Question

Analyze the case using the 8-Step Model for Ethical Analysis; Gather the facts, Define the ethical issues, Identify the affected parties, Identify the consequences, Identify the obligations, Consider your character and integrity, Think creatively about potential actions, Check your gut.

Case Information

Josh O’Shaun, newly appointed CEO of Morris County Hospital (MCH), faced many problems in his 200-bed facility. One of the most pressing, in terms of patient service, was a nurse retention rate that continually caused understaffing. His root-cause strategic plan included hiring a chief nursing officer (CNO) who would have equal status on the O Team. He was fortunate to hire Nicole Franz, a well-respected RN, for the position. During the first staff meeting, Mr. O’Shaun asked for ideas on how to deal with the nurse retention issue. Ms. Franz presented research that showed that lack of respect for nurses contributed to this problem. With the support of their O Teams, other hospitals had instituted a policy of zero tolerance for physical, sexual, and verbal abuse. Specifi-cally, they had implemented a program policy called Code White Coat. In this program, whenever a physician or other health professional acted in an abusive way, the nurse could call a “code white coat.” This action would bring available nurses to stand as witnesses to the event and, if possible, intervene in the immediate situation. Research results in other facilities showed this policy led to a significant reduction of abuse incidents. Her suggestion led to a lively discussion about differences in percep-tions of the nurse retention problem and lack of respect for nurses. The chief of medical services (CMS) said that physicians were there to save lives and had a right to get angry if nurses did not perform according to their standards. He believed that tales of nurse abuse at MCH were just gossip. The chief financial officer pointed out how much the cur-rent turnover rate cost the hospital but did not have an opinion about its cause.After much debate, the O Team decided to try a new policy that did not tolerate abuse in any form and then instituted their version of the Code White Coat program on a trial basis. They decided to evaluate the program one year after its implementation to see if it had made a difference in both turnover and morale. The CMS, although he thought the program was laughable, agreed to support it.After the MCH staff training, there was an increased consciousness of the lack of respect for nurses, and that factor, in and of itself, seemed to decrease the incidence of nurse abuse. However, after three months, Mr. O’Shaun heard a “code white coat” called. He quickly responded and found Dr. Peters, his only neurosurgeon, still screaming at a nurse. Two other nurses were present as witnesses to this action, but their presence did not stop the physician. Through colorful language, he accused the nurse of being insubordinate and unprofessional.Mr. O’Shaun asked Dr. Peters to come to his office immediately and contacted the CMS for a conference. He also called the CNO and asked her to meet with the nurse and her witnesses. He needed Ms. Franz’s report before considering final action on the situation. By the time the CMS arrived, Dr. Peters was calmer and explained what had made him so angry. Many personal factors besides the nurse’s behavior contrib-uted to his outburst. However, he felt that the nurse did not act quickly enough to his order. He also stated that, since he was a neurosurgeon, he had the right to treat nurses any way he chose. After all, he held patients’ lives in his hands. He was aware of the hospital’s policy of zero tolerance for abuse, but he did not think he was abusive: All he did was raise his voice.The CMS explained that there were other ways to deal with the situation other than public outbursts and abusive language. He emphasized that the zero tolerance policy applied to physicians as well as the staff at MCH. The CMS warned Dr. Peters that continuing such behavior could lead to sanctions, including loss of privileges if necessary. He also asked Dr. Peters if he would like to have assistance with anger manage-ment or other counseling. Seeing that the new policy was not just a joke, Dr. Peters said that he would apologize and watch his temper in the future. The CMS then said that Dr. Peters would receive notice if the hospital decided to take further actions.After Dr. Peters left, Mr. O’Shaun, the CNO, and the CMS met to discuss the situation. The CMS expressed surprise that this incident happened. He knew that physicians were demanding, but he had never thought the issue of nurse abuse was real. The CNO said that she was not at all surprised. The incident was in keeping with some of her observations of physician–nurse interactions at the facility. After much discussion, the team decided that the appropriate ethics response required some action on this incident. Dr. Peters received a warning letter to document the incident and drive home the serious-ness of the matter. The letter also mandated that Dr. Peters attend an information session on the zero tolerance policy and anger manage-ment counseling.

Answer 1

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