During Influenza outbreaks, nurses often face ethical issues in the workplace. One of our nurses works in a hospital emergency department. She is a single mother with three small children, and a sole caregiver of her elderly parent who is recovering from a stroke. There is lack of appropriate resources and specialized protective equipment in the emergency department. While many patients decide to object to influenza (flu) vaccine due to fear or personal beliefs, information and circumstances change rapidly. A number of deaths associated with the flu virus grows.
Many of the nurse’s colleagues refuse to work during the outbreak. Even though she is committed to her patients, colleagues and family, the nurse is overcome with fear that she could be exposed to a serious and deadly virus. For a moment, she considers refusing assignments, but still decides to report for her shifts. At the earliest opportunity, the nurse meets with her immediate supervisor to present her ongoing concerns both verbally and in writing. Understanding the need to protect her own health and the health of her family, the nurse is torn by a conflict of how much personal risk to accept as part of her job.
Indeed, many nurses experienced similar situations in their professional practice. It is not always possible to find a resolution that satisfies everyone, and there, often, may be no right or wrong answers. During crisis situations, personal factors often influence nurses’ professional life, thus affecting their ability to fulfill commitments to patients and colleagues. Furthermore, reliable resources and appropriate protective equipment are vital in supporting safe nursing practice.
Although the nurse’s obligations to her parent and children are significant enough to outweigh the professional duty, she understands that, as a nurse, she may face a certain amount of personal risk. She could have refused to work. But, she is ready to face the risk for the sake of her patients’ health and well-being. For instance, she may come into contact with airborne infection or infected fluids due to lack of specialized protective equipment.
During Influenza outbreaks, ethical issues arise when nurses have to choose between their duties to care for patients and the need to protect their own and their families’ health and well-being. It may be acceptable for nurses to refuse assignments in some situations, such as when their ability to provide safe care and meet professional standards of practice is compromised by unreasonable expectations, lack of resources and ongoing threats to personal well-being.
Nurses face challenging ethical situations when health care needs of the large population have to be balanced with personal needs. An importance of allocating resources and continuous support for resolving ethical issues, as well as working through the decision process ahead of time needs to be recognized by every nurse.
Only by reflecting on ethical situations, nurses can practise their professional judgment and critical-thinking skills, which are important for solving ethical issues. When in doubt, nurses must discuss their concerns with a supervisor, identify the support they need, and look for up-to-date information from reliable sources. At the same time, nurses are expected to apply precautionary measures to minimize the risk of infecting themselves, colleagues and patients.
In everyday practice and in crisis situations, nurses encounter ethical issues that force them to choose from among different values, and it is not an easy task to determine which values to apply. Therefore, nurses need to reflect on and think through their own values, beliefs and fears, and assess for exposure to any potential risks. While solving ethical issues in any given situation, nurses need to make evidence-informed decisions using their knowledge, skill and judgment, as well as collaborate with other health care team members and ethics experts.