Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: Two nurses at the rank of captain have been in a relationship with each that has broken down.  They are using a friend of yours as a line of communication whom is feeling quite stressed about the situation. What should you do?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers professional behaviour between two healthcare professionals who are also military officers. It is an open-ended question as to what rank or profession the “friend” is and in what particular environment this situation has arisen.  However, it is clear that if this were in an operational environment, such a situation could compromise operational effectiveness, team cohesiveness and patient care.

Step 2 – ANALYSE

Patient: The principles of non-maleficence and beneficence. Patients expect the highest professional standards from all healthcare professionals at all times and not allow personal relationships to interfere in patient care or the working environment.

Clinical: Whilst there is no patient clinical involvement, healthcare professionals should at all time work effectively and collegiately as a team so that they give the most appropriate care to their patients and do not at any time compromise the reputation of the healthcare profession due to any personal or professional differences, no matter who their professional regulator is.

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 1.8 states that, “Nurses demonstrate professional values such as respect, justice, responsiveness, caring, compassion, empathy, trustworthiness and integrity. They support and respect the dignity and universal rights of all people, including patients, colleagues and families.”  Similarly, at 2.5 The code says that, “nurses demonstrate professional values such as respect, justice, responsiveness, caring, compassion, empathy, trustworthiness and integrity. They support and respect the dignity and universal rights of all people, including patients, colleagues and families….” At 3.3, this code says “Nurses are active in developing and sustaining a core of professional values”.

Societal/Military: the employer (Adjutant) has the right to know about such a situation in order that operational effectiveness and patient care is not compromised. This is also a disciplinary issue as officers need to set the right example to their juniors.  Low standards, both professional and personal, damage team cohesiveness and effectiveness. The military demands high standards and officers and healthcare professionals need to put others needs before their own. This situation is not acceptable and therefore the situation will need to be quickly resolved.

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 principle of non-maleficence ensuring that there is no harm to patients due to the lack of communication between the two nurses. By using a friend they are unintentionally causing harm to a patient. All healthcare professionals have a duty of care to their patients and the current status quo has the potential to cause harm. It also considers beneficence as a positive duty of all healthcare professionals is to communicate effectively and efficiently with both colleagues and patients.

Step 4 – DECIDE

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

This scenario considers inappropriate behaviour in a military environment. Also, two officers, allowing their personal relationship to interfere in a professional environment. This is both a professional and disciplinary issue that can be addressed by the adjutant

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.