Caught between a rock and a hard place?

Often nurses values do not blend or match the work environment where they are expected to provide care without judgement.  Abortion is one example where some nurses may have conflicting convictions about what is the right or moral thing to do and that may not include terminating a pregnancy.  The Daily Telegraph found that abortions were taking place based on gender and doctors were presigning certificates which is against the Abortion Act (1967) as it is written "two doctors are to agree that the risk to a woman's physical or mental health will be greater than if she continues with a pregnancy than if she ends it".  The NHS considers abortion health care and tax payers pay for the procedure to be done in hospitals throughout the UK.  Nurses can feel dis empowered when they are working within systems that lacks respect for the unborn and they too will feel disrespected if they have to work with women making this choice if they don't hold the belief that abortion is not a moral issue.  The system is so open about abortions that Ann Furedi, Chief Executive of the former British Pregnancy Advisory Service categorized the matter as a "regulatory matter" instead of a Judicial or political one and dismissed the time and effort made by the inquiry to bring the matter to the attention of the public and politicians as "shocking" and that resources had been "squandered" on the investigation.  The nurse is subsequently put in a compromising position of not being aligned with the values of the organization or the leadership that allows this kind of illegal practice to take place and the society that may be polarized about the issue of abortion depending or their own particular spiritual or religious understanding and moral conviction.  This is the rock and a hard place to be!
I recommend that your read  Vicki  Lackman PhD, MBE, APRN who is an expert on the subject of moral courage.
 http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Strategies-and-Moral-Courage.html

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• HomeCourage and DistressStrategies and Moral Courage

Strategies Necessary for Moral Courage

 

Vicki D. Lachman, PhD, MBE, APRN

Abstract

Moral courage involves the willingness to speak out and do that which is right in the face of forces that would lead a person to act in some other way. In this article the author discusses the CODE acronym she has created to help nurses remember key components for actualizing moral courage. After introducing the virtue of moral courage, the author presents strategies to operationalize moral courage, organizing the discussion around the CODE acronym. “C” represents the courage (moral courage), the willingness to overcome fear and stand up for core values. The “O” reminds nurses of their obligation to adhere to the American Nurses Association Code of Ethics for Nurses, which delineates nurses’ ethical responsibilities in a variety of circumstances. The “D” is for danger management, with a focus on developing cognitive strategies and overcoming risk aversion. Because moral courage is essentially an act, the “E” reflects the expression and action component. Assertiveness and negotiation strategies are presented along with clinical examples.

Citation: Lachman, V.D., (Sept 30, 2010) "Strategies Necessary for Moral Courage" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 3.

Nobody can make you adhere to the hierarchical system but if you choose to step out of the system and go higher with concerns you may face disciplinary action or termination by your employer who may report you to the licensing board for investigation.  Communication is commonly emphasized as the path to bringing all parties together to work on a problem.  There are managers who tow the line with the organization because they know they will be replaced in a heart beat if they don't and nurses who feel that the trust that they develop and care that they provide to patients is greater than loyalty to managers and an organization.  That's being between a rock and a hard spot!
Communication has become a buzz word for the politically correct and in listening to physicians speak about how they felt retaliated against when they whistle blowed their communication was used against them and the organization eventually gave up working on the issue citing the failure of communication that would result in the physicians termination. 
I congratulate investigative reporters who were awarded The Sun's Pulitzer finalist series "Do no harm" through creating a data driven study of Las Vegas hospitals.  The vivid snapshot led to five new legislative reforms in Nevada.  One law requires physicians to tell patients about hospital acquired infections.  Quite an impact in one area of the country and if that could be duplicated through the US changes would be inevitable.  To quote a friend "When something is made public, it tends to change or stop."  That's my experience in working in health care.
Communication effectiveness was listed as the number one patient perception by one study.  If nurses are short staffed they are not allowed to tell the patients because they are not viewed as supporting the organization and management in so doing.  Most nurses are extremely busy and as about 80% of what we communicate is done non-verbally I expect they see a tense nurse who hardly has time to stand still long enough to hear their need.  This may be perceived as the nurse not wanting to listen effectively and allay anxiety by being a calm presence. 
The good thing in the US is that there are several hospital systems to choose to be a patient at or work in and that will not be the case once there is a national system in place.  The ideal is to find a culture that works with you and for your and the patients.  Sometimes that takes a long time searching and being prepared to leave an organization that doesn't operate in a way that feel aligned with your moral choices and beliefs.
Patients today are interested in alternative health and there are schools for acupuncture for instance where nurses can become qualified practitioners.  I recommend looking into suitable alternative careers where you do not have to use your nursing license and where you can build a business in your own time and be able to support yourself and your family should you ever encounter a state board investigation.
Explore your options and think about an extra career that you can transition into if your prefer the work and having your own clients and making your own income.  Do a google search and join face book to network with people who are expert and social media marketing and join groups that share common interests in health and well being.  Visit your local Small Business Association and talk to someone about getting advise about starting your own business.  It is an opportunity to grow and actually reach new heights in personal growth.  If you feel that you are questioning more and more about the working conditions and expectations as far as doing what is right then consider an alternative career.  You may think that you can work things out in the system but the system is either open or closed and from what I understand the medical system is closed.  Connect with other nurses and go to entrepreneur classes at local universities and colleges to buddy up with someone and be prepared to put some hours into business at first but as it grows and income comes in you can ease off a litter.  Your reputation with your clients is what will attract more people to come to you for your service or products.
Take care of yourself and pray often and believe in your inner power to work through any challenges and to make your best life ever!  Nothing can stop you if you have a positive attitude and have the high inner energy level that comes with that called the law of attraction.  That is another topic and I highly recommend that your read the book and Napoleon Hill and Jim Rohn.  All very successful and highly motivated. 
Please feel freee to contact me at lawrencerita511@gmail.com or friend me on facebook.