Letter to the Editor on "Administrative Ethics and Confidentiality/Privacy Issues"

Administrative Ethics: What's Your Integrity Quotient (IQ)?

December 13, 1999
in response to Administrative Ethics: What's Your Integrity Quotient (IQ)?

Dear Editor:

I have been practicing as a professional nurse for the past 20 years. The last 12 of those years, I have been working in some capacity as a supervisor of a nursing unit in a hospital. There have been many changes over these years. I agree that the growth of information systems and the involvement of third parties in decision making have created new issues regarding confidentiality. I worked through a time when the organization for which I worked was being investigated by the federal government. In this world that is changing so fast, "ethics" needs to be part of the fundamental values of every healthcare organization. Hence I appreciated the article "Administrative Ethics and Confidentiality/Privacy Issues."

The healthcare industry has become "business oriented," instead of "caring oriented." The hospital for which I worked went through a reorganization and downsizing of layers of administrative personnel. There has definitely been a reduction in the quality of care. Nurses have become scarcer on the units. The workload has become increasingly difficult to accomplish.

I have been in a few situations in my life as a nurse where someone with whom I am working has diverted narcotics. My first job was as a graduate nurse on a medical-surgical unit on the nightshift. The staff consisted of two nurses, a charge nurse and myself. I remember, after not being there too long, taking the night supervisor aside and asking to be transferred to another unit. The charge nurse on the shift with me was exhibiting strange behavior. I described this as a Dr. Jekyl and Mr. Hyde personality. I was finding it increasingly difficult to deal with the situation. I was transferred to another unit. Three weeks after my talk with the night supervisor, this charge nurse was fired. An investigation was completed and my charge nurse was found to have been diverting drugs and using them on the unit during the shift. Thank goodness we have come a long way from this scenario and now support our impaired nurses. I was involved in a similar situation not too long ago. Again, the charge nurse on the night shift and again the same situation. I was the charge nurse on the day shift, this night nurse was exhibiting behavioral changes which pointed to the possibility of drug use. Since my earlier days, I have been educated in these changes, and am aware of committees, such as Peer Review and Ethics, and programs, such as TPAPIN (Texas Peer Assistance Program for Impaired Nurse) and the American Nurses Association (1985) Code for Nurses. I did confide in the Director of Nursing on the unit. We gathered facts regarding specific behavioral changes and how they were increasingly more visible in this nurse's performance. This nurse was offered and chose to go to a rehabilitation program. She actually corresponded with her fellow nurses on the unit while she was there.

I have seen nurses return to nursing under the TPAPIN program. These nurses are supported throughout their return. There is a clear set of guidelines for monitoring and supporting them in their work.

I have always had a personal ethic or values to live by. My compassion and concern was for the patients as well as my fellow nurses. When drugs are diverted people suffer, especially on the postoperative unit. We have had times when I have had to ask patients if they received drugs that were signed out for them on the unit, as I was not sure they were actually given. I have sent drugs back to the pharmacy to see if they have been tampered with before I would administer them to a patient. Administrators and other persons in positions of authority and leadership do have a responsibility to practice in a consistently ethical manner and protect the confidentiality of all within their organization.

Maureen Davis
Clinical Manager
Capital Surgeons Group
Austin, Texas