A key ethic in the nursing profession is serving as advocates for patients. At times, nurses may stand up for patients when their actions challenge authority. Included in Provision 3 of the American Nurses Associations Code of Ethics is a focus on the patients rights to privacy, confidentiality, and patient safety (Lachman 2009). The code directs nurses to report actions that may harm the patient. That directive is clear, and it is taken seriously by professional nurses. HR support for nurses when they are advocating for their patients is important because the nurses are fulfilling their ethical duty. Consider the following summary, compiled from newspaper and blog accounts (see Elbein 2011; Lowes 2010; Sack 2010), of an incident that happened in Winkler County, Texas. As you read this summary, consider the role and ethical obligations of those involved to their patients and employees. What should the hospital leaders have done at various times during the two-year ordeal for the nurses as they served as patient advocates

Two nurses had worked at the same Winkler County hospital for more than 20 years. One of the nurses was in charge of quality assessment, and her responsibility included au-diting hospital records to ensure that quality of care was maintained. The other nurse was the compliance officer, responsible for ensuring that hospital physicians and pharmacists were following state regulations. In 2007, the hospital hired a new administrator to serve as an executive director and head manager; later, he was described by the compliance of-ficer as not a listener, saying He didnt want us looking at anything or making comments about anything . . . (Elbein 2011). In 2008, the hospital hired a new physician, who became friends with the new administrator and the towns sheriff. As the compliance officer, the nurse reviewed charts (medical records) of patients, including those under the new physicians care. She found the new physicians treatments to be highly unsafe and found evidence of a conflict of interest. Specifically, he was giving patients samples of elixirs that were not approved as medicine by the Federal Drug Adminis-tration. These elixirs consisted of fruit juice and dietary supplements, and they were sold only by the physician and through his website. Moreover, she found that the physician prescribed thyroid medicine to patients who did not have thyroid issues, failed to appropriately treat a diabetic patient who should have been referred to another hospital for skin grafting, and performed surgeries at the hospital even though surgeries were not allowed at the hospital.She expressed her concerns to the new administrator, but the administrators response was minimal. He instructed her to write a waiver for patients to sign; the waiver released the hospital from liability resulting from the elixirs. Additionally, he told her to write a letter to the physician to inform him about hospital policies (such as physicians were prohibited from prescribing medications that had not been approved by the FDA and from performing surgeries on site). The administrator refused to take further actions.Next, the compliance officer, the quality assurance nurse, and a nurse who worked with the physician reported their concerns to the hospitals board of directors. One board member interrupted them and shut down their attempt to inform. Frustrated, the nurse who worked with the physician quit her job, but the compliance officer and quality assurance nurse continued to voice their concernsbut to no avail. In fact, the administrator issued an order that no one employed in the hospital may report any doctors without his permission; the board passed this order as policy. In 2009, both nurses anonymously wrote a letter to the Texas Medical Board detailing the physicians unsafe clinical practices.After the physician (who already had a restricted license) was informed he was under review by the state board, the sheriff launched an investigation and obtained a warrant to search the nurses computers. A copy of the complaint letter was found on the computer used by the quality assurance nurse. Both nurses were fired, arrested, and then indicted for misuse of official information, which carried a $10,000 fine and possible imprisonment of up to ten years. The Texas Nurses Association established a legal defense fund for the nurses, and other state nurse associations as well as the national nurse association con-tributed financial support. Letters and e-mails of support poured in for both nurses before and during the trial. n the end (between 2010 and 2011), the charges were dropped (before the trial) against the quality assurance nurse;the compliance officer was found not guilty after a jury deliberation that lasted less than one hour; the two nurses sued the hospital, county, and the sheriff and prosecutor in civil court and received damages of $750,000;the administrator resigned from the hospital, was charged with and pled guilty to a misdemeanor of abuse in an official capacity, and turned over evidence against the sheriff;the sheriff was found guilty of retaliation, misuse of official information, and two counts of official oppression and was subsequently removed from office, sentenced to four years of probation and 100 days in jail, and fined $6,000; andthe physician pled guilty to two felony charges of retaliation and misuse of official information, surrendered his medical license, was sentenced to 60 days in jail and five years of probation, and was fined $5,000 1. Review the events in this two-year conflict. What were the unethical HR practices that took place?

2.If you worked in HR at the hospital, what were your ethical obligations to prevent these unethical practices? Consider, for example, the ethical standards of justice, beneficence, nonmaleficence, and autonomy and the responsibility to patients, employees, and physicians with practicing privileges.

3.Are you concerned by the administrators actions (or lack of) that led up to one nurse leaving and two nurses getting fired? Why or why not