Nurse presence growing on hospital ethics committees
While it was not always so, nurses are now members of ethics committees in most hospitals, and are participating in consults where they traditionally were not.
"The physicians concentrate so much on the physical aspect, making sure the patent is being treating correctly, while nurses, being with the patient more and with the family more, can be a go-between, an advocate, and help broaden the view," says Celia Mills, RN, BSN, PHN, PCCN, clinical manager of the ICU/CCU and medical/surgical departments at Ridgecrest (CA) Regional Hospital.
Mills has been on the ethics committee at her hospital for many years, a panel made up or half medical staff, the other half non-medical staff.
"We have always chosen people from nursing [for part of the medical staff representatives]," she explains. "I am in ICU, and it makes sense because lots of ethical issues arise out of the ICU."
Some ethics committees, especially in smaller institutions, include only physicians and those from the philosophy disciplines.
"Voices and opinions of other disciplines that may have a more in-depth, day-to-day knowledge or simply another point of view of the case, go unheard and thus unheeded," nurse Penelope Chase wrote in comments to South Carolina Nurse in 20041. "Ethics committees and services that do ethics consultations should be interdisciplinary, and need to include more nurses than is usually the norm."
A manual developed by the American Society for Bioethics and Humanities (ASBH), "Core Competencies for Health Care Ethics Consultation," in use by hospital ethics committees nationwide, was created by a task force that included members of the American Association of Critical Care Nurses, Chase points out.
Mills says probably because nurses have been a part of ethics consults and the ethics committee at her hospital so long, "it's a very collegial atmosphere."
"Everyone is invited to speak their mind," she adds. "It's a very level playing field, one that doesn't seem very territorial."
The involvement of nurses on the ethics committee and on subcommittees convened to deal with specific cases flexes depending on the case, she says.
"If a case involved a pregnant woman, it would involve the obstetrics department nursing-wise and physician-wise, and perhaps a lawyer and chaplain," she says.
The presence of nurses, in addition to providing broader first-hand experience with patients and their families, adds an important perspective to ethics discussions, Mills believes.
"Sometimes you can get tunnel vision [when there is] a big problem, and having someone else with a different viewpoint can really help," she explains. "Also, we still find in the older population, the physician being viewed as an authority figure, and they might not want to question him, but will ask the nurse all the questions instead, and that gives you an insight or a perspective that a physician or other person on the ethics committee."
Reference
1. Chase P. More nurse members needed for ethics consultation, ethics committees, and ethics services. SC Nurse 2004;11:22.
Source
For more information, contact:
- Celia Mills, RN, BSN, PHN, PCCN, clinical manager ICU/CCU and medical/surgical, Ridgecrest Regional Hospital, Ridgecrest, CA. Phone: (760) 499-3500.
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