Running head: ETHICS PAPER

Department of Nursing
Bridge to Practice Assignment Ethics Paper
Casey Hughes
James Madison University
4/19/15

Spring 2015
800 S. Main Street
Harrisonburg, VA 22801
hughe2ce@dukes.jmu.edu

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INTRODUCTION
In many clinical settings research has found that patients do not believe student nurses are
prepared and knowledgeable enough to care for the patient. Patients refusing care from student
nurses is a problem I have encountered frequently in the clinical setting. According to Suikkala
and Leino-Kilpi (2009) patients feel as if student nurses cannot easily solve problems the patients
face while caring for them. Suikkala and Leino-Kilpi also found that patients feel as if they are
receiving better quality of care if the instructor is watching the student closely to ensure patient
safety. In the clinical setting patients have the right to refuse care from student nurses if they feel
as if they wont receive the care they deserve. Torrance (2012) found that many RN participants
felt as if they would have a problem if patients started refusing care from students. Many RN
professors believe that if nurses have to ask permission from every patient for a student to
perform skills on them the patients might all start saying no. Students no longer able to perform
skills and care on patients will not gain the necessary knowledge and experience needed for after
the students graduate. Many studies found that the real life clinical setting is an integral part of
student nurses education. Without the hands on experience students cannot learn to apply what
they have learned in the classroom to a real life situation. However, there is a fine line between
needing the students to learn and obtaining consent from the patient. I have first-hand experience
of a patient not wanting to have skills performed by me because I was a student nurse.
BACKGROUND
In my womens health clinical I was given the opportunity to watch a vaginal delivery.
The nurse in charge of the patient had asked for the mothers permission to have myself and
another student watch the delivery. The mother agreed so the nurse told the mother that we
would only be watching and not caring for or assisting the mother in the delivery. A new nurse

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came in to help take care of the baby and mother. The baby was delivered and the second nurse
started to care for the newborn by bathing and weighing her. The nurse asked the other student
and myself if we would like to give the baby the vitamin K shot. Being the eager nursing
students we all are we both jumped at the opportunity. I was able to give the baby the vitamin K
shot for the first time. It felt good to be able to help with the delivery in some way. It was also
invaluable to be able to perform the skill instead of reading about it in a textbook. These hands
on experiences in clinical are the reasons I have gained confidence in patient care.
I administered the vitamin K shot and the two nurses went to the side and started
whispering to each other. Afterwards the first nurse told me she had promised the patient that the
students would not be caring for herself or her newborn. I was unaware that the patient had not
wanted students to perform any skills on the baby. Since she did not speak very good English the
nurse did not decide to bring it up to the patient because she did not seem upset with what had
happened. I felt guilty after the incident because I knew we had promised the mother we would
not care for them even though I was unaware of it. I was morally distressed because I had not
apologized to the mother for the misunderstanding that occurred. From a nurses perspective it is
very distressing to unknowingly violate your patients wishes. As a profession we do everything
in our power to take care of our patients and to make them comfortable in the hospital.
METHOD
The eight JMU key questions will be used to analyze the situation I have discussed. The
short and long term outcomes of the actions I took in response to the situation will be discussed.
Then I will discuss actions that are fair and equal to all parties involved in the situation. I will
talk about what legitimate authorities expect me to do such as the RNs involved in care for my
patient and the American Nurses Association. The freedoms and autonomy that apply to my

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patient and what rights she has will be included. My responsibilities to the patient as a student
nurse will be included. If my patient were my sister or family member how I would react to the
situation will be discussed. Finally, how will the actions I take in an ethical dilemma help me to
become my ideal self and nurse? (James Madison University, n.d.).
FINDINGS
The eight JMU key questions are answered to demonstrate how the morally distressing
situation was addressed. The short term outcomes of treating a patient when she was told a
student would not be caring for her could be anger towards the people involved. Patient
dissatisfaction can be a major problem that can lead to decreased quality of care and lack of trust
between the patient and the nurse. The nurse must keep their word to the patient and do as they
wish in regards to their care. The legitimate authorities in this situation are the RN responsible
for the patient and my clinical instructor. They both expect me to learn by having real life
experiences in clinical. Another legitimate authority is American Nurses Association and the
code of ethics. According to the American Nurses Association (2015), provision 4 discusses how
the nurse has the sole authority, accountability, and responsibility for nursing practice. The nurse
must make decisions and take actions that provide only the optimal care possible and promote
the health of the patient. This provision helps to guide my actions as a nurse with a morally
distressing situation because it describes how every action a nurse takes should safeguard the
patient. It is our responsibility as nurses to follow our patients wishes while also giving them the
best possible care.
Patients have the right to refuse treatment and have total autonomy over their care. As a
nursing student we want to have the opportunity to learn and gain experience. As a nurse it is our
responsibility to provide the best care to our patients and to keep them safe and healthy. If this

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situation included one of my sisters I would want her to receive the best care possible in order to
keep her safe. I would also want to honor her wishes and for her to be content with the care she
received. The actions I take now as a student nurse will help me to become my ideal version of a
nurse. Learning how to take action in these situations and learning what not to do from past
mistakes will help me to continue to learn and grow in the health care profession.
CONCLUSION
In retrospect this situation could have been avoided with better communication with all
parties involved. The patients wishes should have been conveyed to the nurse coming on duty
and to myself. This situation could have been better handled after the fact if we had obtained an
interpreter and explained to the patient how the misunderstanding occurred. We could have also
explained that I am a student nurse under the close supervision of teachers and on duty RNs and
that learning through experience will help me to become an RN. The analysis of the JMU eight
key questions helped me to better understand the situation from the perspective of the patient by
seeing through the eyes of the patient and trying to understand how they feel. It also helped me
to better understand the rights of both the patient and the nurse in a situation that is morally
distressing. While nursing students need the experience of real life clinical situations it should
never supersede or interfere with the quality of care for the patient and how the patient wishes to
be cared for.

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REFERENCES
American Nurses Association. (2015). Code of ethics for nurses. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur
ses/Code-of-Ethics-For-Nurses.html
James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in
action. Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml
Suikkala, A., Leino-Kilpi, H. and Katajisto, J. (2009). Factors related to the nursing student
patient relationship: the patients perspective. Scandinavian Journal of Caring Sciences,
23, 625634. doi: 10.1111/j.1471-6712.2008.00648.x
Torrance, C. Mansell, I. Wilson, C. (2012). Learning objects? Nurse educators views on using
patients for student learning: ethics and consent. Education for Health, 2(2), 92-97. doi:
10.4103/1357-6283.1034