Morals, Ethics, and Nursing: Loyalty to your Employer VS Loyalty to the Patient [Interview][Transcript]

Dr_Leah_Curtin_Moral_Dilemmas_Patient_Life_ExtensionGuest: Dr. Leah Curtin
Presenter: Neal Howard
Guest Bio: Dr. Leah Curtin is an internationally recognized nurse leader, ethicist, speaker, and consultant in the nursing field. A strong advocate for the nursing profession as well as the quality of patient care, Dr. Curtin has long been known for her contributions to the nursing community and brings a wealth of experience and expertise to her audience. Dr. Curtin is the executive editor of American Nurse Today, the official journal of the American Nurses Association, and a clinical professor of nursing at the University of Cincinnati College of Nursing and Health.

Segment overview: Dr. Leah Curtin discusses the question of doing good for the health care practitioner, when extending life comes at a terrible cost of pain and suffering for the patient.


Health Professional Radio – Patient Life Extension

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us today. Our guest in studio today is Dr. Leah Curtin, hailed as a living legend by the American Academy of Nursing in 2009 for her extraordinary influence and career in training and helping nurses to improve the quality of patient care, especially from the nurses’ standpoint while well being loyal and doing what they consider to be right, in a world we’re sometimes so much great area that you can’t navigate. How are you doing today Dr. Curtin?

Dr. Leah Curtin: I’m doing just fine. How are you?

N: I’m doing well. When it comes to being loyal to your employer, your healthcare facility that’s allowed you practice there or to help save lives there. And then being loyal to the patients that you’re giving care too, seeing them on a daily basis getting to know them and sometimes forming bonds that could possibly last for years depending on the outcome of the patient care. As an experienced nurse and educator, what do you see as some of the most common dilemmas when it comes to being a loyal nurse?

C: Well there are a lot of them. But one of them, I could give you an example, does that help?

N: Yes great, yeah.

C: Okay. When I was a visiting nurse, I would come in to take care of Medicare patients. Okay? And many times at home they develop something called “pressure ulcers” or bedsores more commonly.

N: Okay.

C: Okay. And when you are taking care of a person who has bedsores – you dress the sore, you take care, you put medicine, you give the medicine and the bedsores starts to gets better. Until it reaches a certain point. And then it goes into what’s called “stasis” that is the wound does not get better, does not get worse, it stays the same. And if you can work your way to thru that, then it starts getting better again and can even heal up. Now the problem is that Medicare regulations forbid you to come if you’re not making a difference. So if the wound stays the same and you document that it’s the same, then you have to stop taking care of the patient, you can’t come in and care for them anymore.

N: Wow.

C: And therefore the wounds starts getting worse again, then you can come back. But you can never get it healed up because you’re not permitted by the regulations and the laws and also the institution you work for who won’t get paid if you come in to heal the wound.

N: Now aren’t some these thing addressed when legislators get together and they’re talking about, especially now with healthcare reform in full effect, aren’t some of these things being addressed?

C: No.

N: Not at all?

C: I would say probably not. The big problem is of course that legislators do not know anything about caring for patients. Not only that, most of them don’t have any idea what the various regulations are. They usually have someone on their staff, in fact they always do, who deal with healthcare matters and issues and this person might know. But the legislator himself or herself basically usually don’t know, now they may, but they usually don’t.

N: So they have got someone on staff, yeah?

C: And that person may or may not beware of a particular problem. But even if they are aware the problem is this, Medicare doesn’t want to take care of long term care that’s why nursing home care is only covered under Medicare for the first 30 days after someone’s discharged from a hospital.

N: Just 30 days?

C: Just 30 days.

N: And then…

C: Because the government doesn’t want to get into the business of paying for long term care.

N: Well if the government doesn’t want to get into the business of paying for long term care, then how do nurses get around? How do you take care of patients? How do you keep this alive?

C: Well the problem is you either have to lie on your chart. That is the date that you keep, which by the way is against the law, which is considered fraud, which can get you put in jail, which can certainly make you lose your license to practice, you see? Or a new staff coming in to take care of the patient.

N: So how do you tell nurses to proceed through what are such this, are there resources they can consult together just to get around or to at least tackle the moral and ethical dilemmas of some of these very muddy and unclear legal situations when they comes to taking care of patients?

C: Well this is where the nursing organizations and medical associations and so on come in to play because by working together with those within your profession in an organized fashion, you can begin to have some impact on other legislators. Because you can come in, you can pay for lobbyists, you can come in and talk about these problems and that’s the only possibility of getting the law changed.

N: Well, where do you see in your experience at, what is the consensus of folks that think that being loyal to the institution or to the patient, one or the other more important?

C: Oh there is no question. Nurses and particularly to the code for nurses are very clear on this issue. Our primary obligation is always to the patient and of course to one’s self.

N: But when we’re talking about following the money or talking about following the money.

C: Yes.

N: Your bound by your employer. And each employer may have different rules or regulation depending on the state that they’re in or depending on I guess the administrator’s whims.


C: Oh I wouldn’t say whim but I do think that there are certainly institution that have much more patient friendly.


C: I guess an atmosphere, policies.

N: It’s policy … than others do. Though I don’t think you’ll find any institution or agency who needs healthcare services going to say they don’t place patients first.

N: That’s not good marketing.

C: But the problem is this, and if I could just go thru this real quickly.

N: Sure.

C: The problem is if you don’t have any money, you don’t have admission you don’t keep the doors open. The problem is also that we have radically changed health. There was a time when the nurse was completely devoted to patient, the physician was completely devoted to patient and so on. The nuns who were at the hospital or something were completely devoted to the patients, well now what do we have? We have corporations, many of which are owned by investors who wants to maximize profits. And we buy drugs from drug companies that are owned by investors who want to maximize profit. And we get equipment from corporations that are owned by investors that want to maximize profit. And we have hospitals that are owned by investors that want to maximize profit. And we have long term care agencies who are owned by investors who want to maximize profits. And all of these developed contacts with each other and where is the patient?

N: Stock in the middle.

C: Not even stock in the middle, not even discussed.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio today talking with Dr. Leah Curtin, Executive Editor of the American Nurse Today the official journal of the American Nurses Association and the Clinical Professor of nursing at the University of Cincinnati College of Nursing and Health. And she’s been here with us today discussing the problems that arise when doing what is good and doing what is right when the nursing world conflict. It’s been great having you here with us today Dr. Curtin.

C: Thank you very much.

N: Thank you. Transcript and audio of this program are available at and also at and you can subscribe to our podcast on iTunes.

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