Case Study: An Expensive Source of Contamination
James is a nurse manager with responsibility over three 30-bed units in a large metropolitan
medical center affiliated with a large university. Over five years, a team of staff nurses and
university faculty gathered data on the rates of hospital acquired infections on the three units.
Infection rates were low and stable during the first four years, but rose dramatically at the
beginning of the fifth year and showed a gradual upward trend throughout the fifth year. Many
patients’ hospital stays were prolonged because of hospital acquired infections and three elderly
patients died from hospital acquired pneumonia.
Completing the systematic investigation, James and the nurse research team concluded that
the rising infection rates began when they adopted a new hospital-wide very costly medication
delivery system. With the new system, the nurses pushed carts to each patient’s bedside. The
nurses moved back and forth from the carts to the patients’ bedsides and used an attached
electronic scanner to validate patients’ identification. Onsite investigation revealed that, even
though the nurses were washing their hands properly between patients, the carts and scanners
themselves had become harbors for pathologic organisms. Further, the team was unable to find
any evidence-based strategy for preventing or eliminating the source of infection.
Representing the research team, James presented the data to the hospital’s research council
and subsequently to the hospital administration. After a four-month delay, James received a
letter explaining that the medication systems would not be investigated further. The letter
recommended that he conduct education sessions with the nurses focusing on infection control
and stressing the importance of hand washing.
Think About It
1. What are the professional and personal values that support James’s research
project?
2. How do these values connect with ethical principles?
3. What institutional versus personal values conflict in this situation?
4. What strategies can James and the research team employ that would maintain their
ethical integrity without risking their employment?
5. What happens when a nurse manager “rocks the boat” in an organization in order to
satisfy ethical principles?
Feedback
1. It is impossible to know with a certainty what values support an individual’s actions, but in
this case it would seem that James acted from a sense of responsibility and a desire to
remove potential harm — i.e., beneficence.
2. Anytime a nurse strives to help a patient, to support a patient’s decision and to remove
harm, ethical principles are in evidence. The nurse doesn’t need to know the name of the
principle or be able to define it, but the action demonstrates adherence to principle-based
values.
3. The institution is often viewed as the “bad guy” in discussions of ethics in the workplace.
But, even when institutional decisions conflict with individuals’ decisions, the institutional
policy may adhere to ethical principle on another level. In this instance, the institution may
understand that there is ultimate benefit to patients if staff is more efficient with the
medication carts. Their solution of educating the staff to utilize the equipment in a way that
reduces risk of infection adheres to the principles of beneficence and justice. Justice may be
involved since more people will have access to health care that is efficient.
4. Since James is an employee of the facility, it is his responsibility to abide by the policy in a
way that is most beneficial to patients. He could provide educational sessions to his staff
and then re-test the medication carts for evidence of success or failure.
5. Although it can be dangerous to “rock the boat” in institutional settings, managers who
adhere to ethical principles, while thoughtfully considering the implications for both the
patients and institution, will likely be valued within the organization.