A nurse is preparing to participate in a root cause analysis after a sentinel event involving a surgical procedure performed on the wrong site. Which nursing action is the most appropriate to prevent this type of sentinel event from recurring?

Rationale:

A. The physiologic status of the clients on the unit is correct because client acuity and the complexity of care needs are the primary factors in safe and effective assignment planning. The charge nurse must consider each client’s medical condition, risk for complications, required interventions, and level of monitoring to ensure appropriate nurse-to-patient ratios and patient safety. Assignments should match the skills and competency level of each nurse to the acuity of assigned clients.

B. Social relationships between nurses working the oncoming shift is incorrect because personal friendships or interpersonal dynamics should not influence assignments. Decisions based on social factors can compromise patient safety, fairness, and professional standards.

C. The most experienced nurse receives the more complex clients is partially correct but not the sole consideration. While assigning complex clients to experienced nurses is a common practice, the overall physiologic status of all clients and skill mix of the entire team must guide assignments rather than relying solely on experience.

D. Personal comfort level in making the assignments is incorrect because the charge nurse’s comfort is not a valid factor for patient assignment decisions. Assignments must be objective, patient-centered, and based on client needs and staff competencies, not personal preference.

Rationale:

A. Utility is incorrect because the principle of utility focuses on maximizing overall benefit or the greatest good for the greatest number of people. While utility considers outcomes for many, the nurse’s action here is focused on protecting an individual’s privacy, not on weighing benefits for a group.

B. Justice is incorrect because justice refers to fairness, equity, and impartial treatment in healthcare, including allocation of resources or services. Maintaining the surgeon’s confidentiality is not an issue of equitable distribution or fairness, but rather an ethical responsibility to the individual.

C. Paternalism is incorrect because paternalism involves making decisions for someone else, potentially overriding their autonomy, because you believe it is in their best interest. In this case, the nurse is not making a decision for the surgeon; rather, the nurse is honoring the surgeon’s right to privacy and autonomy regarding personal medical information.

D. Nonmaleficence is correct because nonmaleficence embodies the ethical principle of “do no harm.” By refusing to disclose the surgeon’s medical diagnosis, the nurse is preventing potential harm, which could include professional consequences, discrimination, stigma, or emotional distress. Protecting confidential information is a key way that nurses uphold nonmaleficence, ensuring that their actions do not inflict harm on patients or colleagues.