Running head: ETHICS PAPER

Why Words Matter

Bridge to Practice Ethics Paper
Christie Macey
James Madison University
April 10, 2015

Running head: ETHICS PAPER

INTRODUCTION
Nurses frequently encounter negative discussions about clients in the workplace.
According to a former UK health secretary Stephen Dornell, nurses who gossip about patients
behind their backs are uncompassionate, incompetent, and unprofessional (Gillen, 2014).
Gossip is a part of a phenomenon called horizontal violence which is prevalent in nursing
(Weinand, 2010). Horizontal violence consists of behaviors comprised of gossip, innuendo,
scapegoating, passive aggressiveness, and bullying (Weinand, 2010). Health care professionals
experience the consequences of horizontal violence, and therefore gossip, regularly. Furthermore,
many individuals ignore forms of horizontal violence which worsens the situation and can lead to
job dissatisfaction, leaving a position, and emotional distress (Weinand, 2010).

BACKGROUND
During clinical on the family birthplace unit, a newborn was delivered to a mother who
had a history of Percocet abuse. It was reported that the patient had stopped using Percocet for
the last three months up to her babys delivery but had been using Percocet for the first six
months during her pregnancy. After report, I overheard the nurses being skeptical about how the
patient passed her most recent drug test. They vocalized that they thought she might be lying and
speculated that she had used someone elses urine. In addition, they said it was her own fault
her baby was fussy due to the abuse of Percocet during her pregnancy. While this discussion
was taking place, I remained silent. However, a potential alternative to this situation was
speaking up for the new mother. I could have defended the patient while the conversation was
taking place, or in private after the nurses were finished talking. Another course of action would
have been to bring up the issue with my clinical instructor and ask for guidance.

Running head: ETHICS PAPER

In this situation, I experienced moral distress. I did not do the right thing because of the
power differences between myself and the practicing nurses, and for fear of being ridiculed.
Additionally, I perceived that the nurse leading the discussion disliked teaching students and
therefore would not be open to discussing the situation with me if I had brought it up to her.

METHOD
The James Madison University Eight Key Questions were used to interpret this
experience. The Eight Key Questions are a tool created by JMU that students can use when they
need guidance in ethical situations (The Madison Collaborative, 2013). They can help make
confusing issues more understandable, which can aid decision making. Specifically, JMU
nursing students can take the Eight Key Questions beyond clinical into their future nursing
practice when they are faced with ethical dilemmas or moral distress.

FINDINGS
What is the fair or just thing to do? In this situation, the new mother should have been
given respect and dignity. This includes not discussing her health issues when she is not present
because ultimately she is a patient that came to the hospital for help and proper treatment.
What are the short and long term outcomes for all involved? The kind of discussion
that took place can have a negative impact on the treatment and care this woman receives, even if
the nurses on the unit are unaware of it. For example, before the gossip began I did not have a
bias towards the baby or the new mother. But after the discussion when I saw the patient on the
unit, I had a negative outlook that tainted my experience. Similarly, the nurse in charge of the
new moms care may treat her differently even though she may not intend to. For example, she

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could forget to get that patient more water or blankets when she would not have forgotten under
ordinary circumstances. Failing to address this behavior with the nurse is also communicating
that gossiping about patients is acceptable in the hospital. This inaction makes it more likely that
the nurse will exhibit such behavior again. In summary, gossiping about clients can lead to
negative patient outcomes and promotes a hostile work environment.
What duties or obligations apply? I was aware that this discussion did not align with
the codes and ethics of nursing, but I was also feeling that it was not my responsibility to speak
up because I was not an actual employee of the hospital. I think the nurses on the unit had a
responsibility to uphold the values of their work environment, which includes not judging or
speaking negatively about the actions of their patients.
What action reflects best reflects who I am and the person I want to become? The
person I want to become would have spoken up. I also acknowledged this type of behavior as the
kind I do not want to emulate in my own practice.
How does respect for freedom, personal autonomy, or consent apply? This patient
could not speak up for herself so it was unfair to discuss her private life while she was not in the
room. While many people may not agree with the new mothers choice to abuse Percocet during
her pregnancy, she still has a right to be autonomous and make her own decisions for herself.
What would I do if I cared deeply about those involved? If it was my mom or sister that
was being mistreated, I would have spoken up and switched hospitals the next time someone in
my family needed care. I may have even written a letter or placed a formal complaint to the
department of human resources or to the nursing supervisor. I may also have shared this
experience with members of my community, who may not choose that hospital based on the

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experience I revealed to them. Losing patients would also affect the running for any awards or
Magnet status the hospital was hoping to achieve.
What do legitimate authorities expect of me? Provision One of the American Nurses
Association Code of Ethics states that nurses should practice with compassion and respect for
the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of
social or economic status, personal attributes, or the nature of health problems (American Nurses
Association, 2011). In this situation, the nurses on the unit were not acting with respect and
were letting the patients drug abuse act as a barrier to viewing her with compassion, and
therefore they were not upholding the professional Code of Ethics of Nursing.
The last question to be asked is, what rights apply? Patients have the right to privacy
and speculating about her private life went against that right. The patient also trusted her nurse to
act in her best interest as her patient advocate and engaging in workplace gossip did not uphold
that trust.

CONCLUSION
After answering the Eight Key Questions, next time a situation like this arises I will bring
it up with my clinical instructor and I will consider communicating to the nurse in private about
her actions. The Eight Key Questions gave me a better understanding of why speaking up would
be the right decision. I am also better able to identify the barriers preventing me from choosing
the right action, and I now understand that I am not forced into inaction. The Eight Key
Questions are incredibly useful in uncertain situations like the once I faced, and can help lead me
to better decisions in the future.

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References
1. Code of Ethics Overview. (2011, January 1). Retrieved April 11, 2015, from
http://www.nursingworld.org/Mobile/Code-of-Ethics/code-of-ethics.html
2. Eight Key Questions. (2013, January 1). Retrieved April 8, 2015, from
https://www.jmu.edu/mc/Docs/131101 8KQ Handout Revision.pdf
3. Gillen, S. (2014). Fee rises could further damage our reputation, admits NMC
boss. Nursing Standard, 28(31), 11-11.
4. Weinand, M. (2010). Horizontal Violence in Nursing: History, Impact, and
Solution. JOCEPS: The Journal of Chi Eta Phi Sorority, 54(1), 23-23.