NEW YORK NURSE: January/February 2012
Q.: I work on a med/surg with patients who have many co-morbidities and sometimes histories of substance abuse. Recently, a diabetic post-op patient developed a serious wound infection, requiring invasive debridements and dressing changes. The physician ordered 3ml of normal saline IM, ½ hour prior to dressing changes, four times a day and as needed for pain – and also wrote an order for nursing not to tell the patient that he was receiving saline. When I asked why, the physician said the patient was not in pain, just seeking drugs for an addiction. Is this legal?
A.: This situation confirms continued attitudes among healthcare professionals of mistrust and disbelief of patients’ complaints of pain. This alone demonstrates the need for continuing education regarding evidence-based practice in pain management, and maintaining competency. Even more critical to nursing practice is the intertwining of ethical and legal components, regarding both the order and the physician’s statement that the patient is drug-seeking rather than in pain.
The nursing staff has a professional responsibility to inform the patient about treatments and medication ordered for him. In ordering the nurses to lie, the physician is requesting that they ignore the Code of Ethics, which was developed from the moral principles of respect, honesty, fairness, and avoiding harm. Most facilities have an Ethics Committee available to investigate ethical issues.
Nurses are also obliged by the standards and guidelines set forth by the American Nurses Association and organizations such as the Joint Commission (formally JCAHO) to provide quality care based on best practice. Research has provided us with sufficient evidence surrounding the issue of inadequate pain management and sequelae that show increased physical and psychological damages incurred by patients and increased costs incurred by facilities.
The legal aspect for nursing involves potential charges of professional misconduct including filing false reports (documenting that the patient received education about the medications he was receiving), practicing fraudulently (not divulging that the supposed pain medication he is receiving is actually saline), and gross negligence (by not intervening and/or following the order). The patient’s rights are also being violated. The Patients’ Bill of Rights states that patients must receive complete information about diagnosis, treatment, and prognosis.
In our increasingly litigious society, nurses must remain mindful of our ethical and legal responsibilities to advocate for patients to ensure that their rights are protected. As always, follow the facility’s policies for any concerns you may have; speak with the ordering physician to share your concerns or ask questions; and if your facility is represented by NYSNA, be sure to include your nursing representative in all discussions.
Continuing education on pain management, ethics, and legal issues can be found on e-LeaRN™ at www.elearnonline.net.
This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA nursing representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800-724-NYRN, ext. 282.