Empowering Nurses to Handle Ethical Dilemmas

Podcast Transcript

Carol Pehotsky (00:04):

There's no shortage of ethical situations nurses find in our daily practice. End of life care, disagreements between patients and their families, equitable access to healthcare, the list goes on and on. I'm joined today by Dr. Georgina Morley to learn more about nursing ethics and resources that are available to help nurses manage moral dilemmas. Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career to navigating tough, on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

(00:49):

Welcome back, everyone. In reflecting on today's topic around nursing ethics, yeah, I'm reminded of one of the many patient care stories from way back in my clinical days, and I suppose as many of us, the story of my clinical career goes into that when you know better, you do better. And most of my clinical care came from the PACU world, where I, I wasn't privy to the conversations had between surgeon and patients, surgeons, patients, and their loved ones going into surgery. And one story that comes to mind is a patient who was of advanced age, and we took care of several patients who were 90 and plus. I remember taking care of a few who were 100-plus in the PACU. And you're thinking, "Whoa, all right. Great. I hope they had a really thorough (laughs) conversation about goals of care."

(01:33):

And one patient, you know, unfortunately they did code in the PACU. And there was not a do not resuscitate order on that patient's chart, and this is many, many years ago. We do a much better job of getting advanced directives, but we didn't have one on that patient's chart. And so, there was a team actively looking for that patient's family, and so as we're providing that resuscitative care, you know, a lot of long faces and heavy hearts about, you know, "What are we doing here?" And, and we resuscitated that patient to the best of our ability, but lots of really challenging, concerning thoughts about that and just the whole nature of the surgery in general. And thankfully, we got a hold of the family. They did ask us to stop. They did come back and visit their loved one, and they were very gracious to us and, and were able to share that information that they'd absolutely had had very rich and thorough conversation about goals of care with the surgeon, with their loved one who had said, "I want to try this." Knew very well what they were getting into, had said their goodbyes just in case, and so went in with completely eyes wide open, and that family was so gracious to us for giving that person a chance.

(02:37):

I left that experience feeling far less conflicted than I entered that experience. But not everybody gets that opportunity. And I think about other experiences like that that, where I was conflicted. And we know that's the nature of healthcare, but we also know that's the nature of nursing. And so, it's my great pleasure to introduce you all to Dr. Georgina Morley. Dr. Morley is with us today. She is the director of the Nursing Ethics Program at Cleveland Clinic, something very special that we're very proud of, and I'm so glad to have you here today.

Georgina Morley (03:05):

Thank you. Thank you for having me.

Carol Pehotsky (03:07):

Of course. So, tell us a little bit about your professional path. It's an unusual one, it's an exciting one, and what made you pursue a career as a nurse and a nurse ethicist?

Georgina Morley (03:16):

Yeah. So, there's not that many of us nurse ethicists.

Carol Pehotsky (03:19):

No. (laughs)

Georgina Morley (03:20):

Which I'm proud of, but also very passionate about trying to develop other pathways for nurses that are really interested in this role. I kind of came into it in a, a slightly unusual path, I suppose.

Carol Pehotsky (03:34):

Okay.

Georgina Morley (03:34):

I actually did a philosophy degree at university, and in part because I just was really interested in philosophy when I was at school. And I was like, "I want to learn more." And then as I was graduating, I was thinking, "Oh, okay."

Carol Pehotsky (03:35):

"Now what?" (laughs)

Georgina Morley (03:49):

"How am I going to get paid employment now?" (laughs) Like, "Okay. Am, am I going to kind of just sit in an ivory tower and, you know-"

Carol Pehotsky (03:57):

So, you were always a thinker?

Georgina Morley (03:58):

Yeah.

Carol Pehotsky (03:58):

(laughs)

Georgina Morley (03:59):

I was like, "This doesn't seem like there's a ton of different kind of pathways once you come out of philosophy." The, they don't feel obvious, anyway.

Carol Pehotsky (04:06):

Okay.

Georgina Morley (04:07):

So, I knew that I wanted to... And it's kind of cliched, but it's also true. Like, I wanted to have a positive impact on the world, you know?

Carol Pehotsky (04:08):

Okay. Yeah.

Georgina Morley (04:17):

When I leave this place, I would like to think that I added positively to the people that I was around-

Carol Pehotsky (04:22):

Mm-hmm.

Georgina Morley (04:23):

... and, you know. So, I thought that I would just give nursing a go, which felt very kind of unusual, I guess, because there's not really very many medical people in my family.

