Nursing with Integrity Amidst Political Pressures

What if the very institutions we trust for care and compassion could also be centers of enforcement and fear? This episode challenges you to confront the ethical dilemmas in nursing as we explore the shifting role of healthcare providers in the face of immigration enforcement. We promise an insightful look into how hospitals, once sanctuaries, are now arenas where the presence of ICE agents raises tough questions about privacy, patient rights, and the core mission of healthcare equity. By revisiting historical injustices like the Tuskegee Experiment, we spotlight the urgent need for diversity, equity, and inclusion in healthcare settings today.

Boldly addressing the current landscape, we examine the fine line healthcare workers must walk, ensuring that spaces meant for healing remain secure and compliant with legalities. Discover the strategies nurses and hospital staff can employ to uphold patient confidentiality and dignity amidst complex legal frameworks and the challenges posed by ICE's potential intrusion into private units. As we navigate these murky waters, we underscore the paramount importance of adherence to HIPAA standards and hospital protocols to protect both patients and healthcare professionals.

Compassionate care knows no borders, and this episode is a clarion call for nurses to reaffirm their ethical commitments. Through NCLEX-style scenarios, we unpack the challenges of maintaining unbiased care, particularly for undocumented immigrants facing medical and legal hurdles. Our discussion extends to the ethical responsibilities of respecting patient autonomy, managing personal biases, and ensuring accountability in nursing practice. We also delve into the sensitive topics of gender identity and personal freedoms in healthcare, probing the implications of recent political developments on patient rights and ethical decision-making. Join us as we advocate for unwavering dedication to the health and dignity of all patients, regardless of their background or circumstances.

Resources:

https://www.nilc.org/resources/factsheet-trumps-rescission-of-protected-areas-policies-undermines-safety-for-all/

https://www.statnews.com/2025/01/23/ice-hospitals-citizenship-status-undocumented-workers-health-care/

https://www.shipmangoodwin.com/insights/immigration-enforcement-for-health-care-facilities-dont-slip-on-ice-and-break-your-hip-aa.html#:~:text=Although%20ICE%20agents%20may%20be,a%20federal%20judge%2C%20absent%20exigent

https://www.seattletimes.com/seattle-news/health/wa-hospitals-issue-guidance-on-what-to-do-if-ice-arrives/

https://healthbegins.org/immigration-enforcement-in-healthcare-settings-how-to-prepare-and-respond/

Transcript

Navigating Boundaries in Healthcare

Speaker 1 0:00

Welcome to Nursing Life 101, the most important nursing class you never got to take in nursing school. We will be traversing different objectives, like interviewing, what to do in nursing school, boundaries, burnout and so much more. If this interests you, I hope you are taking good notes because class to Nursing Life 101. We're so excited to have you here with us as we dive into the world of nursing, sharing our experiences, insights and a little bit of fun along the way. I'm Christopher and I couldn't be happier to introduce my co-host.

Speaker 3 1:00

Hey guys, it's Colby. Together, we'll be bringing you real stories, practical tips and discussions about all things nursing, whether you're a fellow nurse or just curious about life behind the scrubs. We're thrilled to have you join us.

Speaker 1 1:12

We're definitely not excited about this topic. It's something that needs to be talked about, but it's something that feels very heavy.

Speaker 3 1:21

Yes, before we started recording, I shared that I was actually kind of scared to do this one. But, like Christopher said, despite having these feelings we both share, we also share the feelings that it's imperative that we kind of share this information.

Speaker 1 1:39

So, yeah, we'll get down to the nitty gritty. Yeah, and even in kind of the lead up to this podcast, it was kind of sprinkled in that it would be a little bit in terms of, like, ethical dilemmas or ethical saying a hospital is outside of politics and has its own ethics. You know, there's various things that you and I have done and doctors, we have oaths that we say that are meant to be very patient, focused in the healing and health of a patient, right? So the reason why this was even kind of a topic that I even started to think about was one of do if ICE decides to come to the unit. And I sat and I looked at this huck and was like I have no clue.

Speaker 3 2:58

Yeah, and then Christopher texted me.

Speaker 1 3:02

Yeah, because I was like, oh, Colby's got to know.

Speaker 3 3:04

And I was like, uh, good question, like excellent question by our huck, and I don't have an answer, Like I don't know, and we hadn't talked, like we haven't gotten any instruction or there's been no conversation about it at our healthcare system. So we all kind of just look at each other like unsure. I guess we have to do our own research.

Speaker 1 3:34

Yeah, yeah, and it's unfortunate because that question was asked like two weeks ago and we've still yet to hear something about it.

Speaker 1 3:45

Though now that I've kind of done some research and I am no way a like expert on any of this, and I do want to say that the views and thoughts and opinions expressed by both Colby and I are solely ours and don't reflect or represent any of our employers. And this podcast is for informational entertainment purposes only and should not be considered professional medical or legal advice. And that's being said because I want us to be open and honest in this conversation, because we want to be just as real with each other as we are with y'all, and that's a way to kind of cover ourselves so that we can be. But what does it mean? For I guess, really and truly to make you aware as a listener, since the change in political leadership, there has been an increase in deportation of illegal immigrants, specifically criminal illegal immigrants, Immigrants, specifically criminal illegal immigrants. But, as multiple news sources have said, there are quote unquote collateral people that have also been deported children families, families.

Speaker 1 5:19

And this overall was being done outside of safe havens like churches and schools and hospitals. Right. But with the newest administration thank you. There has been a release to be able to go into those specific safe haven areas. Go into those specific safe haven areas. So what does that mean for you as a hospital? Yeah, hospital yeah. We'll start with hospital and we'll narrow down to healthcare and nurses specifically. Okay, so, like I said, hospitals are safe haven. What does what? Do you think that in your words?

Speaker 3 6:17

what do you think kind of like a hospital? Being a safe haven means their status, whether they're illegal or an illegal immigrant or natural born citizen, that they can come there and get the service that they need medical service that they need.

Speaker 1 6:30

Right.

Speaker 3 6:31

Without questions being asked, without insurance being necessary, without a means to pay. It doesn't matter. That's the place where you can get the care you need.

