Chapter 11: Perspectives on the Rights of Nurses Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition

Multiple Choice

1. Which of the following is an example of a conscientious objection?

a. A nurse refuses to care for a homosexual patient.

b. A nurse refuses to care for a patient with cocaine addiction.

c. A nurse refuses to assist in an abortion.

d. A nurse refuses to care for patients of the opposite sex.

ANS: C

Feedback

A Incorrect This is not an example of a conscientious objection. Refusing to care for a patient on the basis of sexual orientation would be considered discrimination and contradict the ethical principles of beneficence and nonmaleficence and of the nurse’s professional duties and responsibilities.

B Incorrect This is not an example of a conscientious objection. Refusing to care for a patient on the basis of the patient’s behaviour would contradict the ethical principles of beneficence and nonmaleficence and of the nurse’s professional duties and responsibilities.

C Correct! This would be considered a conscientious objection. As long as the procedure is not an emergency, the nurse does not have to participate in a procedure or provide care that the nurse finds objectionable on moral or religious grounds. To avoid such situations, it is important that the nurse makes his or her moral or religious position known to the employer in advance. However, the nurse cannot refuse to care for a patient who has had an abortion.

D Incorrect This is not an example of a conscientious objection. Refusing to care for a patient on the basis of gender would be considered discrimination and contradict the ethical principles of beneficence and nonmaleficence and of the nurse’s professional duties and responsibilities.

DIF: Cognitive level: Synthesis a. It is acceptable because the nurse might become infected and could then pass the infection on to her family. b. It is not acceptable because the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses states that in a natural or human-made disaster, nurses have a duty to provide care to all patients. c. It is acceptable if appropriate safety precautions are not in place. d. It is not acceptable because the principle of justice dictates that a patient with an infectious disease deserves the same care as everyone else.

2. Is it acceptable for a nurse to refuse to care for a patient with a highly contagious illness, such as severe acute respiratory syndrome (SARS)?

ANS: C

A Incorrect The chance that the nurse might contract SARS is not a valid reason to refuse to care for the patient.

B Incorrect This correct, but nurses also have the right to protection.

C Correct! It may be acceptable for the nurse to refuse to care for this patient if appropriate safety measures and training are not in place. The CNA Code of Ethics for Registered Nurses states that “during a natural or human-made disaster, including a communicable disease outbreak, nurses have a duty to provide care using appropriate safety precautions.” It is the responsibility of the system and organizations to put strategies in place to prevent harm to caregivers in these high-risk situations. In their advocacy role nurses also have a responsibility to ensure that these concerns are known to leaders in the organization.

D Incorrect This is not true in all circumstances.

DIF: Cognitive level: Synthesis a. Reduced absenteeism b. Increased staff commitment to the organization c. High levels of staff satisfaction d. All are correct

3. Which of the following is an indicator of a healthy work environment?

ANS: D

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A Incorrect All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

B Incorrect All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

C Incorrect All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

D Correct! All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

DIF: Cognitive level: Knowledge a. To conform with provincial legislation b. To protect employees and keep employers from “cutting corners” c. To identify and recommend solutions to potential workplace hazards d. To meet collective agreement obligations

4. What is the primary purpose of occupational health and safety committees in the workplace?

Feedback

A Incorrect Provincial legislation may require the formation of workplace occupational health and safety committees, but the primary purpose of such committees is not to conform to this legislation.

B Incorrect Protecting employees is an effect of occupational health and safety committees, not the primary purpose.

C Correct! The primary purpose of workplace occupational health and safety committees is to identify and recommend solutions to potentially hazardous conditions in the workplace.

D Incorrect Collective agreements may outline requirements for membership on occupational health and safety committees, but meeting these obligations is not the primary purpose of these committees.

DIF: Cognitive level: Comprehension a. Compromising patient safety b. Injury and emotional and psychological trauma c. Impact on retention, absenteeism, morale, and productivity d. All are correct

5. Which of the following is an implication of workplace violence?

ANS: D

Feedback

A Incorrect All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

B Incorrect All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

C Incorrect All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

D Correct! All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

DIF: Cognitive level: Knowledge a. Sexual harassment b. Nurses “eating their young” c. Assault d. Bullying

6. Which of the following is the most common form of nurse-to-nurse violence?

ANS: D

Feedback

A Incorrect Sexual harassment is not the most common form of nurse-to-nurse violence.

B Incorrect This phrase depicts nurse-to-nurse violence but is not an actual form of violence.

C Incorrect Assault is not the most common form of nurse-to-nurse violence.

D Correct! Bullying (behaviour toward others that is intimidating, lacking in respect, coercive, critical, or belittling) and incivility (behaviour toward others that is condescending or insulting or that seeks to humiliate or ignore the victim) are the most common forms of nurse-to-nurse violence. This type of violence is often underreported.

DIF: Cognitive level: Comprehension a. Providing mentoring programs b. Altering the skill mix on inpatient units c. Increasing the length of nurses’ shifts d. Increasing the emphasis on justice

7. Which of the following strategies has a positive impact on reducing moral distress?

ANS: A

Feedback

A Correct! Moral distress is minimized in environments in which mentorship is provided.

