A nurse is a trained professional, who gives care –mostly medical– to people who are sick or injured. Nurses are highly skilled health care experts with years of medical and ethical training to master the art of caring. Combining this art with scientific and medical knowledge, nurses often stand as professional assistants to Doctors in any medical institution under any desired medical field. They also help patients with the administration of drugs and medications. And in addition to that, they are often tasked with being medical watch-dogs over patients with chronic health issues.
Importance of Nurses and Nurses Code of Ethics
The importance of nurses and nursing staffs can never be overemphasized. Without mincing words, this can be said assuredly based on the fact that nurses are most often the closest health care professionals to patients. In a way that is more pronounced than subtle a good Patient-Nurse relationship often goes a long way to aid in quick and speedy recovery. A nurse is involved in the education of patients around health and disease processes whilst providing quality health care assistance to such patients.
Unfortunately though, many nurses are faced daily with the tedious task of caring for numerous patients with very little assistance, as they also try hard to stay within the tenets of medical and health care efficiency. Although, some might argue that this is just one of the many perks that comes with their service to humanity –a service they have sworn to uphold– it is however necessary to remember that nurses, like patients are also human and as such can be prone to errors and mistakes; only such mistakes could often be on a life threatening scale.
According to page 1 of the International Council of Nurses Code of Ethics for Nurses, it states that “Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering”. Although all medical professional are guided by a similar Code of Ethics, those of the nurses are much more centered on a very direct patient care. This means that, when it comes to administering drugs to a patient, it is the nurse’s duty.
It would seem as not much of a task until one goes to add, say, 50 patients to the roster of a particular nurse and anticipate the possibility of him/her being able to attend to each and every one of them effectively and efficiently. Such an outcome would be most unlikely and it is then that a clearer picture of one of the pressing issues plaguing the profession comes to light.
For decades there has been a rule that required that nursing staffs were to administer medications and drugs to patients within 30-minutes of the scheduled administration time. In 2008, the Centers for Medicare & Medicaid Services (CMS) issued Appendix A, Survey Protocol, Regulations and Interpretive Guidance for Hospitals, which spells out the conditions of participation for hospitals to receive Medicare or Medicaid payments; The effective adherence to the 30-minutes rule was one of the conditions.
In late September 2010, a survey was conducted by the non-profit organization ISMP (Institute for Safe Medication Practices) that elicited responses from almost 18,000 Nurses.According to their survey, most of the respondents made it clear that changes to drug delivery methods, plus the gradually increasing complexity of care and other factors, made the long-standing CMS “30-minutes rule” impossible to follow. Many of the nurses, the survey reveals, reportedly felt pressured to take a couple of shortcuts just to comply with the CMS rule. Some of the shortcuts include:
- Not thinking critically about drug administration while rushing through verification of new orders and actual drug administration
- Leaving medications in the room for the patient to take at the right time.
- Documenting administration at the scheduled time, but actually giving the drug early or late
- Altering drug administration schedules to avoid documenting late administration
- Skipping important double-checks due to time constraints
- Borrowing medications from one patient to administer to another patient and so on.
Although a lot of the shortcuts that many nurses who partook of the survey revealed may very well go against the tenets of the ICN Code of Ethics, there is no doubt, that many of these nurses do intend well for their patients. Nonetheless, these at-risk behaviors are often unintended consequences of attempting to comply with a rule that aims to optimize the efficiency of nursing staffs, but succeeds in only pushing them to taking routes that often leads to harmful errors.
The organizers of the survey have indicated intent on going to the CMS leaders to discuss concerns regarding the rule’s unintended effects on patient safety. And one would think the best outcome of such a meeting or interaction would only result in a temporary solution to a growing condition that plagues nursing staffs. However the question is: could there be a more definite solution to these concerns? And if there could be from whence can one expect such a solution to emanate?
We currently live in a digital and technological age. And although there are some innovations that have proven more harmful than good over time, it appears as though; technology may very well house the solution to the health care plight of nursing staffs in the effective and efficient dissemination of their duties. One would feel the time has definitely come for the medical and health care sector to usher in an innovative era that will aid Nurses and nursing staff in being able to provide timely and quality care for patients.
It would appear it has come to time when Nurses can instead of just being assistants to the Doctors, can also get assisted by the far reaching hands of a cutting-edge technological innovation that would assure them of the fact that they can stick to their sworn Code Of Ethics without compromising the health and safety of the patients under their care.
- Laura A. Stokowski. Timely Medication Administration Guidelines for Nurses: Fewer Wrong-Time Errors? Medscape. Oct 16, 2012.
- International Council of Nurses (ICN) code of ethics for nurses 2005
- Guidelines for timely medication administration Response to the CMS “30-minute rule” https://www.ismp.org/newsletters/acutecare/articles/20110113.asp Jan 13, 2011.