While the first provision of the Code of Ethics for Nurses addresses the need for compassion and respect for all individuals, the second provision identifies the primary concern of nursing care – the patient.

Consider this situation: Inmate Sorokin is in administrative segregation for fighting with an officer last night. During medication rounds he tells nurse Vargas that he needs to see the doctor about his wrist, which looks swollen and bruised. He states that he cannot move his fingers “normally.” He states that he asked to be seen by medical last night, but no one came. The segregation officer tells the nurse that Officer Jenkins, her friend, is out for at least a week after the altercation with “this guy”, and asks why she would want to help him. Nurse Vargas replies that it is her job. The officer then tells nurse Vargas that she should not worry about it, he will tell the pod officer about Sorokin’s request when medpass is completed. Nurse Vargas is super busy, and still has four more housing units in which medications must be administered. In light of the comments of the officer, she has a feeling that the officer will not make contacting medical for this patient a priority, but she thinks that perhaps if he has to wait, Mr. Sorokin might not be so quick to attack an officer the next time. On the other hand, the injury did look like it needed medical evaluation and perhaps even an x-ray. What should Nurse Vargas do?

To help her make the decision, Nurse Vargas should consider the ANA Code of Ethics for Nurses, Second Provision that states the nurse’s primary commitment is to the patient.

Provision 2: The Nurse’s Primary Commitment is to the Patient, Whether an Individual, Family, Group, Community or Population.

Patients First

The primacy of the patient as the focus of nursing care is a key component of nursing ethics. In fact, a nurse’s primary commitment is to the patient in all situations. This central focus allows ethical decision-making in situations where multiple loyalties may need to be considered. Ethical practice requires that the needs of a patient be given greater consideration than any competing needs of the employer, peers, and even ourselves. It is the therapeutic nature of the nurse-patient relationship that forms the basis for the primacy of the patient. Unlike personal relationships that are bi-directional, benefiting both parties, the nurse-patient relationship is unidirectional and intended for the benefit of the patient, not the nurse.

Competing Loyalties

Everyone at some point must deal with competing loyalties. Whether to parents, employers, spouse, or friends, we can have conflicting priorities that must be weighed and sorted. These priories, however, often vary depending upon the role we are fulfilling at the time. In the role of nurse, our ethical framework dictates that our responsibility to the patient must outweigh any conflicting loyalties that we might feel toward others, such as a colleague or employer.

Moral Courage

As a Correctional Nurse, there are often additional pressures from our custody colleagues, our employers and even other inmates to not place the well-being of our patients as the top priority. In these instances, we can look to the development of moral courage to help us be resilient. Moral courage is needed to overcome the fear of being ridiculed, ostracized, or unfairly treated for taking a patient-focused stand in a situation where dual loyalties exist. Here is some additional information for gaining and using moral courage in your nursing practice:

• Moral Courage: Do You Have What It Takes?
• Moral Courage: How Do I Find Some?
• Moral Courage: Dealing With Uncertainty
• Moral Courage: Being Assertive

What did Nurse Vargas do?

Nurse Vargas considered the offer of the officer to notify medical when the medpass was finished in the unit, but realized that she was responsible for her patient, and getting him to medical in a timely manner. She did not identify the patient’s condition as an emergency, and so she finished the medication pass in that housing unit, and then called her colleagues in medical to report Mr. Sorokin’s need for evaluation, including his potential need for an x-ray. The nurse in medical requested that he be send down right then, and nurse Vargas continued with her medpass to the other units. Mr. Sorokin ultimately was diagnosed with a Colle’s fracture, for which he required a cast.

How about you? Are you challenged to keep the patient primary in your correctional practice? Share your thoughts in the comments section of this post.