OO - Organizational Overview

OO19: The organization’s policies and procedures that address patient/resident ethical issues/needs. Describe the leadership of nurses in developing and participating in these programs. (EP23)

Jersey CityMedicalCenter is committed to providing ethical patient care and has policies and procedures which insure that the needs and concerns of their patients are addressed.

First and foremost, the MedicalCenter insures that the patients understand their rights and responsibilities (Reference 0019-A) especially pertaining to their medical treatment and/or patient care team, and to make decisions about their care. These rights and responsibilities are distributed to both inpatients and outpatients upon admission.

Another important way that the MedicalCenter addresses the ethical needs of the patients is by the complaint and grievance process (Reference 0019-B). Ideally complaints should be addressed immediately by direct care nurses and nurse managers. These nurses are in critically important positions to identify and resolve most issues/complaints. In situations where the issue cannot be resolved, the Patient Care Representative is responsible for managing the process.

Another significant way that JCMC addresses the ethical concerns of patients is through the process of Advance Directives (Reference 0019-C). This refers to a written document in which a person states his or her choices for medical treatment or delegates a healthcare representative (medical power of attorney-proxy) who will make treatment choices if such person should lose decision-making capacity. During the hospital registration process, the Patient Access Representative or any other delegated admitting person will ask the patient whether he/she has completed an Advance Directive and will place the document in the patient’s medical record.

Another avenue for addressing the ethical concerns of the patients is the ethics consultation. The Ethics Committee is an interdisciplinary group that provides advice and consultation to healthcare professionals, patients and families on ethical dilemmas which may arise in the course of medical decision-making. Consultations to the committee can be made by healthcare workers, patients or the patient surrogate and family members.

Currently there are nine registered nurses on the Ethics Committee. These nurses are involved in the decision-making process regarding ethical concerns and recommendations made to care-givers. They also participate in developing ethics policies and procedures. Policies that the Ethics Committee have participated in revising can be seen in Reference OO19-D, E, F, G, H, I, J. Nurses provide a unique perspective to the committee and one that is valued by committee members. The names and roles of the nurses are as follows:

OO19-Table 1

Part of the role of the Ethics Committee is providing educational offerings to all physicians, staff members, and nursing personnel. This education is used to enhance the ethical tenor of our healthcare providers. Educational components of the Ethics Committee are described below:

OO19-Table 2

Many issues are addressed by the Ethics Committee to include End of Life issues, Do Not Resuscitate and criteria for brain death. See the table below to review the most recently discussed ethical issues:

OO19-Table 3

Nurse Leadership in Ethics

Advanced Practice Nurses, because of their excellent assessment capabilities, and their close interaction with nursing staff and physicians and other members of the interdisciplinary team, are frequently called upon to function as advocates for ethical issues arising with patients. Nancy Pain APN-C, Pain and Palliative Care Coordinator, functions as a liaison between critical care nurses and patients. Ms. Pain is a member of the Ethics Committee and also an integral part of the Ethics Subcommittee which convenes to find resolutions to specific problems and to provide additional insight and support. Other members of this special team include a Social Worker, Pastoral Care, Patient Representative (Advocate), Chief Resident and other key healthcare providers involved with the patient. Ms. Pain is an important element in illuminating certain issues and bringing them to the Ethics Committee.

Interdisciplinary Rounds on the units frequently bring ethical issues to the fore. Nelly Idrobo-Campos BSN, RN, CCRN a Charge Nurse in the ICU, during interdisciplinary rounds discovered an ethical issue. A 78 year old patient was admitted from a Nursing Home to the ICU from the Emergency Department. She was diagnosed with respiratory failure and altered mental status. Her oxygen saturation was 85%. The patient had no relatives or next of kin. The patient was assigned a state guardian. During the admission process, the patient’s guardian stated that the patient can be intubated if needed. The document presented to the ICU staff did not meet the legal requirements; there was no physician or patient signature. It was determined that further clarification was needed. Ms. Idrobo-Campos notified the Ethics Department to inform them of the need for compliance with New Jersey law as well as standards of care.