Speaker 1 6:42

Yeah, and you know that this is broader than just the topic that we're talking about right now. Black, white, asian, hispanic, like it doesn't matter what creed color, yeah, and it doesn't have to be like it's not.

Speaker 3 6:59

It has nothing to do with your race, it has. You know it can be like a disability that you have, like there's it's no discrimination Right and we're you're going to be provided the care that you need.

Speaker 1 7:09

Healthcare is healthcare, no matter what.

Speaker 3 7:12

Yeah.

Speaker 1 7:13

And that's. That's the kind of main bucket that I want us to kind of keep a lens, our eyes looking through. That lens is healthcare is being provided by a hospital and healthcare doesn't matter. Everybody gets sick, everybody caught COVID, everybody catches the flu At some point in your life. You get older, your body breaks down, it starts to get like. These things happen. You know, unfortunately, even now, as a black male who works in the health care system, I have to be very conscious of the tuskegee experiment, henrietta lacks these were just within within 200 years of right now that these things happened in healthcare and we are experiencing these transitions and shifts into growing a healthcare system that is equitable for all. Right, and you know, dei has also been kind of pulled out and man, I did not expect to talk about that. But DEI is all connected.

Speaker 3 8:28

It really is.

Speaker 1 8:30

And that is yes. This is the lens that I want us to kind of focus on, because it doesn't matter. It doesn't matter, but another thing is we have as a healthcare system any healthcare system, something called HIPAA.

Speaker 3 8:45

Right, this is throughout the whole US. This is a federal agreement that was made to protect patient information.

Speaker 1 8:54

Right, and a lot of the times you'll hear us, you might hear us say P8I P as in Paul, h as in hot, I as in integrity, but it's patient health information and I just that's a lot of words, so I'm probably going to say P-H-I a lot, but P-H-I is what HIPAA protects. It allows you, as a healthcare provider, a hospital, to ensure that you don't flippantly give information to those that ask just because they ask Correct. And it allows you, as someone who goes to the hospital, to know that your care is going to be taken in a very secure manner and you're just going to be focused on. And, yes, it has to go to your insurance, but they only give a certain amount of information. It's only what's at.

Speaker 3 9:54

Right.

Speaker 1 9:54

It's not like, yeah, I went running 30 miles and tripped on a tree and broke my knee. I mean they just will say, you know Broken knee, yeah, broken knee Right and broke my knee. I mean they just will say, you know broken, broken knee right, like the stories that you give us and tell us and confide in, stays within us with all that. The left lens is your ability to be a safe haven, health care for all, equitable. And then the right lens is maintain professional and patient privacy.

Speaker 1 10:26

Yeah, we kind of sit in the stage there right now. What? What is ice and what's the difference between ice and the police?

Speaker 3 10:35

This is a tricky one because I feel like there's a lot of question and I think that's like a lot where a lot of confusion stems from, especially how certain entities present themselves and that's kind of like a tactic, whereas like where a police officer and someone who works for ICE they can look very similar if you think about. Like most people's perception of law enforcement, I would say, starts with media and whether that's like a TV show or the news or whatever. Yeah, you may see, like FBI they wear jackets that say FBI on the back. Like you're going to see an ICE individual wearing probably clothes that say ICE on the back, and so like there's an it's a like a gray, blurry line at first, like assessment, and so it can cause a lot of confusion. What is the definition of ICE? What does ICE stand for?

Speaker 1 11:33

So ICE stands for US Immigration and Customs Enforcement. It's a federal agency that enforces laws related to immigration, customs, trade and border control laws related to immigration, customs, trade and border control Right, and I mean it was created in 2003 and has been something that has helped reduce immigration illegally, and actually I mean it's monitored legal immigration too.

Speaker 1 12:02

So those things are. It's good and 100%. I understand the importance of this branch of government, for sure. But going back to the lenses, we can't allow healthcare to be tainted by something just because a person is sick and isn't supposed to be here.

Speaker 3 12:26

Right, and I do think maybe part of the issue of why we haven't discussed it in our health system is that we do live in a quote-unquote white bubble and I don't think that that's smart to ignore it until it becomes a problem. But I do think that's part of the issue. I think it's just like it has everything to do with the location, and I've worked in other hospitals in our state where they were more metropolitan and there is way more variety. I think it's just because of our location in our state and I don't really know that there's a real excuse for it, but it is the truth, and so I think that it kind of issues and topics like this kind of get put on the wayside because it's not in the forefront of their minds.

Speaker 1 13:14

Right, which is why we're bringing it up. Yes, because we know that we're not the only health care system that is probably allowing this to kind of pass by, unless absolutely necessary, allowing this to kind of pass by, unless absolutely necessary.

Speaker 1 13:28

And, honestly, the location that we're at, yes, is primarily white, but is actually a fairly big recruitment for those that are trying to come to the United States. To the United States because we are really accepting and really open-minded. But that also puts a target on this particular area because of what ICE is currently doing and we want to make sure you're aware so that you don't get caught with your tail tucked underneath your leg. I want to ask what would you do if ICE showed up to your unit?

Speaker 3 14:17

Well, before I did my research for this podcast, I think I would just call my manager immediately, right, right, because, like, just based off, like what I've seen in the media, like there's some question about whether or not how they're going about things is fully legal, or it just seems shady, and that's just from the media that I've consumed. You know, like someone else's consumption of media might have been the opposite. They might, you know, give them whatever answers that they want. I do think, like you should. Obviously, first line is like, let your management know. I mean you would do that for any kind of law enforcement presence, because you're not. I mean I'm not.

Speaker 1 15:01

I hope so.

Speaker 3 15:02

Yeah, and I'm experienced and have been working on the unit that I'm working on for many years. I have no idea what to do in the case of any form of law enforcement coming. I'd be like, hold on a second. I'd be like, please hold, let me get my boss.

Speaker 1 15:17

I am not the boss.

Speaker 3 15:18

I'm not that person and we will figure this out.

Speaker 1 15:21

Right.