B Incorrect All skill mixes are susceptible to moral distress.

C Incorrect Increasing the length of nurses’ shifts has not been shown to have a positive impact on reducing moral distress.

D Incorrect Justice is an ethical principle but is not directly related to moral distress.

DIF: Cognitive level: Comprehension a. Taking immediate disciplinary action when a nurse is accused of bullying behaviour b. Undertaking risk assessments to identify vulnerable environments c. Following up on every incident d. Engaging leaders in in fostering awareness in their teams about what constitutes workplace violence

8. Which of the following is the least effective way of managing workplace violence?

ANS: A

Feedback

A Correct! Bullies are often insecure, fearful, or jealous or have been bullied themselves. They may lack insight into their own behaviour. If an investigation reveals the validity of the accusation, then the first step should be counselling and a conversation to uncover the reasons behind the behaviour.

B Incorrect Some environments place nurses at a higher risk. Also, data related to turnover, absenteeism, and so on may indicate an unhealthy work environment.

C Incorrect Victims of bullying, incivility, or interpersonal conflicts are more likely to quit jobs, feel worse, and be less happy with their jobs and leaders; therefore, it is important to investigate the situation as soon as possible and ensure that the victim is receiving the appropriate support.

D Incorrect Bullying is most often found in organizations with a negative social climate and unsupportive leadership. Awareness is important, and leaders can play a key role in these discussions and model appropriate behaviour.

DIF: Cognitive level: Analysis a. Engage and pay for the services of an agency nurse. b. Revisit the request with the manager, and try to negotiate a reciprocal arrangement. c. Express concerns to the manager’s supervisor. d. Plan to call in sick.

9. A nurse who works in a busy emergency department is invited to a family reunion planned for the weekend she is scheduled to work 12-hour shifts. She has been unsuccessful in having her manager change the schedule or in finding colleagues to relieve her. What are her next steps?

ANS: B

Feedback

A Incorrect This would not be appropriate for the nurse to do. This would be a management responsibility.

B Correct! The nurse should try again and explain the importance of the family event. Perhaps the nurse and the manager can come up with a win-win solution.

C Incorrect This would not be an immediate next step. If lack of support from the manager is an ongoing issue, it would be important to discuss this view with him or her before taking it forward.

D Incorrect This constitutes professional misconduct and would put the nurse at risk of disciplinary action.

DIF: Cognitive level: Analysis a. Arbitrations and decertification processes b. Representing nurses during a disciplinary process and preventing the termination of a nurse with cause c. Collective bargaining and the management of grievances d. Performance appraisals and sick time management

10. Union representatives are involved in which of the following two functions?

ANS: C

Feedback

A Incorrect Decertification processes are initiated by dissatisfied union members, not the union executive.

B Incorrect Unions do represent nurses during the disciplinary process but they cannot prevent the termination a nurse. They can grieve this and take it to arbitration.

C Correct! These functions are set out in the collective agreement.

D Incorrect These are leadership and human resource functions.

DIF: Cognitive level: Analysis TRUE/FALSE

1. Home care nurses are expected to deal with additional risk in their jobs because they are sent to unknown environments.

ANS: F Feedback

Correct Home care nurses may encounter additional risk in their jobs because they are sometimes sent to unknown environments, but nurses should not expect to be put in a position of danger without adequate support or security measures. Home care nurses should never go alone to an unknown area or unknown client without some type of safety backup in place. This may include the use of communication or panic-alert devices or working with a colleague. Nurses have the right to refuse unsafe work, and home care agencies have policies covering employee safety.

Incorrect This statement is false.

DIF: Cognitive level: Comprehension

2. Moral distress is the state of being convinced of the morally correct action to take but being unable to carry out the action.

ANS: F Feedback

Correct Moral distress is the emotional and psychological pain that results when one is convinced of the morally correct action to take but is unable to carry out the action.

Incorrect This statement is false.

DIF: Cognitive level: Comprehension

3. The main purpose of collective bargaining is the protection of workers’ rights.

ANS: F Feedback

Correct The main purpose of collective bargaining is the protection of the rights of both the workers and the employer. Collective bargaining involves the rights and obligations of both parties.

Incorrect This statement is false.

DIF: Cognitive level: Synthesis

4. Unions in Canada are organized under the provisions of the Canada Labour Relations Act.

ANS: F

Correct Unions involved in provincial or territorial organizations are organized under their respective labour relations acts. Only federally regulated industries organize under the Canada Labour Relations Act.

Incorrect Unions involved in provincial or territorial organizations are organized under their respective labour relations acts. Only federally regulated industries organize under the Canada Labour Relations Act.

DIF: Cognitive level: Knowledge

5. A common concern of nurses considering a strike vote is based on the ethical principle of nonmaleficence.

ANS: T

Correct Nonmaleficence is the ethical principle that means “do no harm.” Nurses considering strike action do not want any harm to come to their patients and may find that the values of the collective group, in terms of wages and working conditions, are in conflict with the professional values that direct nurses’ care of patients.

Incorrect This statement is true.

DIF: Cognitive level: Analysis