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Review the case study below and answer the questions

Savannah, a registered nurse in charge of direct patient care, attended a party the night before a scheduled 12-hour work day, overindulged in cocktails, went to bed around 3 a.m., and came to work the next morning at 6:45 a.m. with a hangover and alcohol still on her breath.

This situation placed Savannah in ethical violation of the organization’s values and the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2015), as well as a legal violation of the state board of nursing. If alcohol is on a person’s breath, it is still in the bloodstream, which could alter Savannah’s judgment in patient care and result in unsafe patient care and treatments.

• Discuss the ethical implications of Savannah’s partying before work. Please explain your rationale.

• Explore specific ethical violations in Savannah’s case in terms of her personal behavior, the hospital’s ethics and values, patient safety, the ANA Code of Ethics for Nurses with Interpretive Statements, and the state board of nursing.

• Can you think of other options that Savannah should consider other than going to work with an altered state of mind? Make a list of the pros and cons of at least two other alternatives Savannah could have chosen.

• Describe and justify how you would have handled this situation had you been Savannah. Justify your strategies by using an ethical framework: theory, approach, or principle.

• Do you believe the nursing supervisor should take action against Savannah? Why or why not? If you believe the supervisor should take action against Savannah, describe the specific options for disciplinary action based on your general knowledge of institutional and state board of nursing disciplinary protocols. For this answer, you could search the Web for general institutional disciplinary protocols and your state board of nursing’s disciplinary actions if you need more knowledge on this topic. Explain your rationale.

• Do you believe the supervisor should report Savannah’s behavior to the state board of nursing? Why or why not? Explain your rationale.

Provisions of American Nurses Association

The nursing profession is always surrounded by the ethics and code of conducts as it is related with the lives and health of people. Ethics are related to providing the difference between right and wrong. The two main international organizations American Nurses Association and International Council of Nurses have provides the code of ethics for nurses which mainly include dignity, respect, and confidentiality. The dignity described in ethics does not allow the nurses and other employees to party and to consume alcohol before and after their working (CNA, 2010). The ethical theory Utilitarianism states that one can use his/her ability to predict the result of the act being performed. The provision 6 of ANA includes that a nurse is responsible for maintaining issue free healthcare environment. It indicates that employees should be able to work with full freshness and attention in healthcare organization because any mistake in taking care of patients can lead to a great impact on their health and creating an unethical environment. It the given case study, by following the theory of Utilitarianism, Savannah could have eliminated the chances of occurring ethical violence at hospital. She should have also taken care of the time because it is not possible for anyone to take rest only in 3 hours after consumption of alcohol (Constantino, 2014).

According to the provision 9 of the code of ethics provided by American Nurses Association, which is related to the ethics of Assertion and Articulation of Values and integrity of profession, Savannah should not have come to the workplace in the alcoholic situation. The ethical theory of intuitionism also have not followed in this case which states that every person has an inbuilt power and sense that can help in find out the difference between right and wrong. Savannah should have followed intuitionism theory and should not have come to hospital to predict the impacts on patients. Provision 3 of ANA provides that nurses should not do any act that can adversely affect the health of employees. She had breached this provision 3 of ANA that is related to the promoting culture of safety at workplace. As Savannah was suffering from hangover, the patients could be get afraid by her unstable condition or behavior. Also the acts of a nurse in hangover condition is not trustable by the patients as well as by the management (Fairchild, 2010).

In the given case study Savannah could also choose any other option instead of going for work in mental instability. She could choose any of below-mentioned alternatives:

Utilitarianism and Intuitionism

She could ask for a leave for that day after telling the appropriate reason related to her mental health. It is possible that her supervisor might have said some unpleasant words because of consumption of alcohol and being unethical but still, it could be a better option instead of going to the hospital in the alcoholic mental state.

She could save herself from breaching the ethics and creating legal violation at the workplace.

The chances of losing the job could also be eliminated.

She might have praised by the supervisor for her truthfulness.

The patients did not have to suffer from any type of unethical conducts by Savannah.

This could result in declining the image of Savannah in the eyes of her supervisor.

The supervisor and authority could also take a strict decision after knowing about the consumption of alcohol. Because medical sector employees especially nurses are not supposed to consume alcohol as it can be the reason for severe health issues (Hamid, Kanwal, Bajwa, Khalid, & Mubarak, 2016).

Savannah could exchange her job responsibilities with another nurse who would be on leave for that day. In return, she could make a promise to another nurse to perform her duties on some other day at the time of urgency.

This could save her from the violation of ethical rules.

Her job responsibilities would be performed without any delay.

Patients did not have to suffer from any kind of delay in treatment and unethical issues.


Savannah’s image could have down in terms of an employee following ethics and code of conduct (Jameton, 2017).