Carol Pehotsky (04:23):

Oh, okay.

Georgina Morley (04:36):

It's, you know, I don't have...

Carol Pehotsky (04:38):

The generations of-

Georgina Morley (04:40):

Exactly.

Carol Pehotsky (04:41):

... healthcare providers saying, "Yeah, come here."

Georgina Morley (04:42):

Yeah.

Carol Pehotsky (04:42):

Okay.

Georgina Morley (04:43):

So, it felt very, like it was just, I don't know, a stab in the dark, I guess. So, I applied to nursing school and I, you know, I had some very difficult placements as a nursing student.

Carol Pehotsky (04:55):

(laughs)

Georgina Morley (04:56):

I think that probably lots of nurses can resonate with that.

Carol Pehotsky (04:59):

Mm-hmm.

Georgina Morley (05:00):

But I essentially fell in love with the profession. Like, I absolutely loved nursing. But the thing is, is that I saw all of these ethical issues and these ethical challenges-

Carol Pehotsky (05:10):

Oh.

Georgina Morley (05:10):

... every day, and I was like, "Why aren't we doing thing?" Like, why aren't we trying to figure this out? So, I'd ask people around me, like, you know, "There seems to be an ethics issue. Like, how do we work through this?" And people were like, "What do you mean?"

Carol Pehotsky (05:10):

(laughs)

Georgina Morley (05:24):

"Just carry on." And I'm like, "But shouldn't we, like, talk about this? Like, shouldn't we be doing something?" Like, one of my first jobs was on a, a newly established trauma ward in central London, and we had all of these patients that were coming in with head injuries and, like, young patients.

Carol Pehotsky (05:24):

(laughs)

Georgina Morley (05:42):

So, they abscond. They could leave the units. And we would be, you know, these young, new nurses, like, chasing them down the street.

Carol Pehotsky (05:50):

Oh, gosh, yeah.

Georgina Morley (05:51):

Because we didn't know what else to do-

Carol Pehotsky (05:51):

Right.

Georgina Morley (05:52):

... and we're, like, we're, we're their protectors. Like, we, surely, we have to stop them. So, there were, like, all of these kinds of issues that we kept seeing, and some of it was, it was a new unit, we were still figuring things out. So yeah, I was asking these questions and I felt like I wasn't necessarily getting, like, the space that I wanted to talk about the issues. And so, I started looking... I, I actually did my master's, I did some research looking at nurses' experiences of caring for patients with substance use disorder and in pain.

Carol Pehotsky (06:23):

Oh.

Georgina Morley (06:23):

Because we saw a lot of-

Carol Pehotsky (06:23):

Okay.

Georgina Morley (06:24):

... that in patient population.

Carol Pehotsky (06:25):

Mm-hmm.

Georgina Morley (06:26):

And that got me onto this theme of, like, nurses trying to do the right thing, but encountering these barriers. And then I kind of stumbled across the moral distress literature, and I was like, "Wow. Okay. This is giving voice to these issues that I've been experiencing." And then I learnt about clinical ethics consultation as being something available in the US, so that was really kind of my pathway to then, I knew if I wanted to come and be an ethics consultant, that I needed to do a PhD. I actually did my PhD with the aim of doing ethics consultation training. It was a meandering path, which is often what happens with people that work in bioethics. It's a-

Carol Pehotsky (06:26):

Really?

Georgina Morley (07:08):

... very multidisciplinary field, yeah. But it kind of felt very full circle as well once I'd gone into nursing and then was focusing on nursing ethics. Like, it felt like I'd kind of come home to my, like, philosophy kind of roots, I guess.

Carol Pehotsky (07:21):

Yeah.

Georgina Morley (07:21):

But in a very practical orientation, so.

Carol Pehotsky (07:24):

E- so let's go back to the barriers and the moral distress.

Georgina Morley (07:28):

Yeah.

Carol Pehotsky (07:28):

Tell me more about that.

Georgina Morley (07:29):

Yeah, so one of the things that came out of my master's research was this theme of nurses, you know, had identified that these patients, that e- had substance use disorder and were in acute pain, they weren't necessarily getting the pain management treatment that they needed. And often what they were seeing was, you know, they were interacting with physicians who were not prescribing the appropriate kind of, you know, medications because they were worried that they were going to make the addiction worse. But of course, we all know that with acute pain, if you don't treat that acute pain, it leads to chronic pain and all of these other issues, and also that those patients tend to have, you know, they need higher doses of opiates. So, this theme of them really trying to advocate for patients but encountering these barriers with then, you know, the more powerful person that could prescribe the medication was something that they felt morally distressed about. So yeah, that was kind of what led into the moral distress literature and that world for me.

