BWH Nurses Participate in First Clinical Ethics Residency Program
Shortly after she became the director of the Critical Care Nurse Intern Program, Mary Pennington, MSN, RN, CCRN, recognized that the nurse interns were experiencing moral distress. During program evaluations, they reported feeling unprepared, confused, conflicted and upset in response to ethical issues they observed or experienced in the ICU.
“It’s tough to be in a situation where emotions are flying, where you believe you don’t have the power or knowledge to be effective or helpful to make the right decision. At times like these, it’s easy for ethical worries to be silenced,” she said. “The nurses needed more than just the clinical piece—they also needed to talk about and address the ethical issues.”
The skill of ethical reasoning is not generally taught in school, but is crucial for ICU nurses. Pennington wanted to revise the current Critical Care Nurse Intern Program to include reflection on ethical problems, moral perspectives and education that supported the development of ethical reasoning skills. To do this, she sought Martha Jurchak, PhD, RN, executive director of the Ethics Service, as a partner.
Pennington is now one of 18 BWH and MGH nurses participating in the Clinical Ethics Residency for Nurses, a program funded by a grant from the U.S. Department of Health and Human Services’ Health Resources and Services Administration. The program is a collaboration with MGH and Boston College.
With a lack of access to ethics resources and confidence in ethical decision-making, nurses may experience moral distress in these high-stake situations. The program was created to help a group of nurses develop these skills so that they can serve as resources to other nurses.
“Ethics issues are complex; you need a robust skill set to recognize and address them,” said Jurchak, who is the sub-contract principal investigator for the residency program. “Preparing a cadre of nurses as clinical ethics resources will help direct care nurses enhance their clinical ethics skills. This will give all nurses the resources to recognize and address difficult ethics issues.”
Each nurse in the program dedicates 96 hours of time over the course of seven months in three areas:
The simulated learning, which involved nurses playing the roles of different members of the care team or the patient’s family, was especially powerful, according to the participants.
“You learn what it’s like to be in other people’s shoes during an ethics consultation,” said Karen Legere, BSN, RN, OCN, nurse in-charge for Tower 5B. “It was a great opportunity to put your own feelings aside and get a glimpse of how others see things.”
The simulated learning and seminars emphasized the importance of remaining objective when addressing an issue.
“I realized that I sometimes reacted to an ethical situation based on my own values, but we’ve learned how to look at these cases more objectively and reasonably, rather than emotionally,” Legere said.
The program helped nurses develop the skills to identify and articulate the ethical components of a particular case.
“Sometimes you just know that something isn’t quite right, but it’s difficult to put into words,” said Jon Jehle, BSN, RN, nurse in-charge for the Neuroscience ICU. “After learning the principles and fundamentals of ethics, you can uncover the ethical question and address it more appropriately.”
The five BWH nurses who are participating in the program have found it extremely valuable in helping them develop skills they can immediately apply in their practice and on their units.
“Over the past five years, we have had the opportunity to work with Martha Jurchak on twice a month (day and night) NICU-based multidisciplinary ethics rounds,” said Marianne Cummings, MSN, RN, nursing director of the NICU. “These rounds have provided NICU staff with a forum to review the facts of each case and to collectively explore potential care strategies. One important outcome from the Clinical Ethics Residency for Nurses program will be to look for opportunities to expand this work by creating CWN-wide ethics forums to address and discuss the complex cases that are unique to the patients that we serve.”
Both Cummings and Elizabeth Eagan-Bengston, MS, RN, assistant nurse director of Shapiro 9 and 10, began ethics rounds on their units prior to this program.
“My role so far has been as an observer,” Eagan-Bengston said. “I want to build on the work we’re doing on our unit to encompass continuity of care, safe hand-offs and patient confidentiality to facilitate an ethically grounded hand-off report. This program was extremely helpful in understanding how you can enhance nursing practice with skills in clinical ethics.”
The diversity of nurses’ roles and backgrounds within the program, as well as the collaboration with MGH and Boston College, augmented the learning experience.
“The energy and expertise of different people in different roles has been remarkable,” Jurchak said. “We had directors, nurses in charge, staff nurses, nurse educators—all from different specialties and services.”
The goal is for the nurses who participated to become resources for their areas.
For assistance in addressing an ethical question, contact the Ethics Consultation Service.