Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: A female nurse of the same rank heard a male nurse say about a 43-year-old female Warrant Officer admitted for abdominal pain, ‘I wonder why at 43 years old she is not married. Do you think she is a lesbian?’ What should the female nurse do? What are the ethical issues?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics of professional behaviour, promoting professionalism and upholding the reputation of the profession when giving care to a patient.  It also involves the human rights and dignity that all patients should expect from those professionals who provide them with care and treatment. It also involves disclosure by a registrant to a higher authority against another registrant and also them challenging their behaviour and not being an inactive bystander.

Step 2 – ANALYSE

Patient: 2 principles of beneficence and non-maleficence apply. The patient has the right to be treated with respect and dignity and questioning her sexuality in this way is degrading, inappropriate and unprofessional. It is not relevant what the patient’s sexuality is or whether she is married or not. What is important is the fact she has been admitted with a physical ailment. The male nurse could be exhibiting unconscious bias against, a 43-year-old unmarried woman with abdominal pain and is unintentionally causing harm to her through their discriminatory perception of the woman’s sexuality, which has no relevance. If the patient were to have heard the male nurse’s views this could have caused them emotional harm and unnecessary distress.

Clinical: given the patient’s age, it would seem appropriate to exclude or confirm pregnancy in any event in the process of determining diagnosis and the most appropriate care pathway. If she were found to be pregnant there will be implications of her pregnancy on her continued employment on the operational tour. However, if she is not then a full diagnostic investigation would need to be performed to ascertain the reason for her abdominal pain.

Legal: The International Council of Nurses Code of Ethics is at: https://www.icn.ch/sites/default/files/2023-04/ICN_Code-of-Ethics_EN_Web_0_0.pdf

At section 1.2 it says that in order to be ethical nurses ought to promote an environment in which the human rights of the individual are to be upheld and respected. Similarly, at section 1.8. nurses ought to demonstrate professional values such as respect, justice, caring, compassion, empathy, trustworthiness and integrity towards all those careful.

Societal/Military: to hold ethical values both nurses should display a personal commitment to the standards of practice and behaviour set out in their regulatory code (of whatever country) and the International Code of Ethics. The female nurse therefore has a duty to disclose to a higher authority the comments of the male nurse and challenge him on the inappropriateness of them.  If the warrant officer had overheard the male nurses’ comments undoubtedly, she would find these to be not only hurtful but potentially discriminatory, which would raise further issues of a possible formal complaint being submitted against the male nurse. In such circumstances, the adjutant of unit would be involved in any investigation and possible discipline of the nurse following.

Nurses should care for their patients without prejudice or discrimination. All nurses are bound by a professional code. In the United Kingdom, the Nursing Midwifery Council (NMC) that regulates all nurses, nursing associates and midwives’ states that the professional standards of practice and behaviour of its registrants includes; privatising people, practising effectively preserving safety and promoting professionalism and trust. As in all nursing regulatory bodies the primary function is for the protection of the public and the reputation of the profession and such language by the male nurse fails to uphold the dignity of the woman and damages the reputation of the profession.

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

This scenario considers the dignity, respect and compassion of the warrant officer owed to her as a patient by those who provide her with clinical care and treatment against the unprofessional and disparaging comments of the male nurse against her, whose priority seems to be questioning her sexuality as opposed to her clinical complaint. There might also be a discussion about the fitness to practice of the male nurse in light of their comments and whether such comments could be construed as professional misconduct and impairment.

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

The female nurse has a duty to not only disclose the inappropriate comments to her immediate line manager but also challenge the male nurse on the inappropriateness of them.

References and Further Reading

International Council of Nurses (Revised 2021), The ICN Code of Ethics for Nurses at Code. Available at ICN_Code-of-Ethics_EN_Web_0_0.pdf; accessed 24 August 2023

Nursing Midwifery Council: Future nurse: Standards of proficiency for registered nurses. Available at future-nurse-proficiencies.pdf (nmc.org.uk); accessed 24 August 2023

Nursing Midwifery Council. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates - The Nursing and Midwifery Council (nmc.org.uk) accessed 24 August 2023

Nursing and Midwifery Board of Australia. Available at https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx; accessed 24 August 2023

Contributor - Lt Col Janet Kelly VR RGN RM DIpHSM MA (HRM) LLB (Hons) PGHCE PhD. Senior Lecturer in Midwifery, Healthcare Law & Ethics; University of Hull. Chair for the Nursing Midwifery Council's Fitness to Practise Conduct and Competence Committees (2013 to 2021). She has served as a commissioned officer in Queen Alexandra's Royal Army Nursing Corps both as a regular and reservist for over 30 years and is now at the rank of Lieutenant Colonel.