Nurses need to think ethically


If you watch cable TV, there’s a good chance you’ve watched “Nurse Jackie,” the Showtime hit series about an emergency room nurse who abuses a wide array of prescription drugs.

That she nearly killed a diabetic patient recently by administering the wrong dose of insulin should have come as no surprise to anyone who’s watched the ugliness, narcissism and selfishness of her addiction play out on the screen.

What should also come as no surprise to anyone who’s studied even a little about the behavior of medical professionals is that the day-to-day reality in too many American hospitals gave birth to this fictional TV show. The American Nurses Association says approximately 10 percent of nurses are dependent on drugs, making the incidence of drug abuse and addiction among nurses basically consistent with that of doctors and the American population as a whole.

With about 3 million registered nurses employed in the U.S., that means almost 300,000 RNs may be substance abusers, men and women whose drug impairment could cost you your life.

Look at more than 100 disciplinary actions taken against nurses by the Nevada State Board of Nursing since February and you soon discover that at least 13 cases involved drugs, with discipline ranging from license revocation to reprimand.

It’s safe to say that few people in Las Vegas become more upset by unprofessional conduct by nurses than Debra Scott, the executive director of the State Board of Nursing. For instance, while only one-half of 1 percent of Nevada’s 41,135 nurses were disciplined in 2012-13 — of 1,876 complaints, 10 percent resulted in discipline — she sees that as far too high.

At the age of 62, Scott, who practiced for years as a psychiatric nurse, still seems stunned there are nurses who could put patients at risk through their drug abuse, who could take advantage of the elderly by making themselves executors of wills, who would willingly work in concert with Dr. Dipak Desai, the orchestrator of money-saving, unsafe injection practices that led to Southern Nevada’s 2008 hepatitis outbreak and his ultimate conviction and imprisonment last year for murder.

Desai’s chief nurse anesthetists, Ronald Lakeman and Keith Mathahs, are both serving prison sentences on charges that included criminal neglect of patients.

“We can never lose sight of the fact that our primary mission is to protect our patients, patient advocacy, ” Scott says.

If nurses would adopt the oldest type of ethical theory in Western philosophy, virtue-based ethics, she argues in an editorial in the Nevada State Board of Nursing News, “there would be no need for the board of nursing to spend a majority of our budget on investigations and discipline.”

Now if that isn’t irrepressible optimism, Pollyannish thinking at its zenith, nothing is. Just buy into the virtue ethics ideas of Plato and Aristotle and their more recent followers — character traits such as kindness and generosity and compassion and integrity must be developed and then nurtured — and people can make the correct decisions in life.

And the problem with bad nurses will be history. Really?

“I’ve been told around here that I’m a Pollyanna,” she says, laughing as she sits in her office.

She may be a Pollyanna but I’m glad somebody is pushing ethics. Yet is it possible the nursing profession, or any other profession for that matter, can be populated only by those with a moral compass? Come on. We live in a country where mixed morality messages are the order of the day. Mike Tyson becomes more popular after he spends time in prison as a convicted rapist. Martha Stewart becomes more admired after she spends time in the slammer for lying about a stock sale.

What’s a kid to think? Don’t Grandpa and Grandma brag about doing some things “off the books” so they get out of paying more taxes? In a country that both celebrates and abhors those who do the wrong things, it isn’t surprising that many children, future nurses included, don’t know right from wrong. No matter how powerfully a family, a church or a school preaches that goodness begets goodness in an effort to build a foundation for a child’s character, it’s difficult for it not to crumble when so much of society believes that right is what you can get away with.

Still, of all the professions I’ve dealt with in almost 70 years of life, I suspect the one where an appeal to ethics stands the most chance of gaining traction is nursing. From what I’ve seen — as head of communications for a hospital I got to see a lot — it attracts an inordinate number of people with strong ethical foundations, women and men who go the extra mile to help their fellow man, whether he be black, white, gay, old, infirm or AIDS infected, without expecting any kind of payback.

I’ve seen black nurses holding the hands of patients in distress who know their families refer to them by the N-word. I’ve seen nurses comfort the dying for hours past quitting time. I’ve seen them take family members and pets of a patient home for safety. I’ve seen them raise money for families down on their luck. I’ve seen them cry as they hold weeping parents who’ve just been told their baby didn’t survive a procedure. And then I’ve seen them go into the restroom to wipe their eyes and put on a smile for other patients down the hall.

They didn’t have a publicist to trumpet their good deeds. They just did the right thing.

Life, Scott knows, has a way of testing a person with even the strongest character. A painful car-crash injury can get someone addicted to pain medications. A spouse who loses a job can fracture the family budget. What she wants nurses to do, particularly when tested, is to contemplate the personal ethical code that often led them to nursing in the first place.

“If you imagine the ideal in professional decision making and strive for that ideal,” she writes, “it is your character that is reflected in your conduct. You do the right thing because that is part of who you are both as a person and as a nurse.”

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.