Speaker 3 15:26

But after doing some research and learning about, like the status of hospitals being quote-unquote safe havens and where where ice is allowed to be in because it is a I mean, obviously a hospital is a public space and that's the point of it being a safe haven, so that anybody could come and get the care that they needed. They are not allowed in private spaces. Right. And so that means like not, they're not allowed to just like walk onto the unit and like walk into a patient's room and arrest them Like that's violating their own rules.

Speaker 3 15:58

So if I, we and we all like in our health system, every unit is a locked unit and you have to ring a doorbell to get in so I was I honestly would be a good question for our leadership is our units considered private spaces because of that locked door, but even outside of that, like people come in all the time, someone badges in and then someone walks in behind them and that's just the nature of of that, of having doors like that.

Speaker 3 16:26

So that's not to say that like, oh, don't, like, I'm not going to worry about this, because this unit is a locked unit and so it's a private space, so they shouldn't be here. Like they could still walk in. And then what are you going to?

Speaker 1 16:36

do right.

Speaker 3 16:37

So, having the awareness that, like they are not allowed to come into a patient room, you can tell, tell them that Again, like you don't want to put yourself in harm's way and you just don't know, like how intense these situations and interactions could get. So I always would say reach out to your manager, call security for the hospital. You could call the police A lot of times I can't say a lot of times because I don't really know but I feel what I have, again, what I have seen and consumed in the media, is that what they're supposed to do is to have updated the local law enforcement or police. So it would be a coordinated event. And what I have actually seen on media is that they are not doing that have actually seen on media is that they are not doing that. So I think it would be beneficial for you and your patients to also make contact with the local law enforcement if they were to come onto your unit.

Speaker 1 17:36

Yeah, and you know, let me. I'm going to address a couple of things that you had said in terms of the unit being a private space. From what I was kind of deducing from reading a lot of different things, it seemed like a unit was a private spot.

Speaker 3 17:55

Yeah.

Speaker 1 17:55

Like they're not even really supposed to come onto the unit.

Speaker 3 17:59

Right.

Speaker 1 17:59

Now A lobby yes.

Speaker 1 18:02

They can come into the lobby which a lot of patient family members stay in, that lobby, which then that patient family member is interrogated, and unfortunately we have no control over that.

Speaker 1 18:15

They can go to the cafeteria, they can go to the bathrooms, because those are public too, the bathrooms, because those are public too. But I also think to what you were saying it's very easy to have you know someone badge in and then the door opens and then. But now I think this shows that we just have to be extra diligent to be like I'm sorry, you don't have a pass to come through, you must ring the doorbell to get in. And I think, really and truly, like I said, focusing on encouraging and empowering people to say I'm sorry, your badge One. We're supposed to. We, as in our healthcare system, are supposed to have our badge visible at all points of us being in the hospital, us being in the hospital. If we don't have our badge, we actually are supposed to go get a temporary badge, pay $20 to get a temporary badge so that we can be in compliance in terms of our dress code. We don't really have one.

Speaker 3 19:15

It's also part of JCO that we have to have name tags and like what our roles are.

Speaker 1 19:20

Okay, yeah.

Speaker 1 19:20

So JCO requirement as well, that's good to know. I mean, that's done for a reason specifically like this one. Like you can say I'm sorry, you do not have a badge, please go get a visiting badge downstairs at our front desk and we will gladly be able to assist you after that In terms of being cautious when or if they do access your hospital. If you impede them or hide the person or try to help escape the person they are looking for, that is a criminal offense. Do not do that.

Speaker 1 20:02

Yes, I care about all people, but you unfortunately have to be a little selfish here because you've got to make a living too and that doesn't make it easy to kind of sit back and kind of see what's going on. But, like I said, if you are able to have them stop at the door, you can have them stop at the door, like you don't have to let them in. You don't let any other patient family member that doesn't have the right information in. That is the same. Those, that is not different. You're not making an extreme case to prevent them from coming in.

Speaker 3 20:41

Right they need to have. Like they come in, let's see they get through. Like there are requirements for them to, there's paperwork requirements for them to be there if they're going to act on being there. So you, as a healthcare provider, can ask to see the warrant and if it's not, like if they don't have one, then they don't have a legal right to be on the unit like they would need to leave, in which case is why it's important for you to contact your management and security and local police.

Speaker 1 21:13

And that warrant needs to be judge appointed and judge signed. Yeah, it's very specific.

Speaker 3 21:21

It is and there are different kinds of warrants. So again, it's important to have local police, your security and management there, so that that is appropriately scrutinized, I guess you'd say, to make sure that they have the correct documentation?

Speaker 1 21:39

Yeah, yeah, and when you reach out to your management, I mean I'm going to be honest when I mean somebody reached out to me Right and I had no clue, so I had to reach out to my director because I was like I don't know what I'm doing and I did not learn this in nursing school.

Speaker 3 21:58

Yeah, I wasn't Right.

Speaker 1 21:59

And so even our director was like, yeah, this is something that is definitely new, right? It's just like COVID, you're constantly learning. We had to adjust, we had to pivot. Now we're adjusting and pivoting to this new political climate that we are in right now. And he was saying like don't hesitate to reach out. And I feel like I was doing some research and there were as a hospital, because we haven't quite narrowed down to the specific role of a nurse as a hospital. Hospitals need to make an action plan. They need to have a. They have. They already have people that have an action team for snow, an action team for mass casualty, an action team for all these different things.

Speaker 1 22:58

We now need an action team for ice and deportation involvement.

Speaker 3 23:04

Yeah.

Speaker 1 23:05

And that team needs to include security. It needs to include a spokesperson that talks to the media and news. It also needs to include someone that we can reach out to, we as in the frontline staff, because, yes, the managers, we do want to be involved, we want to be aware and know what's going on, but we can only do what our unit can. You know, we only have the control of our unit. What if ice decides to go to some other unit, like you were to have all this whole slew of managers trying to bond together, when we can all have one person? That kind of is funneled through, and then you can be like to the ice enforcement agent that you can say oh yes, let me get this particular person that deals with this specifically and allows it to kind of deflect that responsibility off of you. Now, as a nurse, do you remember doing the Nightingale Pledge? I think at our pinning ceremony I might have done that, do you?

Speaker 3 24:19

remember it. No, okay, it goes, the one and only time so it is.

