Skip to main content

Ethical Conflicts and Legal Liability in Professional Nursing

  • Chapter
  • First Online:
The Medical-Legal Aspects of Acute Care Medicine
  • 853 Accesses

Abstract

When one thinks of the nursing profession, many images often come to mind: the reservoir of knowledge, the supportive listener, the thoughtful caretaker, or the quick-thinking multitasker, to name a few. With a continually increasing acuity seen in the patient population, combined with a widening gap in the nursing shortage, nurses are having to face new challenges and adapt to new roles. With a rapidly evolving profession come newfound responsibilities; and an ever-increasing number of nurses are faced with ethical and legal conflicts throughout employment. Specifically, as a critical care nurse, it is not uncommon to encounter multiple ethical or legal debacles within one 12-hour shift (Gutierrez KM, Dimens Crit Care Nurs. 24:229–241, 2005). In the coming pages, we will explore examples of ethical dilemmas among critical care nurses and how ethics and legal liability are beginning to shape the field of nursing.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. About U.S. boards of nursing. In: NCSBN. https://www.ncsbn.org/about-boards-of-nursing.htm. Accessed 25 Jan 2019.

  2. Advanced directives: making your wishes known and honored. In: New York state attorney general. 2019. https://ag.ny.gov/sites/default/files/advancedirectives.pdf. Accessed 2 Feb 2019.

  3. Andrews DR, Dziegielewski SF. The nurse manager: job satisfaction, the nursing shortage and retention. J Nurs Manag. 2005;13(4):286–95.

    Article  PubMed  Google Scholar 

  4. Ashley RC. Understanding negligence. Crit Care Nurse. 2003;23(5):72–3.

    Article  PubMed  Google Scholar 

  5. Aycock N, Boyle D. Interventions to manage compassion fatigue in oncology nursing. Clin J Oncol Nurs. 2009;13(2):183.

    Article  PubMed  Google Scholar 

  6. Bakker AB, Le Blanc PM, Schaufeli WB. Burnout contagion among intensive care nurses. J Adv Nurs. 2005;51(3):276–87.

    Article  PubMed  Google Scholar 

  7. Bauer-Wu S. Seeds of hope, blossoms of meaning. Oncol Nurs Forum. 2006;33(4):K927. Oncology Nursing Society.

    Google Scholar 

  8. Brandon HMA, Inc. v. Bradshaw, 809 So. 2d 611 (Miss. 2001).

    Google Scholar 

  9. Buerhaus PI, Skinner LE, Auerbach DI, Staiger DO. Four challenges facing the nursing workforce in the United States. J Nurs Regul. 2017;8(2):40–6.

    Article  Google Scholar 

  10. Clynch N, Kellett J. Medical documentation: part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation. Int J Med Inform. 2015;84(4):221–8.

    Article  PubMed  Google Scholar 

  11. Corley MC. Moral distress of critical care nurses. Am J Crit Care. 1995;4(4):280–5.

    Article  CAS  PubMed  Google Scholar 

  12. Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care. 2005;14(6):523–30.

    Article  PubMed  Google Scholar 

  13. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care. 2007;13(5):482–8.

    Article  PubMed  Google Scholar 

  14. Epp K. Burnout in critical care nurses: a literature review. Dynamics. 2012;23(4):25–31.

    PubMed  Google Scholar 

  15. Farmer v. Willis-Knighton Medical Center, 109 So. 3d 15 (La. Ct. App. 2012).

    Google Scholar 

  16. Fine RL. Point: the Texas advance directives act effectively and ethically resolves disputes about medical futility. Chest. 2009;136(4):963–7.

    Article  PubMed  Google Scholar 

  17. Freudenberger HJ. Staff burn-out. J Soc Issues. 1974;30(1):159–65.

    Article  Google Scholar 

  18. Gilson S, Salicco S. Starting the movement and spreading the word: legal risks in critical care. The american association of critical care nurses: NTI recorded session C60M373. 2019. https://www.aacn.org/education/ce-activities/nti17373/starting-the-movement-and-spreading-the-word-legal-risks-in-critical-care . Accessed 4 Feb 2019.

  19. Gutierrez KM. Critical care nurses’ perceptions of and responses to moral distress. Dimens Crit Care Nurs. 2005;24(5):229–41.

