Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: You are on an operational tour and are a junior NCO.  You witness a verbal altercation between the SNO with the DMD both Colonels. Patients and staff can hear this altercation. 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 senior military officers.

Step 2 – ANALYSE

Patient:  The principles of non-maleficence and beneficence apply. Patients expect the highest professional standards from all healthcare professionals at all times.

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 . 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, the Declaration of Geneva (1948, 1968, 1983, 1994, 2005 and 2006 versions) that includes the “the modern Hippocratic oath” at Declaration of Geneva – WMA – The World Medical Association states that, doctors must always maintain the highest honours of professional conduct. Clearly, this scenario shows that professional conduct is not at the standard it ought to be. Accordingly, this could harm the patient by giving them the impression (and all military personal) that there is a dysfunctional and ill-disciplined healthcare team caring for them and in a leadership position.

Societal/Military: due to military rank structure, it is unlikely the junior soldier would intervene in such an altercation. It is more likely that they would either inform their immediate line manager such as the Regimental Sergeant Major or the Adjutant as to was happening. The employer (Adjutant) has the right to know about the altercation overheard by colleagues and patients. Whilst they may not wish to know the context, it is the effect of the altercation that not only compromises operational effectiveness, it is unprofessional to all colleagues and does not maintain the values and standards of any military organisation.

Step 3 – FUSE

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

This scenario addresses a potential compromise of operational effectiveness in a clinical environment and unprofessional behaviour between two high-ranking officers in high-ranking leadership positions.  The Adjutant may encourage both to meet to discuss their differences and or advise the Commanding Officer to meet with both officers to discuss and defuse the situation. There might also be a discussion required on mediation between the two and an admission, and acceptance that their behaviour is a poor example of leadership in front of patients’ and military staff. Patients may be concerned that two senior colleagues are having such an altercation in the open rather than address their differences privately.

Step 4 – DECIDE

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

This is likely to be a personality issue between two high-ranking officers that needs to be diffused as quickly as possible so as not to compromise operational effectiveness, unit cohesiveness and patient care.

References and Further Reading

Declaration of Geneva – WMA – The World Medical Association Available at https://www.wma.net/what-we-do/medical-ethics/declaration-of-geneva/; accessed 25 August 2023

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.