Ethical Duties in Patient Care

Speaker 1 24:23

It is very. I mean, it's known that the nightingale pledge is like the, the pledge for nurses. It's like the hippocratic oath for doctors, as in yeah for doctors is for nurses. And I do want to read it because it is important. And it says I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully.

Speaker 1 24:47

I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge. In the practice of my calling, with loyalty will I endeavor to aid the physician in his work and devote myself to the welfare of those committed to my care. So the main part I want to focus on is I will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge and the practice of my calling, and then to devote myself to the welfare of those committed to my care.

Speaker 3 25:37

Yes, it all comes down to. It doesn't matter what, who or what the patient is, or what they need. It matters that they're getting the care that they are like looking for. They're requesting.

Speaker 1 25:50

Right Welfare of those committed to my. We're ensuring that they are going to leave the hospital better than when they came Right. That is what we, as nurses are supposed to do. Now it's hard because there are people that are politically they lean more to the left, or there are some that politically lean more to the right. That happens, but you can't allow that to deter or change the way you give care to a individual. You have to see that individual as yourself, or as your grandmother, or as your grandmother, or as your father or as your sibling, and you would not want detriment to be done to them in a safe place where they have. I mean, there's some. Literally you wipe people's butts because they cannot do it.

Speaker 3 26:54

I think it's the same sentiment as like when we're treating an inmate from a prison or jail yeah.

Speaker 3 27:01

Like we are not giving that patient any less care than we would someone who just walked off the street like or is a friend or a family member. Like it doesn't matter why they're in jail. They could have done something absolutely heinous, but if they are there for a medical reason, you're providing the medical care. We are supposed to be unbiased. We are supposed to just do our jobs and help a patient become healthy and get them on their way. Like that's solely our position here.

Speaker 1 27:36

Right and really and truly. It is not your business if they are. Unfortunately, it's a little easier to see if they're an inmate, but it's not your business if they're an illegal immigrant. It's not. You don't need to know that and really and truly shouldn't know that, because unless they have confided in you, which good job for you this brings up an interesting case or topic sideline.

Speaker 3 28:04

Our health system in our state does not require that we ask a person's immigration status when they get admitted, but there are two states in the us that have made it a requirement that they ask on like part as part of their admission documentation so some people don't have the, I guess, like some people don't have the ability not to ask, but one part, like one tip, would be that like if you don't live in one of those two states, so you're not inquiring, like just ask what you need to know right I will say, like living, I we've had, I've taken care of or at least have had them on the unit at least at least like five in the last year of patients who were illegal immigrants to the us and they had heart issues and we discovered that they were not legal immigrants when we started working them up for like an LVAD or a heart transplant, and then that became a whole

Speaker 3 29:05

like a huge stopping point because we would need to like investigate further about, like, how we could get them on like Medicaid and all that stuff. So it's it's very tricky, but I think, if you're lucky enough to live in a state, one of the out of outside of the two states that require the hospitals to ask patients about their immigration status, don't, don't ask yeah, it's not necessary and it and if you, if it comes up in conversation, I wouldn't document it anywhere because it shouldn't change how you're providing care.

Speaker 1 29:41

Right, and I mean, interestingly enough, we've given kidneys to.

Speaker 3 29:47

Yeah.

Speaker 1 29:47

And I mean.

Speaker 3 29:50

We've put a heart in an illegal immigrant, but they were going to die without a heart transplant.

Speaker 1 29:55

Because their life is important.

Speaker 3 29:57

Yeah.

Speaker 1 29:59

And that's what it boils down to. It's like are you really allowing somebody's life to possibly die just because they're not here in the United States?

Speaker 3 30:10

Right. I think that change, like your focus as an individual in your role, like you're not focusing on the right thing, right. I think that changed like your focus for your as an individual in your role, like you're not focusing on the right thing?

Speaker 1 30:17

No, not at all. And so what should you do? As a nurse, you should make sure you're educating yourself. Like Colby and I took some time, and this was, you know, just being transparent. This was a pivot from the original scheduled episode.

Speaker 3 30:33

To record, yeah, to record, this was not one you know, just being transparent, this was a pivot from the original scheduled episode to record.

Speaker 1 30:36

This was not one that we had worked up a couple of weeks ago, but literally I mean it took us a couple of days and we did research, we looked and I was like Colby, I don't think we can record it yesterday because I don't think I'm ready yesterday, because I don't think I'm ready, I don't think I'm ready to get it out there, and I want to make sure we're at least somewhat knowledgeable on the topic, at least a little bit, to kind of help start the conversation. And luckily Colby agreed because I was like oh good, because I'm not ready.

Speaker 3 31:07

Yeah, I still don't feel totally ready and I would like to just like reiterate that this is like, in no form or fashion, like actual legal advice or anything, but just like more of like a plea to do your own research and to like empower yourself with some knowledge on the subject in the case that you do run into this situation, because I feel like at this point, it's just a matter of time. It is.

Speaker 3 31:29

It's a ticking clock, like I said before, even being in a quote unquote white bubble, where we are, we both have had patients where we're of illegal immigrant status and provided care to them. So it doesn't matter if you live in a metropolitan area and 90% of your patients could be illegal immigrants. It doesn't matter if maybe 1% of them are. Like it truly could happen, like the situation where ICE agents are in your hospital to anybody anywhere at any point, and it's important to empower yourself is really like the hot word is empower yourself with the knowledge to know what to do in the case that it happens.

Speaker 1 32:11

Yeah, and then go ahead and educate your patient, Like we, no matter what. You are still an educator. If it's not only to yourself, it's to the patients you provide. If they do confide in you that they are an illegal immigrant, go ahead and read them the rights to remain silent when they are being arrested.

Speaker 3 32:35

Something I did come across that I found interesting yesterday was like, while they have the right to a lawyer, the government is not required to provide one for free, so because of their illegal status. But there are law groups out there that provide this service yeah, excuse me, service at like low fees or no cost. So I feel like if you do know that your patient is an illegal immigrant and in these certain climates right now that we're in, I would encourage them to just be prepared in the back of their mind, like if you are able to establish a report with a patient on that level, or or like have a conversation with, like, a social worker who might be able to direct themide in the information that or, excuse me, we do provide a safe place and hold dear the information that we are given.

