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Case: How nurses can prioritize care


There never seems to be enough of me to go around for all my patients. How do I decide who and what take priority regarding patient care?

Although the answer rests on clinical competence to discern patient status, it is essentially an ethical question. Nurses, like all human beings, are finite creatures. Our patients always will have more legitimate needs—physical, psychological, or spiritual—than we will be able to meet. Inadequate staffing, one of the most common problems today, further limits what a nurse is able to do for his or her patients.

When we decide whose needs take priority, we must rely on principles of justice. To make decisions fairly, we can use certain rules that help sort out what factors should count, morally speaking. For example, a well-known rule of justice is to treat individuals as equals. But in practice, patients are not all the same. So if we are going to acknowledge differences, what differences should count, morally speaking? Take into consideration specific needs, and gauge their urgency (e.g., which are life-threatening), along with other factors. If two patients have equal need, but one has a better chance for an effective outcome as the result of our action, concentrate more on the patient with the better prognosis.

Another rule of justice applicable to all patients is to protect the safety of patients and nursing personnel. Attention to safety is bolstered by the obligation not to harm, as well as the desire for justice. Protecting the safety of patients and nursing personnel makes both short- and long-term sense. In the short term, attention to safety issues prevents immediate harm from dangers such as drug errors; in the long run, it prevents permanent problems such as back injuries.

Even if we fulfill the demands of justice and allocate our time, attention, and skills in a fair manner that ensures patient safety and doesn't place unrealistic demands on our limited physical and emotional resources, we still may feel uneasy or dissatisfied with our work. Most people don't become nurses to do the minimum for patients. The desire to benefit patients goes beyond justice and requires an environment that supports our aspirations to deliver quality care.








AMY HADDAD, RN, PhD, a member of the RN editorial board and a widely recognized ethicist, is a professor at the Center for Health Policy and Ethics at Creighton University in Omaha. She is the co-author of Ethical Dilemmas in Perioperative Nursing, Ethical and Legal Issues in Home Health Care, and The Arduous Touch: Voices of Women in Health Care.

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