Nurses in Management and Leadership Forums Response to the RCN and NMC Guidance on Not to Treat

Leadership during crisis management is often about making the best bad decision possible at any given time, knowing in hindsight that the lessons learned will show different actions may have been preferable. While the RCN and NMC guidance with regards to the refusal to treat patients if there is a lack of suitable PPE and the associated implications for registrants who decide not to treat is helpful to a point, they do not fully embrace the fundamental moral and ethical dilemmas colleagues may face during such decision making: whether to protect themselves and their loved ones or provide care to patients.

The foundation of ethical decision making that we do every day are based on our morals and beliefs about what we consider to be the right thing to do; our professional codes of conduct and the different ethical frameworks and processes we can use when deciding how best to make and enact our decisions. When there are clear answers based on the best empirical evidence, the systems and rules inform us of how this should be used, we are left to answer the third, is it morally the right thing to do? Here were guided by ethics, the application of which have many possible ways to interpret.

It would seem the moral question of whether professionals, educated to assess and answer using critical analysis and professional judgement, should provide care when there is insufficient PPE is being clouded by the narrative of “heroes and heroines”. Here we see social and political discourse invoking the language and spirit of World War Two. There is a “call to arms”, with a “keep calm and carry on” attitude, and the promise of a medal as a reward for those on the front line providing care despite the lack of appropriate or sufficient supplies of PPE.

This discourse is not, in our view, a helpful narrative. We are concerned that individual colleagues across the health and social care sector may become vilified; when in truth, it is the systems in place that will force many into a position where they feel morally obliged to favour the “rules of duty” at the expense of their professional better judgement. The emotional and psychological harm of this response, or using the words of the current narrative, the “collateral damage”, could be untold and we believe it is morally reprehensible they are being subjected to it.

As a profession we must resist the use of a social and political discourse of heroic wartime language and posturing and instead focus on enabling professional judgements to be made, allowing colleagues to do the morally right thing based on empirical evidence and sound guidance on a case-by-case basis? When the lessons learned are being reviewed, we should not have individuals who are seen as lesser, simply because they acted with professional courage and refused to treat, or worse, who paid the ultimate price due to a forced moral obligation. So, can we have some real moral leadership, please?

This blog is based on a tweet made by the Nurses in Management and Leadership Forum.