Speaker 1 33:50

And we don't allow kind of politics to influence our decision as a health care system what exactly?

Speaker 3 33:57

if we're staying within that lens, what are we what? And we are forced into a situation. What are we what? What are our rights? What are we doing?

Speaker 3 34:05

Um, we already touched on it, but, like warrants and consent, they can't like. Unless they have a warrant that's specifically signed by a judge or magistrate for a specific identified individual, they don't have a right to be there. We, as health caregivers, have a right to remain silent. They could ask us questions and you can say I don't know anything about that. Like you, I don't. I don't have anything to share on that. I don't have anything to say. I cannot answer that question. I'm sorry, I don't know the answer. Like that, I don't have anything to say. I cannot answer that question. I'm sorry, I don't know the answer. Like, do you have the right to remain silent?

Speaker 3 34:38

And this is all stuff coming straight from National Immigration Law Center's webpage, which you guys can go check out to some of the websites that we used for our research in the podcast, and I strongly encourage you all to kind of take a look at them as well.

Speaker 3 34:59

Like we did the heavy lifting for you, just read it. Like we'll put it all in one spot for you. They have the awareness that they have rights to look at anything that's in plain view. So if they have a name of a patient, like, for instance, on our units we have we call them grease boards, but they're like they're on large television screens and they'll have like patient's last name, like the nurse assigned, the team assigned and like a couple other things. So that way if, like, a consult comes, they're like hey, who has this patient? We can direct them to the board, that sort of thing. So, like anything that's in plain view, they have the right to like go up and look and just know that. So don't try to impede or like get in the way of that. Again back to the private areas. Like only authorized persons are allowed to enter private areas and I think, under the interpretation of how our units are at our facility, they are locked units.

Speaker 3 35:45

And that means, in order to get in, you need to be an authorized individual, or you need to be an authorized individual okaying someone to come in. So we are allowed to not okay someone to come in basically Like we can say yes or no because we are the authorized individuals. Now, if they're standing there at the camera with a warrant, we may want to investigate that further because, again, you don't want to impede or get in the way of that legal action.

Speaker 1 36:10

And I mean really and truly sorry. I'm going to interrupt just for clarity. These cameras aren't like 4K zoomable, so like you can say, that looks like a warrant. I'm going to get the proper people to come and ensure that they can meet you outside the unit.

Speaker 3 36:27

I will call security and local police and they will meet you outside the unit, because that's unimpeding, that's saying okay, we will get someone to check that.

Speaker 1 36:37

Yep and do it.

Speaker 3 36:38

And yeah, and then actually do it yeah.

Speaker 3 36:40

Again, because you don't want to be accused and then arrested yourself. Things to look for in the warrant Is it a valid judicial warrant? Is it signed by a judge or magistrate? Judge? It states the address of the specific premises to be searched. So they may come to your unit and it might have the patient's name on it. But what if it's not the hospital's address and this is not the place where they had a warrant to search? So that's also, you know, that's key right there. And is it being executed during the time period specified on the warrant? So these are small little things to just keep your eye on that could easily be missed if you just see like, oh, the judge signed it. Right.

Speaker 3 37:20

Again, hopefully you, as a bedside nurse, aren't the one that's scrutinizing this document, because that's a lot of. That's a lot of pressure. And it's not really in our jurisdiction or anything like that. Hopefully the powers that be in in security, local police or at the very least your management like and what the probable cause could be for a possible legal immigrant patient.

Speaker 3 38:10

Overall, it's a very informativeorg and I highly recommend, just at the very least, like they have. There's an insane amount of information, but they have like information cards, like something that you know makes it very quick for you to see. Like you can go to this link that we will provide and you'll get just a wealth of information.

Speaker 1 38:32

Yeah, yeah. And I just want to kind of end this part of it by saying you know this is what's going to happen. If we stand firm to all of that, we continue to have a safe haven for those that need health care and that includes those that will already might have slight hesitations toward health care and shows, you know this, if a health system stands up, know this health system is not about the money because really and truly, you know I'm being a positive and a negative here illegal immigrants do not pay us that's true.

Speaker 3 39:28

Taxpayers pay the cost of their care pay the cost of their care right, and that means you know the unfortunately that that's you and that's me and that's you as a listener paying for that person's health care right, but I would also, before we go further, would like to just like make one point where it's a little bit different, but some but could be interpreted similarly is like we have to have something in place where, like if there was somebody that was here that is not a legal citizen of the US, it could be like reframe it in your mind as like you went on vacation to Europe and you broke your ankle falling on a cobblestone road and you go to their hospital.

Speaker 3 40:13

It's very low to no cost, right for that for us, because the way their government also covers, like people who don't live there and don't have their insurance, or on their social like, because you know it's all set up different than from the us, but like they are all, like their government is also paying for what would be some of your health care over there. So if you frame it like more in that like, oh, they're illegal immigrants, they shouldn't be here, we're paying for them, like sometimes things just happen. Yeah.

Speaker 3 40:44

Like they could be illegal immigrants, but like working their tails off and like contributing in that sense, like to sense in taxes and whatnot and still require healthcare. I don't know. But I just wanted to frame it in a little bit, one way that other people who are initially like this is crazy or this is bullshit, just reframe it a little bit so that they can see it from a different perspective.

Speaker 1 41:15

Yeah, I didn't think about it like that. That's a good way to kind of reframe that perspective. Now, if we don't uphold to our lenses that we are saying what happens, it leads to, interestingly enough, more widespread common illnesses cold, flu, covid, pneumonia. These things start to spread more often. Why? Because we have demolished the trust that we had tried to build as a healthcare system.

Speaker 3 41:54

Right Communities of people are not going to come to the hospital for help when they're sick. They demolished the trust that we had tried to build as a healthcare system. Right Communities of people are not going to come to the hospital for help when they're sick and instead of providing public health to people, they're going to be spreading it amongst themselves. They are Spreading it further. Right. It's like a domino effect.

Speaker 1 42:11

It is Mothers are not going to come to the hospital. So increased risk of fetal death, maternal death, emergencies aren't going to happen, so that increases.