    Article  PubMed  Google Scholar 

  20. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007;35(2):422–9.

    Article  PubMed  Google Scholar 

  21. Heitman E. Institutional ethics committees: local perspectives on ethical issues in medicine. In: Society’s choices: social and ethical decision making in biomedicine. Washington, DC: The National Academies Press; 1995. p. 409–542.

    Google Scholar 

  22. Henry BJ. Nursing burnout interventions. Clin J Oncol Nurs. 2014;18(2):211.

    Article  PubMed  Google Scholar 

  23. Hiler CA, Hickman RL, Reimer AP, Wilson K. Predictors of moral distress in a us sample of critical care nurses. Am J Crit Care. 2018;27(1):59–66.

    Article  PubMed  Google Scholar 

  24. Institute of Medicine. The future of nursing: leading change, advancing health: The National Academies Press; 2014. https://www.nap.edu/read/12956/chapter/1#xvii. Accessed 16 Feb 2019.

  25. Iyer P, Levin B, Ashton K, Powell V. Nursing malpractice: volume I: foundations of nursing practice claims. 4th ed. Tucson: Lawyers & Judges Publishing; 2011.

    Google Scholar 

  26. Iyer P, Levin B, Ashton K, Powell V. Nursing malpractice: volume II: roots of nursing malpractice. 4th ed. Tucson: Lawyers & Judges Publishing; 2011.

    Google Scholar 

  27. Jacob SR. Nursing licensure and certification. In: Contemporary nursing: issues, trends, and management. 6th ed. St. Louis: Elsevier; 2013. p. 62–73.

    Google Scholar 

  28. Kohlen H. Caring about Care in the Hospital Arena and Nurses’ voices in hospital ethics committees: three decades of experiences. In: Care in healthcare. Cham: Palgrave Macmillan; 2018. p. 237–63.

    Chapter  Google Scholar 

  29. Kon AA, Shepard EK, Sederstrom NO, Swoboda SM, Marshall MF, Birriel B, Rincon F. Defining futile and potentially inappropriate interventions: a policy statement from the Society of Critical Care Medicine Ethics Committee. Crit Care Med. 2016;44(9):1769–74.

    Article  PubMed  Google Scholar 

  30. Lambert N, Steward N. Staff retreat: a journey to team building. Oncol Nurs Forum. 2007;34(2):501.

    Google Scholar 

  31. Lederer W, Kinzl JF, Traweger C, Dosch J, Sumann G. Fully developed burnout and burnout risk in intensive care personnel at a university hospital. Anaesth Intensive Care. 2008;36(2):208–13.

    Article  CAS  PubMed  Google Scholar 

  32. Luce JM. A history of resolving conflicts over end-of-life care in intensive care units in the United States. Crit Care Med. 2010;38(8):1623–9.

    Article  PubMed  Google Scholar 

  33. Lundy KS, Masters K. A history of healthcare and nursing. In: 5th, editor. Role development in professional nursing practice. Burlington: Jones & Bartlett Learning; 2018. p. 3–47.

    Google Scholar 

  34. Maslach C. Burnout: the cost of caring. Englewood Cliffs: Prentice Hall; 1982. p. 37.

    Google Scholar 

  35. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52(1):397–422.

    Article  CAS  PubMed  Google Scholar 

  36. McClendon H, Buckner EB. Distressing situations in the intensive care unit: a descriptive study of nurses’ responses. Dimens Crit Care Nurs. 2007;26(5):199–206.

    Article  PubMed  Google Scholar 

  37. McFeely JE. Burnout syndrome in the ICU. Critical care alert. 2007;15(5):37–9.

    Google Scholar 

  38. McGrath M. The challenges of caring in a technological environment: critical care nurses’ experiences. J Clin Nurs. 2008;17(8):1096–104.

    Article  PubMed  Google Scholar 

  39. McHolm F. Rx for compassion fatigue. J Christ Nurs. 2006;23(4):12–9.

    Article  PubMed  Google Scholar 

  40. Mealer M, Jones J, Newman J, McFann KK, Rothbaum B, Moss M. The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey. Int J Nurs Stud. 2012;49(3):292–9.

    Article  PubMed  Google Scholar 

  41. Milliken TF, Clements PT, Tillman HJ. The impact of stress management on nurse productivity and retention. Nurs Econ. 2007;25(4):203–12.

