016 护士可以公开批评自己的医院吗？ - 医护前沿 - 奥医教育-奥医资讯-厦门奥医教育咨询有限公司

在临床实践中，小至疾病治疗，大至医院管理，医护人员都会有自己的看法，有赞扬，也有批评，那么，医护人员是否可以公开发表自己的这些看法呢？或者，若发表对医院的批评意见，又会带来什么后果呢？

Should Nurses Publicly Criticize Their Hospitals?

Fallout From the Ebola Crisis in Dallas
Carolyn Buppert, MSN, JD

Question
In the wake of the first Ebola patient in the United States, a nurse publicly criticized her hospital's lack of preparedness for, and handling of, patients with Ebola. Can nurses do that? Should they? Must they?

By now, most people have heard about Texas Health Presbyterian, the hospital in Dallas which, when presented with a patient with Ebola, missed the diagnosis. One day after a nurses' union accused that hospital of mishandling the nursing care of the patient, a nurse who worked at the hospital, Briana Aguirre, appeared on the Today show via Skype, airing multiple criticisms of the administration at that hospital. Among her points: personal protective equipment (PPE) issued to the nurses left their necks exposed; training was meager and voluntary; the patient was not isolated immediately; and bags of hazardous garbage built up in the hallways where staff walked about without shoe covers.

She said that when she voiced her concerns to a hospital vice president about the lack of protective suits, he said he would look into it and call her, but he didn't get back to her. "I can no longer defend my hospital," she said. "They should have called in more help... They violated basic principles of nursing care... of medical care." She stated that if she came down with Ebola, she would avoid her own hospital. Aguirre said she realizes that she is at risk of losing her job over this, but she thinks that she is doing the right thing to voice her concerns. She appeared with an attorney, who called her "a whistleblower" and said that he is trying to protect her job. He commented that she was taking a big risk, given that she has two children and is the breadwinner for her family.
The hospital defended itself by saying that it followed Centers for Disease Control and Prevention (CDC) protocols that were current at the time, and that the trash was well contained.
What Can Nurses Learn From This Situation?
Let's look at the pros and cons of speaking out in the news media about perceived or observed deficiencies at one's place of employment.
Pros. This nurse was within her rights to speak. Such rights are guaranteed by the US Constitution. She exhibited considerable bravery in risking her job to bring the hospital's deficiencies to light. She spoke well. She didn't appear to be enjoying herself but did appear to be worried about the well-being of other patients and other staff. There was no "spin" that we often see when administrators and public servants talk about operations and policy problems. The public already trusts nurses, and this nurse most likely will strengthen that sense of trust.
Cons. She is risking her job. Most likely, it will be determined that the Texas whistleblower law does not protect her. The hospital wasn't doing anything illegal. That hospital was in the unfortunate position of being the first in the country to be required to diagnose Ebola and care for a patient with Ebola hemorrhagic fever. It wasn't only the hospital that fumbled around trying to decide what to do; the governmental agencies were doing the same. The hospital didn't necessarily breach any standards of care because it is not yet clear what the standards of care are for treating Ebola.
What did this nurse hope would be accomplished by speaking out? What care will be improved because she spoke up? More than likely, what is happening—that the hospital and the government are gearing up to deal with Ebola—would have happened whether or not this nurse spoke to the Today show. Wouldn't it have been more effective for her to work with the hospital to acquire effective PPE, to find a way to remove the trash from the hallway, and to help solve the problem of isolating the patient? If a vice president didn't call her back, couldn't she call him?
The nurse said she is on the "low end of the totem pole" and looked to the "higher-ups" for direction. However, nurses in general are great at problem-solving. A nurse involved in the early stages of Ebola treatment and care certainly could make a career out of solving the problems that she identified and then telling others how to do it. Entrepreneurial nurses can develop the design for PPE. Research nurses can study the best way to disrobe from PPE without contaminating oneself. Educational nurses can develop training for this process.
In my opinion, the "cons" outweigh the "pros" in this case.
Speak up When Patients or Staff Are at Risk?
Should a nurse speak up when patients or staff are at risk? Yes. Should the nurse do that within the system or go outside the system? It depends. There is no reason why nurses shouldn't weigh in on issues of patient handling. But what is talking to the news media going to accomplish when compared with working within the hospital system to develop solutions to the problems?
Around the same time that this nurse spoke to the Today show, the two Dallas nurses who had been diagnosed with Ebola were being transferred out of Dallas and into hospitals with more experience taking care of patients with serious viral infections. The CDC sent experienced infection control nurses to Dallas to provide peer-to-peer training. The same day Aguirre spoke on the Today show, the hospital, through one of its executives, apologized at a Congressional hearing for not diagnosing the patient with Ebola on the first visit. He acknowledged that the hospital's training efforts were inadequate. The CDC said that it is rethinking its guidelines, given that two nurses became infected even when apparently following protective procedures.
Although the handling of the Dallas Ebola patient may have been bumbling, it's not clear that the Dallas hospital efforts were any worse than how any other hospital (other than a hospital with a specialized biocontainment unit and staff) would have handled the situation. Nurses at Emory University Hospital in Atlanta who cared successfully for two physicians with Ebola who were flown in from Africa have said that they needed to readjust their plans many times as more information became known.
Briana Aguirre could lose her job. It is within the law for the hospital to fire her. She indicated that she was well aware of this possibility and that she might have trouble finding another job. Isn't it possible that she could have kept her advocacy within the organization and done more good, with less risk to herself and her family? Didn't the nurses' union take care of airing the criticisms of the hospital? Nurses' opinions surely are going to differ as to whether the individual nurse should have gone public. Discussion might be productive, because each nurse is going to have to decide how he or she will behave when in the shoes of Ms Aguirre. I suggest that she could have been more effective, with less risk to herself and her family, by working within the organization. Perhaps it is too much to ask of nurses to take leadership in this type of situation, but I don't think so.

原文链接：http://www.medscape.com/viewarticle/833483

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