Speaker 3 42:30

I would argue that there's going to be more emergencies.

Speaker 1 42:32

Oh sorry.

Speaker 3 42:33

Yeah, I would argue to say that there's going to be more emergencies. Oh sorry, yeah, I would argue that because if people are waiting until the last possible reason to come get health care because they're terrified or distrustful of it, you're going to be dealing with an even more expensive problem because it's going to require ICU-level care or insane surgeries or transplants or of organs, like all that stuff. I would, yeah, I would say when we break down that trust in our communities, it's going to become more costly, it's going to become more tiring, like for staff. Right.

Speaker 3 43:12

It's a terrible domino effect.

Speaker 1 43:13

It is like for staff right it's. It's a terrible domino effect it is. And going to the staff topic, there's possible staff turnover that will increase yeah, I could imagine burnout burnout. I mean, who knows? I don't. I don't know joe's wife's immigration status. Yeah, now I must. You know, joe might have a very valid reason for be here and and could possibly be here legally, but his wife might not and Ice might come in to try to interrogate Joe Mm-hmm, and Joe might have to leave.

Nursing Ethics and Accountability

Speaker 3 43:56

Yeah, I mean, that's an extreme example, but not out of the realm of possibilities, no At all.

Speaker 1 44:02

All right, it's time for Pop Quiz. Let's lighten it up a little bit, yeah.

Speaker 3 44:06

Okay, so Pop Quiz is ethics and nursing Kind of goes with our theme of topic here today. So all right, y'all, it's time for another pop quiz. Let's test our ethical decision-making skills with some NCLEX-style questions. Get ready.

Speaker 1 44:26

Question number one patient autonomy versus family wishes. Autonomy versus family wishes. A 68-year-old patient with end-stage renal disease has signed a do not resuscitate, also known as DNR order. The patient's family arrives and insists that everything possible be done to save their loved one if their condition worsens. The patient is unconscious and unable to communicate. What's the best course of action? A. Follow the family's wishes and initiate resuscitation if necessary. B. Explain to the family that their wishes override the patient's directive. C Adhere to the DNR order and educate the family on patient autonomy. And. D Contact the provider and ask them to revoke the DNR order and educate the family on patient autonomy. And. D. Contact the provider and ask them to revoke the DNR order.

Speaker 3 45:18

All right, think about it and lock in your answers the correct answer. So the correct answer is C. C was adhere to the DNR order and educate the family on patient autonomy. The nurse must honor the patient's advanced directive or DNR order and educate the family about autonomy and decision-making. Patients' wishes take precedence over family demands. So, even while the patient was unconscious and unable to communicate, they made a legal document when they were conscious and able to communicate and make sound decision and for the exact occasion that this was to happen right and it's not easy.

Speaker 1 45:58

I'm gonna be. I don't be honest. I absolutely hate dnr orders and I have to fight. Every day. I see one not to like if, and it's not like I do it on a regular, but I'm like I want to do something like I. It's not like I do it on a regular, but I'm like I want to do something.

Speaker 3 46:14

It's in our nature as health care providers to want to make a difference and to turn around someone's health, and so it is tricky. It's all about ethics and legalities, and end-of-life care Nurses have a duty to follow advanced directives, even when emotions are running high. I think that's a very good quote, but yeah, it is our. You know, part of delivering care is following patient wishes.

Speaker 3 46:41

Yeah, but the thing is we have seen people talk patients out of a different status yeah, out of a different status yeah, Again and why most hospitals if not all hospitals have an ethics team, because personal opinions can sometimes bleed in, even though it's our duty to not do that and provide unbiased care. Like we've talked about, when emotions run high, they can bleed into one another, and so that's when you bring it to the ethics team and they kind of look at it from an outside perspective and can kind of bring your focus back in on like what the patient wanted and what is truly the best decision for the patient.

Speaker 1 47:35

Yeah, go ahead and just familiarize yourself to the ethic team of your hospital, because the majority do have one.

Speaker 3 47:44

Okay. So question two medication error and ethical responsibility. A nurse administers the wrong dose of insulin to a diabetic patient and realizes the mistake immediately after giving it. Immediately after the injection, the patient's blood glucose is normal and they're not showing symptoms dot dot dot yet. Okay, what is the nurse's next best action? A Monitor the patient closely but avoid documenting the error to protect themselves. B Report the error to the chargers and provider immediately. C Wait until the patient develops symptoms before notifying anyone. D Ask a colleague to co-sign the chart without mentioning the incorrect dose.

Speaker 1 48:28

All right, think fast. Ethic and accountability matter here.

Speaker 3 48:32

So correct answer is B. The nurse must immediately report the medication error to the chargers and provider to ensure patient safety. Veracity, which is also known as truth-telling, and accountability are essential in nursing practice. This is a big one, guys. Transparency is everything in nursing. Hiding an error is never the right choice. Reporting mistakes prevents harm and protects patients.

Speaker 1 48:56

Yeah, and you know we had briefly talked about me messing up the heparin and there are times where you just you make a mistake. You are human, you're not a robot, and it's OK. And I know our health care system has a way to report these things as a non-punitive way of making sure workflows and processes are done efficiently and to prevent error from happening. To prevent error from happening, that's okay. To report yourself, it is fine. It's actually, I feel, like a very big and bold move for you to say I messed up.

Speaker 3 49:40

Yeah, it is, I feel like, and everyone's done it. So don't be like, don't hide it. Whatever you do, everyone's made a mistake. You know I've made a mistake and I wanted to save it for the next time. We did Woes and Wins, but I will share because it goes on topic where I actually did administer the wrong dose of a medication Of insulin. No, not of insulin, thankfully. But it was pain medication actually, oh interesting.

Speaker 3 50:14

I was giving I think it was either morphine or Dilaudid and the patient was like in so much pain and the order was like one milligram every three hours and I finally got the team to increase the dose to two milligrams and I, like out of habit because I'd been giving it every three hours, just pulled and I didn't. So I just pulled two syringes because they were one milligram syringes that were that were getting put out yeah um, and so I gave them.

