Ethical and Legal Dilemmas: A Reflective Analysis of Nursing Practice

This report presents a reflective analysis of a nursing student's experience during a practical placement at an urban hospital, focusing on an incident involving sharps management and ethical-legal complexities. The student utilizes Driscoll's Reflective Framework to explore the 'What,' 'So What,' and 'Now What' of the situation, detailing a scenario where a supervisor instructed the student to recap a needle, leading to a needlestick injury. The reflection delves into the violation of ethical codes of conduct, disregard for patient rights, and the supervisor's unprofessional behavior. The student examines the legal implications, references relevant Australian nursing regulations, and concludes with a commitment to promoting a culture of safety and ethical practice, while also highlighting the importance of assertive skills and proper mentorship in the nursing field. The report underscores the significance of adhering to ethical and legal provisions in practice and the impact of the incident on the student's understanding of professionalism in healthcare.

Driscoll’s Reflective Framework
Driscoll’s Reflective Framework
Introduction
Healthcare is an important segment of any society. Notably, the healthcare sector gets
regulated through sets of ethical and legal requirements that dictate the roles of healthcare
professionals. As a nurse, there is a threshold expected of one to achieve through the lenses of
ethical and legal requirements. In this paper, I would be keen to reflect on my ethical and legal
experiences during my practical placement at an Urban hospital facility. The reflection would be
done as stipulated in the Driscoll’s Reflective model. The complex clinical scenario I got to
experience that would form the basis of this reflection would be about the management of sharps.
‘What’
As a nursing student, I am fully aware of the significance of remaining compliant to
nursing ethics and legal requirements. I have recently commenced my practical placement, and
during the PEP, I was assigned to work under a registered nurse. Despite the in-depth experience
of the Supervisor, I have always been privy to the fact that ethical and legal dilemmas associate
healthcare practice. Working under a supervisor, one is obliged to follow all their guidance and
advice to the latter (Henderson et al., 2012). On this particular situation, accompanied by my
supervisor, I got instructed to give a patient an injection. I usually get intimidated by very close
supervision, especially from a strict supervisor whom I was assigned. Upon completion of the
injection, I realized there was no kidney dish by the bedside for disposal of the needle.
At the back of my mind, I was grappling with many issues. First was the fact that my
tutor and lecturer had emphasized on the proper handling of sharps while practising. They had
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stipulated that one should dispose a sharp like a needle to a kidney dish and then dispose to a
designated sharps container. I was well aware of the risks of recapping and the fact that my
supervisor was around made the feeling even worse. It occurred that there was no kidney dish by
the bedside. Also, I was not aware of the location of the closest sharps container. I was shaking
and felt undecided on what to do for the first time. Suddenly, the supervisor instructed that I
should recap the needle. This request from my supervisor was literally against what I was taught
and believed in as a nursing student. However, the insistence of the supervisor prompted me to
recap the needle. Given the panic, I, unfortunately, prickled my finger using the needle.
Subsequently, in an arrogant manner, the supervisor demanded the patient for a blood sample to
confirm the rare I had contracted from the needle accident.
I realized the negligence of the supervisor and his disregard for the ethical code of
conduct and safe practice as stipulated within the regulations. Moreover, the supervisor insulted
me during the ordeal, which to me was extremely unethical. I have always upheld the need for
professionalism in the practice environment. Insulting each other is disrespectful and
unwarranted in the practice environment. I felt my rights during the practical placement were
violated against the laws. Moreover, it was critical because my health was in question. I could
have contracted a rare infection from the patient. On the other hand, I felt the dignity and
independence of the patient were violated. It is unethical to demand a sample for laboratory
diagnosis from a patient without requesting and explaining for the provision of consent. I felt the
patient was harassed and devalued by the rude demand of the supervisor who appeared to
disregard all the ethical and legal codes of nursing practice.
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‘So What’
As a nurse, I believe in the significance of the ethical codes of conduct in regards to
protecting the rights of patients and other professionals as well as self against injuries. The
supervisor was violating the Australian regulations on the handling of sharps through his
behaviour. Fortunately, the patient did not have any serious infectious pathogen that would have
placed my health at risk. I had to confirm from other senior colleagues at the facility to affirm the
behaviour of my supervisor. To my surprise, it was clear that the supervisor had a record of
unethical behaviour that violated the existing Australian ethical and legal requirements of
practising nurses. From the legal perspective, he acted in illegality by provoking me to injury.
This is because the outcome of his persistence about recapping the needle would be foreseeable
and likely to endanger my life.
