The Moral Agency of Institutions: Effectively Using Expert Nurses to Support Patient Autonomy

Guest Post: Sonya Charles

Article: The Moral Agency of Institutions: Effectively Using Nurses to Support Patient Autonomy

When you think of nurses, what do you think of?

Florence Nightingale? Nurse Ratchet?

A sassy, but competent woman in scrubs?

Popular culture has not always been kind to nurses and, even when it has, it rarely gives an accurate depiction of what nurses actually do. We might shrug off the misrepresentation of nursing as popular culture rarely gives an accurate depiction of many areas of life. Unfortunately, unlike other professions, these misconceptions of nursing spill over into nurses work environment as well.

In this paper, I consider how traditional views of nurses still undermine nurses’ professional autonomy. Certainly, those who work in modern hospitals have a better sense of what nurses do; however, the hospital, as an institution, is still set-up with a traditional hierarchy in mind. I argue that we need to shift hospital policies and power hierarchies such that nurses can achieve professional autonomy (both as a profession and as individual practitioners). Not only is this good for nurses, but it is also good for patients.

Recently, a woman won a $16 million dollars in a lawsuit against the hospital in which she gave birth. In the lawsuit, she argues that the hospital was marketed to women who wanted natural births. They claimed women would have access to birthing tubs and would have their birth plans respected. When she showed up, her experience was the exact opposite. She was denied the opportunity to birth in a tub and required to lay in bed hooked up to an electronic fetal monitor. Even more egregious, when her son began crowning, nurses forced her back onto the bed and held him in for 6 minutes until the doctor arrived. As a result she was left with permanent nerve damage.

Why do I recount this story? After all the nurses here seem to have done the opposite of protecting patient autonomy. I recount this story because maternity care is one area where nurses’ autonomy is particularly circumscribed. Despite years of research and activism, many (most?) U.S. hospitals still follow a medicalized model of birth. While this particular hospital (located in Alabama) may have been even more “old school” than some, the kind of bait-and-switch tactic is not uncommon. My point in relating this story is to illustrate why it is necessary for nurses and their professional guidelines to be respected in the hospital environment.

In another webpage of birth stories, a nurse who works in maternity care recounts this personal story:
Some places where I’ve worked, it’s like an old boys’ club. They don’t seem to respect women’s bodies; they don’t respect the process. They’re arrogant to the nurses. They don’t seem to practice by ACOG guidelines… I’ve seen fundal pressure, like this, the fist in the stomach. They don’t treat women like human beings. And the nurses eventually start taking on that attitude as a matter of survival. That’s why I work in Berkeley now, because we tend to have more compassionate providers in this area.
While birth stories (perhaps) provide us with the most dramatic stories, there are many areas in healthcare where nurses could do more to help support and protect patient autonomy—if they are given the respect they deserve.

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