The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney
She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be vague and sometimes the issues can be in conflict with our own personal beliefs. In California, nurses look for guidance to their professional body and to the nurse practice act, which is a set of laws that mandates the board of registered nursing to set out the scope of practice and responsibilities for Registered Nurses.
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The California nurse practice act recognizes the existence of overlapping functions between physicians and registered nurses but registered nurses are authorized to perform independent nursing functions related to “direct and indirect patient care services that insure the safety, comfort, personal hygiene and protection of patients. ”(CA nurse practice act, 1995) In California, a registered nurse has a duty to insure safety and protection of her patients. Some of the verbiage in the act is broad and open to interpretation, and it could be argued to what extent they apply in this case.
The practice act further clarifies this expectation by stating; a registered nurse ‘acts as a client’s advocate, by giving the client, the opportunity to make informed decisions about health care before it is provided’. (California code of Regulations Title 16) All of these state laws make it clear that nursing is responsible for managing itself. Nurses have a professional and legal obligation in their advocacy role to assess the care prescribed and act to ensure that the patient does not endure procedures that the patient have not authorized. To act without consent is a form of battery.