Speaker 3 50:46

I scanned it, but I was in a rush and I there was like a window popped up and I just like overrode it. I didn't read it, so again, like not following my five rights. But that's what happened and I gave accidentally four milligrams of morphine instead of two, because when the pocket opened it actually opened up a different pocket and it was two milligram syringes, not the one milligram that I had been giving all day. So then the patient was like feeling great after that, but I did like immediately tell the provider and a charge nurse and was like hey, I messed up. Actually I didn't even realize I messed up at that point. Now that it's all coming back to me.

Speaker 3 51:23

they were doing a count, a narc count, and there was a narc missing and they were like what happened, and I said, oh my God, I still had them both in my pocket, so I could like show and I was like I gave him four milligrams. No wonder why he's totally fine now. I was like holy shit. And like that sinking pit feeling that you get like in the center of your chest or in your stomach, like you're like, oh my God, like I cannot believe. I did that.

Speaker 3 51:53

I did, I wrote up, you know the non-punitive thank you like form online and like explained what happened and it all made sense and I knew that and I talked about it with my manager. We had like a very brief meeting about it where I was like, yeah, I simply did not follow the five rights and obviously it's so important that we do it and I was running around the patient been screaming in pain all day and I had three other patients that were busy doing other things and I just didn't think about it and luckily, there was no harm to the patient.

Speaker 3 52:25

In fact, it actually helped the patient more than what we were doing and now that I think about it, that patient was actually an inmate as well. So, double whammy with the medication area error and them being like a DEI. Yeah, so there's a bonus nurse. Woe for you guys.

Speaker 1 52:48

I do appreciate that All right man ethics can really be tricky but at the end of the day it comes down to honoring patient rights, owning mistakes and always prioritizing safety.

Speaker 3 53:01

Yeah, absolutely, and if y'all want more NCLEX style questions and deep dives on real world nursing dilemmas, let us know. Maybe we'll do a full ethics special. That's kind of what we're doing, though.

Speaker 1 53:13

Yeah, I mean on two specific things, but yeah.

Speaker 3 53:16

Yeah, yeah, yeah, it's, it's, it's very deep.

Speaker 1 53:20

Hit us up on Twitter, on YouTube, on Facebook.

Speaker 3 53:24

Instagram.

Speaker 1 53:26

And if you want to hop up on our Patreon, we have that too and tell us how you did on today's quiz. Would you have picked the right answer? Our last topic isn't going to be as long as the first one, because one I feel like it is very difficult and it is very specific.

Speaker 3 53:45

It could be very polarizing.

Speaker 1 53:47

Yeah, but.

Speaker 3 53:48

Which is wild to say, because I feel like this whole episode has probably been very polarizing for people. But this goes even a little bit deeper.

Speaker 1 53:57

I think I think this one's a lot worse in terms of polarizing than the current political administration released an executive order that is meant for the entire country and medical professionals, and was stating that they're maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child's sex through a series of irreversible medical interventions.

Speaker 1 54:29

This dangerous trend will be a stain on our nation's history and it must end. Countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding. Moreover, these vulnerable youths' medical bills may rise throughout their lifetime, as they are often trapped with lifelong medical complications, a losing war with their own bodies and, tragically, sterilization. Accordingly, it is the policy of the United States that it will not fund, sponsor, promote, assist or support the so-called transition of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures. I want to be the first to say that I grew up a man of faith and I truly believe in the Christian background that I grew up in, but now that I've been in health care. I can't stand behind this.

Speaker 3 55:41

Yeah.

Speaker 1 55:43

And I think really and truly it's because I also know that there are, you know, and they're not talking about this in this situation. I don't believe, but there is very few areas that you can say a person. There are conditions where people come out of the womb, both male and female.

Speaker 3 56:09

Correct, both male and female.

Speaker 1 56:11

Correct. So you know like those things happen and I have seen people go through gender dysphoria. I have seen it and seen how crippling it is to a person. Very difficult for me to quantify, like what would like change in this and like I don't know, and it's not easy, it isn't. But like my, my initial thoughts are like I just can't, I can't allow this to be something that is influencing our way of health care.

Speaker 3 56:54

Yeah.

Gender Identity in Healthcare Ethics

Speaker 1 56:55

I mean, it's been so much so that even our state's attorney general was like us, as a health care system, are not allowed to do these surgeries anymore. And there was a protest. There was a peaceful protest out there, like a couple of days after that announcement from the attorney general. Mm-hmm, what are your initial thoughts?

Speaker 3 57:17

I think, like my initial thoughts on reading this is like whoa, it's very reminiscent of like the beginning stages of like controlling individuals. Like controlling, yeah, individuals. It's reminiscent of like your sexual orientation diverting from the quote-unquote and what they define as normal, or, um, being in the dsm, like it's very like it's giving. It's giving like sliding backwards, yeah, and and in our progress, as acceptance and acceptance of how different people want to live different lives. Yeah.

Speaker 3 58:02

I think I'm also torn, though, because it's they're specifically talking about children yeah, and so it's. It's like, on one hand, I can see, and children, yeah, and so it's. It's like, on one hand, I can see and understand, but it's the undertone of what they're what they're if you're reading between the lines, situation where I'm like this isn't good, but like, at the same time, I'm like these are children who are brains, are not fully developed yet. So maybe making really big decisions like surgical aspects or something like that, maybe that's not the best idea at these young ages, but also it's not my decision to make. I don't know, it's such a sticky. It would definitely be something that I would need more information on. I don't, I don't, so I don't initial my initial thoughts.

Speaker 1 58:59

I don't support this right, yeah, and I have more questions. Yeah, I think, and that's what it like this brings up more questions than I I think, in terms of just being okay with it. Like I 100% agree with you, colby Like it's the fact that they have narrowed it down to children and their definition of children are individuals under the age of 19.

Speaker 3 59:23

Which is also confusing, because if you're a legal adult at 18, why wouldn't they say 18? Why did they choose 19?

Speaker 1 59:30

Right.

Speaker 3 59:31

If we can go out to war at 18, why can't they make a decision about changing their gender at 18? I don't know and and but you know, and that's you know that gets me on a soapbox, but okay, well, and this is like this is real.

