At the beginning of her shift on an orthopedic trauma unit, Laura, a registered nurse with 3 years of experience, identi

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At the beginning of her shift on an orthopedic trauma unit,
Laura, a registered nurse with 3 years of experience, identified
and prioritized several tasks that she needed to complete during
her shift, listing times for scheduled medications, three complex
dressing changes, helping a patient on postoperative day 1 to get
out of bed, and discharge teaching for her patient Mr. Davis, who
was going home after a long hospitalization for the treatment of a
severe compound fracture of his lower leg. Laura knew that there
was another patient in the emergency department waiting for
admission to the unit, but there were no empty beds; the only bed
that was going to be available was the one Mr. Davis now occupied.
Laura anticipated a busy shift. In addition, Laura's patient Mr.
Miller complained of pain in his abdomen and asked for medication
frequently. After assessing each of her six patients, Laura
collected the discharge papers for Mr. Davis and started her
teaching with him and his wife, who was going to continue care of
the large wound in Mr. Davis’ leg at home. Mrs. Davis had numerous
questions and what seemed to be a routine discharge became more
complicated when she asked Laura for a home health referral so a
nurse could help them manage Mr. Davis’s wound at home. Soon, Mr.
Miller rang his call light and asked for pain medication; a nurse
colleague stepped into the room to tell Laura, “Your frequent flyer
in Room 312 rang again.” Several minutes later, the ED charge nurse
called to ask when a bed was going to be ready. The patient in the
ED had been there since 10 p.m. the previous evening. Laura began
to feel a bit of stress but decided to reprioritize her day. As she
stood at the med cart and reviewed Mr. Miller’s pain med use, she
noted to her colleague, “He has got to be drug-seeking. That is the
only explanation.” She decided that she could forgo for the time
being getting a home health referral for Mr. Davis; she understood
that until he went home, she would not have to do the long
admission process for the new patient coming from the ED. When Mr.
Miller asked for pain medication a second time, Laura rolled her
eyes and continued to check the morning laboratory reports; when
Mrs. Davis came to the nurses’ station to ask about the home health
referral, Laura told her, “I called the social worker to come up to
see you, but she is busy and can’t get here until midafternoon.”
Mrs. Davis thanked Laura and walked away, at which point Laura
turned to a new nurse in orientation and told her, “And that’s the
time management skill they don’t teach you in nursing school” and
high-fived another colleague.
1. You are Mrs. Davis, and as you walk away you
hear Laura's “time management” comment. You return to the desk to
ask Laura if she had even called a social worker yet. Why
was Laura's response be deemed as unprofessional or unethical? From
an ethical perspective, how should Laura respond?