Under the ensuing circumstances, I had to refer back to the existing regulations as
embodied in Australia under the Code of Ethics for Nurses in Australia and the Nursing
Competency Standards for Practicing Nurses in Australia. I strongly believed these regulations
guide nursing practice in both the private and public sectors in Australia adequately and provide
the thresholds and benchmark for practice. My findings concurred with my judgment that the
supervisor had conducted himself and behaved contrary to the ethical codes of conduct and
professional nursing practice. The supervisor disregarded my perspective and did not inquire
about my knowledge of sharps management. Instead, they went ahead to impose their wrong
perspective on me against my wish leading to the unintended injury and exposure. As such, it
was clear the supervisor did not respect my autonomy and nursing practice principles
(Waubrafoundation.org.au, 2019).
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I believe that a supervisor should endeavor a collaborative approach while practicing in
the presence of a junior nurse. It was very unfortunate for a registered nurse like my supervisor
disregard the ethical code of conduct and practice competencies expected of them. The
supervisor acted in an aggressive and intimidating manner to me. Further, he harassed the patient
to get their samples, which should not be the case. According to Arli and Bakan (2018), in such
cases, the nursing professional should explain adequately to the patient the situation and make
them understand the importance of using requesting for their blood samples. When the patient
has understood the need for the sample collection, just then should the sample be taken for
testing to ensure safety.
Subsequently, the standards for registered nursing practice, the supervisor was expected
to engage in a “therapeutic and professional relationship” which is standard two. Notably, the
supervisor did not handle themselves professionally and therapeutically given as required in the
practice environment. Moreover, the ethical code of conduct for nurses as provided by the
Australian Midwifery and Nurses body dictates that nurses must manifest kindliness to
themselves and others. By the supervisor forcing his perspective on to me and violating the sharp
management principles is an indication of a violation of this conduct. Also, the supervisor did
not envision a culture of safety by advising me to cap the needle after use. Recapping the needle
led to the accident that exposed my life to danger (Nursingmidwiferyboard.gov.au, 2019).
‘Now What’
I am a believer in professionalism and the fact that it is the mandate of all nurses to act
according to the legal and ethical provisions. I am convinced I should report this matter to the
authorities. Whether any action would be taken against the supervisor rests with the
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administration of the facility. On the other hand, I hold the opinion that the report may backfire
on my image and final report from the practical placement process. Despite this fear, I believe,
my action would count to promote a culture of safety and strict compliance to the ethical and
legal standards for nurses in the practice environment. It will no longer be my fight alone but
also to other students and patients whose rights and privileges could be jeopardized by
unprofessionalism in the future (Tanaka et al., 2016).
Furthermore, due to the negative impact of the incidence to myself, I think it will help so
that I should develop assertive skills to impose my beliefs and values to others positively. It
should not matter if one is junior or not; a wrong idea must be pointed out at the earliest onset. I
would also endeavor that all appropriate safety equipment is in their rightful places where nurses
and other health professionals can easily access them.
Conclusion
In conclusion, the needle accident and the whole scenario exposed me to critical ethics-
legal complexities. I deeply understand the significance of upholding ethical and legal provisions
in practice to the letter. All organizations need to appreciate the significance of safety culture and
protection of the rights of all stakeholders in the health sector. I would always endeavour to
promote the safety culture in the practice environment to protect myself and others. Further, I
would adequately engage others in practice, especially partners, to ensure all the ethical
regulations are not violated. It is also significant that senior practitioners in the nursing field
should mentor the young professionals in placement the right way. In the end, I can say that the
practice environment encompasses many learning opportunities that help one to appreciate the
theoretical concepts taught in school.
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References
Arli, S.K. and Bakan, A.B., 2018. Investigation of the Attitudes towards Needlestick and Sharps
Injury among Nursing Students. International Journal of Caring Sciences, 11(1), p.178.
Henderson, A., Cooke, M., Creedy, D. and Walker, R. (2012). Nursing students' perceptions of
learning in practice environments: A review. Nurse Education Today, 32(3), pp.299-302.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia - Registered
nurse standards for practice. [online] Available at:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx [Accessed 13 Aug. 2019].
Tanaka, M., Taketomi, K., Yonemitsu, Y. and Kawamoto, R., 2016. Professional behaviours and
factors contributing to nursing professionalism among nurse managers. Journal of nursing
management, 24(1), pp.12-20.
Waubrafoundation.org.au. (2019). Code of Ethics for Nurses in Australia | Waubra Foundation.
[online] Available at: https://waubrafoundation.org.au/resources/code-ethics-for-nurses-australia/
[Accessed 13 Aug. 2019].
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