Choosing Patients over Peers: The Ethical Crossroads We Face

In the world of healthcare, nurses are the heartbeat of patient care. We provide comfort, advocate for well-being and act as the crucial link between patients and the broader medical team. Yet, this significant role often places nurses at the crossroads of ethical decision making. One of the most delicate and emotionally charged dilemmas nurses face is choosing between loyalty to coworkers and a duty to advocate for the patient. When the patient’s well-being conflicts with a colleague’s actions or decisions, ethics demand clarity: the patient comes first!

The Ethical Foundation of Nursing

Nursing ethics are rooted in core principles outlines by the American Nurses Association (ANA) Code of Ethics. These principles include:

1. Beneficence - doing good and acting in the best interest of the patient.
2. Nonmaleficence - avoiding harm to the patient.
3. Autonomy - respecting the patient’s right to make informed decisions.
4. Justice - treating patients fairly and equitably.
5.  Fidelity - maintaining trust and keeping promises, including professional commitments.

These are not just abstract ideals. These foundations guide nurses through real-world challenges, particularly when workplace relationships complicate patient care. 

When Ethical Conflict Arises

Nurses work in complex, high stress environments where human error, oversight or even negligence can occur. What happens when a nurse notices a fellow caregiver skipping steps, dismissing patient concerns, or behaving unprofessionally?

Let’s imagine a scenario: A nurse sees a coworker administer a medication to a patient without asking the patient’s name or checking the patient’s ID bracelet. The medication administration is documented, and the shift continues. The patient begins to wheeze, has swelling of the lips and difficulty breathing. A rapid response is called. The patient is treated for anaphylaxis and is recovering. A review of the chart shows that the patient received a medication that she is allergic to. 

In this moment, ALL the “5 rights of medication administration” were violated:

1. Right patient - the medication was given to the wrong person.
2. Right drug - the drug was never intended for this patient, and in this case, was dangerous.
3. Right dose - even if the dosage was correct, it wasn’t appropriate for this individual.
4. Right route - the route might have been correct but it’s irrelevant when the drug and patient are wrong.
5. Right time - the medication was never scheduled or ordered for this patient at this time.

What began as a rushed, unchecked routine becomes a life-threatening error. Now, the nurse that saw this error faces an immediate ethical and professional responsibility: to report the incident accurately, ensure the patient receives proper care, and support systemic accountability. 

Patient Advocacy Above All

In a situation like this, the nurse’s duty to advocate is not optional - it’s critical. This is not about understanding a coworker or assigning blame. It is about doing what’s right for the patient, whose safety has already been compromised.

Acting includes:

• Alerting the medical team immediately- which may save the patient’s life.
• Documenting the event clearly and factually, including the 5 Rights failure.
• Reporting the error through appropriate institutional channels. 
• Participating in post-event analysis, such as a root cause investigation or safety huddle, to prevent future incidents. 

The Weight of Doing What’s Right

It would be easier to stay silent. To protect a coworker. To rationalize it as a one-time mistake. But in nursing, silence in the face of harm is not neutral - it is unethical. Mistakes happen - but they must be addressed transparently and constructively. 

The Code of Ethics is not theoretical. It is for moments like this - when a patient’s life hangs in the balance and the path forward demands moral courage. Nurses must be willing to step up, speak out, and do what is right, even when it is uncomfortable.