In Practice: Reflections from NPs and PAs

Elizabeth Donahue, RN, MSN, NP-C, practices adult primary care medicine in Boston, MA.

First I noticed it all over my social media feed — the story of Alex Wubbels, a burn unit nurse at a university hospital in Utah who was arrested and manhandled by police for not allowing them to take a sample of blood from an unconscious patient without a warrant. Then came a slew of texts, emails and calls from people wanting to discuss the incident, asking me what I thought. Most recently, it came up while laying on the beach with family members, who wanted my reaction to the event.

My reaction is this: I could have been Alex Wubbels. I would have done the same thing she did. And the realization of that fact — after seeing how she was treated for following hospital policy and for protecting her patient — is kind of terrifying but also empowering. But I think most nurses would have done the same and here’s why.

Alex Wubbels knew the hospital policy and she followed it. By nature, I am detail-oriented and I adhere to guidelines. By education and training, my natural tendencies have been “encouraged.” I was taught how to make a perfect bed; I know how to calculate a drip rate by hand using stoichiometry and not a calculator; I have counted another human’s urinary output over a 12-hour period to the milliliter. If a patient is on precautions, you damn well better believe I have “gowned and gloved” to a tee for that level of need. When a parent calls my office about an adult child, the first thing I ask is if we have a signed release on file to share information with the caller — because otherwise, we are not legally allowed to disclose health information of the patient; it is protected under HIPAA.

“Hospital policy” has gotten a lot of flak in the dust-up that has followed this incident — but it exists for a reason, and it is my job and every hospital professional’s job to know it and to follow it, just like Alex did. While it may be impossible to know every policy, providers are trained on where policies are kept, how to read and interpret them, and also how to access supervisors as backup. According to the video footage of the incident, Alex did all of that, and most nurses I know would have done the same. We are cut from this same cloth and trained in the same way.

While most people are familiar with the oath that physicians take to “do no harm” (who knew Hippocrates would still be quoted 2000+ years after his death?), reflecting on this incident made me wonder: Does anyone know where nurses get their call to provide care and avoid harm? The answer is that some graduating nurses still recite the Nightingale pledge made famous by another nurse in the late 19^th century. But our working ethics go beyond this pledge. Nursing education is infused with the principles of caring, integrity, and excellence from start to finish. We are taught that our role centers around advocating for patients and families. We are called to integrate this into our daily practice. While in school, we buy and read copies of the 72-page ANA “Code of Ethics for Nurses with Interpretive Statements,” we study the concepts of Jean Watson’s theory of human caring, and we complete courses titled “Ethical Issues in Advanced Practice Nursing.” It is deeply ingrained within the collective nursing psyche to do what Alex Wubbels did — to put the patient first and advocate for patients, especially when they cannot advocate for themselves.

An annual national Gallup poll of Americans has ranked nursing the highest among 21 major professions in terms of honesty and ethics — for the 15^th year in a row. Our patients place their trust in us to care for them and ensure no harm comes to them. So, thank you, Alex Wubbels, for this example of what it is to be a nurse, for reminding us of our calling.