    PubMed  Google Scholar 

  42. Moore P. An end-of-life quandary in need of a statutory response: when patients demand life-sustaining treatment that physicians are unwilling to provide. BCL Rev. 2007. http://lawdigitalcommons.bc.edu/bclr/vol48/iss2/4. Accessed 14 Jan 2019.

  43. Moratti S. The development of “medical futility”: towards a procedural approach based on the role of the medical profession. J Med Ethics. 2009;35(6):369–72.

    Article  CAS  PubMed  Google Scholar 

  44. Nightingale F. Extending Nightingale nursing in hospitals. In: McDonald L, editor. Florence Nightingale extending nursing: collected works of Florence Nightingale. Waterloo: Wilfrid Laurier University Press; 2009. p. 435.

    Google Scholar 

  45. NYS nursing: laws, rules & regulations: article 139. In: Office of the professions. 2018. http://www.op.nysed.gov/prof/nurse/article139.htm. Accessed 25 Jan 2019.

  46. NYS nursing: laws, rules & regulations: article 139. In: Office of the professions. 2018. http://www.op.nysed.gov/prof/nurse/nurse-licensefaq.htm. Accessed 25 Jan 2019.

  47. NYS nursing: laws, rules & regulations: article 139. In: Office of the professions. 2018. http://www.op.nysed.gov/title8/part29.htm#nurse. Accessed 25 Jan 2019.

  48. O’Brien PD. The legacy of domesticity. Nursing in early nineteenth-century America. Nurs History Rev. 1993;1:229–46.

    Article  Google Scholar 

  49. Oddi LF, Cassidy VR. Participation and perception of nurse members in the hospital ethics committee. West J Nurs Res. 1990;12(3):307–17.

    Article  CAS  PubMed  Google Scholar 

  50. Olmstead JA, Dahnke MD. The need for an effective process to resolve conflicts over medical futility: a case study and analysis. Crit Care Nurse. 2016;36(6):13–23.

    Article  PubMed  Google Scholar 

  51. Poghosyan L, Aiken LH, Sloane DM. Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries. Int J Nurs Stud. 2009;46(7):894–902.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit JF, Pochard F, Chevret S, Schlemmer B, Azoulay E. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007;175(7):698–704.

    Article  PubMed  Google Scholar 

  53. Reverby S. A caring dilemma: womanhood and nursing in historical perspective. In: Hein EC, editor. Nursing issues in the twenty-first century: perspectives from the literature. Philadelphia: Lippincott; 2001. p. 10–25.

    Google Scholar 

  54. Rushton CH, Batcheller J, Schroeder K, Donohue P. Burnout and resilience among nurses practicing in high-intensity settings. Am J Crit Care. 2015;24(5):412–20.

    Article  PubMed  Google Scholar 

  55. Stayt LC. Nurses’ experiences of caring for families with relatives in intensive care units. J Adv Nurs. 2007;57(6):623–30.

    Article  PubMed  Google Scholar 

  56. Urden LD, Stacy KM, Lough ME. Critical care nursing, diagnosis and management, 7: critical care nursing: Elsevier Health Sciences; 2013.

    Google Scholar 

  57. Utter v. United Hospital Center, Inc., 236 SE 2d 213 (W.Va, 1977).

    Google Scholar 

  58. Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care. 2004;42(2 Suppl):II57.

    PubMed  PubMed Central  Google Scholar 

  59. What every nurse needs to know about state and territorial boards of nursing. In: National council of state boards of nursing. 2018. https://www.ncsbn.org/What_Every_Nurse_Needs_to_Know.pdf. Accessed 2 Jan 2019.

  60. Yam BM. From vocation to profession: the quest for professionalization of nursing. Br J Nurs. 2004;13(16):978–82.

    Article  PubMed  Google Scholar 

  61. Zink MR, Titus L. Nursing ethics committees-where are they? Nurs Manag. 1994;25(6):70.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hughes, T. (2021). Ethical Conflicts and Legal Liability in Professional Nursing. In: Szalados, J.E. (eds) The Medical-Legal Aspects of Acute Care Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-68570-6_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-68570-6_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-68569-0

  • Online ISBN: 978-3-030-68570-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics