looked for him. You pull the chart to start making calls, and notice that the charting for this night has already been done, including vital signs at 4:00 and 8:00 pm, scheduled meds given at 5:00 pm and 9:00 pm and a PRN pain med at 10:00 pm. You question the nurse, who casually indicates that she considers him a stable patient and charts â??the usualâ? in advance to make the night easier, but would change it later if something different happens. This nurse has worked on the unit for 3 years. Upon further investigation, youâ??re convinced that this is not a practice among other staff, and youâ??re shocked to see that this nurse doesnâ??t see any problem with any of her actions. Prior to this, the nurse has been a marginal worker at best.

What are the ethical and / or legal problems withâ?¦
â?¦not checking the whereabouts of the patient?
â?¦charting â??in advanceâ??

Should the nurse be fired, or just disciplined?

If you choose to fire the nurse, why did you choose that?
If you choose to discipline but retain the nurse, why did you choose that?

NOTE: For this scenario, assume that your facility policy solidly supports any disciplinary action, up to and including immediate termination. Don't speculate about the legalities; in these circumstances it would be legal to terminate immediatelyâ?¦the choice is up to you