If I would have been in place of Savannah, I would not consume alcohol as my profession does not allows me to do the same. According to the New Jersey Board of Nursing (State Board), the nurses are required to act in a professional manner at workplace and are prohibited to do any act which can lead to violation of ethics and code of conduct at workplace (Jersey, 2018)

But if in case, I would consume any eatables or drinks containing alcohol, I would surely take care of my duties and responsibilities at my workplace and I would try to consume such drinks which could not impact my mental and physical state at my workplace (Ulrich, et al., 2010). Because the ethics of accountability, responsibility and conscience also does not allow a nurse to do create any unethical environment due to the abnormal mental and physical condition Also, I took care of the time segment of consuming drinks. If I had to go for working in the early morning then I would not sleep late at night in alcoholic condition (Ranheim, 2009).

Alternative Options for Savannah

If there would be such conditions that would force me to awake till late night and also I had to go hospital then I would adopt the second option of shifting my job responsibilities to any of my co-worker that could handle my duties and responsibilities in a good manner. Also, I would inform my supervisor about my mental and physical health and said her/him to cooperate with me in shifting the responsibilities. I would have to make sure her/him that I will not repeat this unethical practice in future. The theory of giving respect to the profession allows a nurse to accept the mistake in front of supervisor and not to repeat the same in future. Following this theory, I also would apologize her/him for the inconvenience that they had to face just because of my unethical behavior. Although I may not have in the state of thinking well but I would have followed the situation after considering ethics, dignity, job values and practices related to the profession of nursing (TJ, 2017).

According to the ANA, management has the power to take strict action against nurses in case to violation of ethics (Ulrich, et al., 2010). On the basis of this, the supervisor should take strict action against Savannah for not following the code of conduct and ethics of the nursing profession. She also did a severe mistake by not informing anyone about her mental instability which resulted in the ethical and legal violation of rules of the state board of nursing. For taking action against Savannah, the supervisor can either directly report to the state board of nursing or to report the management first. The supervisor can also suspend her on the temporary basis until the issue is resolved. This is also included in the Nursing Practice Act of America that a nurse is not permitted to perform his/her duty in case of any ethical and legal issue related to him/her until it is not get resolved (NCSBN, 2018). By following this rule, the supervisor can take a strict action for the misconduct performed by Savannah.

According to the New Jersey Board of Nursing, the medical officers, supervisors, and psychologists should report nurse who attends to their patients within the condition of mental instability. This includes the situation when the supervisors think that the nurse is not capable of providing professional services (Kangasniemi, Pakkanen, & Korhonen, 2015). Following above provision, the supervisor should report about Savannah’s behavior to the State Board of Nursing. Being in the profession of nursing, Savannah should have followed the ethics of responsibility and individual and professional competency. She did also know that her physical condition could harm the patients and still came to the hospital in hangover condition. If the supervisor does not report to the board then it can have a negative impact on other employees and they can also repeat the same behavior. Thus it is to be recommended that the supervisor should report against the unethical behavior of Savannah to the higher authorities.


Barlow, N. A. (2014). University of Huddersfield. Retrieved June 23, 2018, from

CNA. (2010). Ethics, Relationshps and Quality Practice Environments. Retrieved June 23, 2018, from CNA:

Constantino, R. E. (2014). ELSI: Ethical, Legal, and Sociocultural Issues in Nursing Viewed through a Complex Synergistic System Lens. The Journal of Nursing Care, 3(1), 1-6.

Fairchild, R. M. (2010). Practical ethical theory for nurses responding to complexity in care. Sage Journals, 17(3), 353-362.

Hamid, S., Kanwal, R., Bajwa, M. H., Khalid, S., & Mubarak, H. (2016). Ethical Issues Faced by Nurses during Nursing Practice in Pakistan. Diversity and Equality in Health and Care, 13(4), 302-308.

Jameton, A. (2017). What Moral Distress in Nursing History Could Suggest about the Future of Health Care. AMA Journal of Ethics, 19(6), 617-628.

Jersey, T. S. (2018). New Jersey Division of Consumer Affairs. Retrieved June 25, 2018, from

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: An integrative review. Journal of Advanced Nursing, 71(8), 1-14.

NCSBN. (2018). Nurse Practice Act, Rules & Regulations. Retrieved June 25, 2018, from

Ranheim, A. (2009). Caring and its ethical aspects—an empirical philosophical dialogue on caring. International Journal of Qualitative Studies on Health and Well-being, 4(2), 78-85.

TJ, B. (2017). The Ethical Dimensions of Incivility in Nursing Education. Nursing & Healthcare International Journal, 1(3), 1-10.

Ulrich, C. M., Taylor, C., Soeken, K., O'Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday Ethics: Ethical Issues and Stress in Nursing Practice. Journal of Advanced Nursing, 66(11), 2510-2519.

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