Speaker 1 59:46

This is what we are struggling with as nurses inside of health care, and I know other people are too and like I'm struggling with it, different than you are because of our different backgrounds, like you know, it's just, it's different and but I mean I remember, I, I, I can, just, I see the person's face. They preferred the pronouns um, he, him, and I remember going into their room and he was like your, your colleagues are not acknowledging my wishes, my preference yeah, yeah and and I'm like this was I wasn't.

Speaker 1 1:00:29

I was not an a and m at the time, I was still clint one and I'm like this was I wasn't. I was not an A&M at the time, I was still a Clin 1. And I'm like I don't even know what to do, like I don't know how to say I'm sorry, like I don't like. I'm sorry is so flippant.

Speaker 3 1:00:42

Yeah.

Speaker 1 1:00:43

Like I prefer it doesn't feel sincere when it's Right.

Speaker 3 1:00:47

Even if, even if it's coming like from a very sincere place, it doesn't feel like it will be interpreted as sincere.

Speaker 1 1:00:55

No, and it's like I mean I did. I went out to the charge nurse and I was like, hey, this particular room prefers pronouncing him. Is there any way that we can make a note of?

Speaker 3 1:01:09

that change how we're addressing him like.

Speaker 1 1:01:10

Make a note of that like change how we're addressing him, Like it was this before our health system made strides and changing the documentation?

Speaker 3 1:01:19

Um, yeah, so we. We now, and it is probably more recent in the last like five or six years, where we can add stuff like that in there, like in their little um, like name, date of birth pronouns, like we can change that information where five or six years ago we were not able to. It was only how someone was what they came out of the womb with. As far as that goes, there were no preferences or abilities to make changes.

Speaker 3 1:01:48

And it really but this, I feel like this executive order is the beginning of a slippery slope where they walk that back Like they're already. This is kind of off topic, but with the current administration like removing anything that has to do with DEI, that also includes that I've seen reports of making staff of federal departments remove pronouns from like their own personal profiles.

Speaker 3 1:02:18

But yeah, I think, if we're already making federal employees lose their pronouns preferences in their email sign-out or just in their profiles, like, at what point are they going to put out an executive order that says, like we're not allowed to use personal pronoun preferences in patient charts?

Speaker 1 1:02:36

Yeah, I don't.

Speaker 3 1:02:38

We don't know. That's the thing I don't yeah.

Speaker 1 1:02:41

But I mean, you know I'm going to be kind of along the DEI track. My vegan aunt, tabitha Brown. She's not endorsing any of this, but she's not really my aunt either, unfortunately.

Speaker 3 1:02:56

But we do love her.

Speaker 1 1:02:57

We do love her, though she had to do a Patreon of like hey, I see what's going on and Tabitha Brown has gone into Target and was like all into Target. And if you don't know Tabitha Brown, she's a black lady, she's vegan, that's all you need to know. Really, she's amazing, but she's like luckily she has a contract with target so they can't pull that contract, but other people were not that fortunate and they're starting to pull those things away and it's like what? It's wild. It's like why?

Speaker 1 1:03:35

like the greater public probably doesn't even know that, like I would never know that if you had not shared that right me but there's, there's other companies that are doing this, just because of this executive order that this current administration has put out. I'm like, are you kidding me? And and you know, and I we're in in the month of February, this is going to be releasing in the month of February. I am, I am, I'm not, I'm not a Malcolm X. I don't go just tirading showing that I'm Black and Black. I am very proud that I'm Black, but I'm not like, I'm not boisterous about that, but I will. I ensure that in February I'm watching all kinds of Black media, I'm watching all types of Black TV shows. I'm funding all types of Black businesses. Now, I should do that, and you know, and I can hear people saying why are you not doing it for the rest of the year?

Speaker 3 1:04:34

You do, I do, yeah, yeah.

Speaker 1 1:04:36

I do, but I make sure to go above and beyond in February, because it's Black History Month.

Speaker 3 1:04:44

But I mean, no, I mean this topic brings up a lot of things, that it, as I said before, is a very slippery slope, and how much are we going to lose? Yeah. As a society, as American people, how much are we going to lose? How much are we willing to lose? Right, it's very scary times.

Speaker 1 1:05:03

Yeah, man, this is not easy.

Speaker 3 1:05:07

Not easy at all, but we did feel like it was super important to at least start the conversation, encourage you to educate yourself yeah, all right I feel like we need like a moment of silence. This feels like we're grieving. It really is, though, in some form or fashion, but I'm gonna go to sleep after this.

Speaker 3 1:05:29

Yeah, this like took, emotionally, a lot out of me, but I'm happy that. I am happy that we're doing it. I feel like we made a good choice and deciding to share this, this episode, create this episode and share this episode with you all yeah, but you know I'm gonna just kind of throw out we're recording this on a saturday.

Speaker 1 1:05:46

It releases this next wednesday, so that that's. That's how important we thought this was we were. We can, like I already had what we were planning on releasing post it ready to go, colby, and I decided to push that back because this was more important yeah, yeah.

Speaker 3 1:06:05

when Christopher texted me and said I think that we need to have maybe we should like do a episode before the rest about ice and everything that's been going on, I I didn't even hesitate. I immediately texted him back and said yeah, I agree, let's do it all right. Well, we're, we would love to continue the conversation and I am I personally, I know I know christopher probably is too like willing to hear all sides. I think it is important to listen to everybody's opinions and views. It's the only way that you gain perspective in the world. So if you have any thought, feelings or you want to share like our socials are open, please reach out. If you have questions, same thing Please look at the links that we're going to include when we post the podcast. There's just like a wealth of information there that could really enlighten you, but otherwise, I think we're ready to wrap it up.

Speaker 1 1:06:57

Yeah, class dismissed. That's a wrap for today's session of Nursing Life 101. We hope you found some useful takeaways to bring back to the floor. Remember, nursing is a lifelong learning journey and we're here with you.

Speaker 3 1:07:13

If you want to connect, find us on Twitter at NurseLife101, or on Facebook at NursingLife101. And don't forget to subscribe and share with fellow nurses. Until next time, keep taking care of yourselves, keep making a difference out there you.