1. Andresen, May-Lynn DNP, RN
  2. Mason, Diana J. PhD, RN, FAAN


Nurses should embrace and share this ethical framework.


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In 2003, 82 patients filed a lawsuit against Redding Medical Center, part of the Tenet Healthcare Corporation in Northern California, for unnecessary cardiac procedures and surgeries by two chiefs of cardiology services, Dr. Chae Hyun Moon and Dr. Fidel Realyvasquez. The unnecessary procedures generated generous profits for the hospital. The British Medical Journal reported on the case:

Figure. Diana J. Mas... - Click to enlarge in new window Diana J. Mason
Figure. May-Lynn And... - Click to enlarge in new window May-Lynn Andresen

"Operating room nurse Kim Schlenker said: "The entire hospital just rotated around Dr. Moon-just one doctor." She said Dr. Moon had so many patients lined up he would rush through delicate heart procedures. "We used to call them fire drills, because he was always in a hurry because he had more cases to do," she said."


Fast-forward to earlier this year, when Anthony Armada, chief executive officer of Swedish Health Services, resigned after the Seattle Times reported that the hospital turned a blind eye to unnecessary but highly profitable neurosurgeries and failed to address staff complaints about the lead neurosurgeon, poor staffing, and inadequate care.


Nurses often see serious problems within organizations, and may fear dismissal or other punishment for reporting unsafe practices. While whistleblower protections need to be strengthened, we'd also like to draw attention to a new Charter on Professionalism for Health Care Organizations ( that could be used to hold health care administrators accountable before they ignore unsafe situations.


The charter was developed by an interprofessional team and patient representatives, with the two of us bringing nurses' perspectives to the table. The work group was chaired by Barry Egener, MD, medical director for the Foundation for Medical Excellence, and received project support from five organizations, including the American Hospital Association and the Federation of American Hospitals. Based on a consensus-building process, the charter identifies four areas of focus:


* Organizational culture. Leaders of health care organizations should be held accountable for ensuring a psychologically and physically safe workplace where trust is fostered and employees are encouraged to speak up about activities not aligned with the organization's values.


* Patient partnerships. This includes inviting patients and their families to partner with the care team and ensuring that their priorities and informed care preferences are respected.


* Community partnerships. To control health care costs and improve people's health, organizations must partner with their communities to, for example, increase access to healthy foods.


* Operations and business best practices. Some hospitals outpace the rest as recognized centers of excellence that are also profitable. Such organizations use best practices such as transparency in supply purchasing and financial reports.



Every nurse should know about this charter and use its principles to spur conversations about whether a health care organization is operating in a professional way. No organization is perfect, but the charter can send the message to the executive leadership that its employees expect it will operate in principled ways, including not putting profits before patients.


The message of the charter is important to everyone. For example, the Joint Commission could build the charter into its accreditation framework and processes. But nurses are key to moving it forward. Invite the nursing director to distribute it to nurse managers and post it on nursing units. Recommend a grand rounds on it. Send a copy to your board of trustees.


As health care organizations attempt to adapt to a changing policy environment, we need guideposts to help their leaders and employees embrace their social responsibility to serve patients, families, and communities in the best ways possible.