Carol Pehotsky (08:36):

Wow. (laughs) I'm having a full circle moment in a couple ways. One, my PACU experience and all of the conversations around patients who've had surgery with chronic pain, but also, you know, throughout this podcast, we've had all these conversations about speaking up, but it really takes a new thread when it's t- really going back to the moral s- d- distress when you're having a hard time speaking up or what it means when you can't and that moral distress that comes with it.

Georgina Morley (09:00):

Yeah. That was something that came through really strongly, and it's something, you know, I think nurses are taught that you're the patient's advocate.

Carol Pehotsky (09:10):

Y- oh, for sure.

Georgina Morley (09:11):

And now often when I'm chatting with nurses, I remind them that you're not the only patient advocate, we're actually part of a team and we're all advocating for the patient. But yeah, I think that that's then something... You get that kind of drilled into you at nursing school, and then you go into practice and you're like, "Oh, it's not that easy."

Carol Pehotsky (09:30):

Mm-mm. (laughs)

Georgina Morley (09:30):

Like, it's not that easy-

Carol Pehotsky (09:30):

No. (laughs)

Georgina Morley (09:31):

... to just say, like, "Hey, this patient needs this thing." And then somebody's like, "Oh, yeah, sure."

Carol Pehotsky (09:35):

Mm-hmm.

Georgina Morley (09:35):

Like, there's... People have differences of opinion, there's different power dynamics, there's a whole lot of various different things that are going on that create barriers and challenges and ethical issues.

Carol Pehotsky (09:47):

So, you came to the States and then you did additional training as a nurse ethicist. Tell me more about that, please.

Georgina Morley (09:54):

Yeah. So, I did my PhD in the UK. That was interviewing nurses to really understand their experiences of moral distress.

Carol Pehotsky (10:04):

Okay.

Georgina Morley (10:04):

Found out some really interesting things and yeah, and then applied for clinical ethics fellowships. Clinical ethics is still, like, a relatively new field.

Carol Pehotsky (10:16):

Okay.

Georgina Morley (10:16):

Like, it's kind of still professionalizing. There are more fellowships now than there used to be. But yeah, applied for clinical ethics fellowships and when I was applying, I met Paul Ford, who used to be-

Carol Pehotsky (10:16):

Oh, yeah.

Georgina Morley (10:29):

... the chair of the Center for Bioethics at a conference. And he was like, "We've been looking for a nurse to do a nursing ethics fellowship. Is that something that you would be interested in?" And I was like, "Yes." Like, "100% yes."

Carol Pehotsky (10:46):

(laughs)

Georgina Morley (10:46):

So, I applied and yeah, very happily ended up at Cleveland Clinic. So yeah, my nursing ethics fellowship was a, a full-time two-year fellowship. It provided me with the opportunity to do clinical ethics consultation, and so I received training on the consult service. And then I also did empirical research, so I worked with Dr. Nancy Albert on my post-doc project, and then I also started providing ethics education to nurse’s kind of across-

Carol Pehotsky (11:17):

Yes, you have.

Georgina Morley (11:18):

... lots of different units, so.

Carol Pehotsky (11:18):

So many nurses have benefited from that.

Georgina Morley (11:20):

So yeah, that was my fellowship and then I, you know, kind of made a plea in 2020 that they should hire me-

Carol Pehotsky (11:21):

(laughs)

Georgina Morley (11:28):

... and that I needed to stay because the work had only just started. And it worked.

Carol Pehotsky (11:28):

And here you are.

Georgina Morley (11:33):

And here I am. And then we established the Nursing Ethics Program, so yeah.

Carol Pehotsky (11:38):

And you've continued to give back with the Nursing Ethics Faculty Fellowship.

Georgina Morley (11:42):

Yes. So, we established the Nursing Ethics Faculty Fellowship in 2021. And so, Dr. Dianna Copley-

Carol Pehotsky (11:50):

Mm-hmm.

Georgina Morley (11:50):

... she was inaugural Nursing Ethics Faculty fellow. She's a clinical nurse specialist on the surgical ICU at main campus, and Dianna and I had already started working together before she applied, so I knew she had this interest in ethics. And I was like, "We need more-"

Carol Pehotsky (12:07):

(laughs)

Georgina Morley (12:07):

"... time and space for you to do some more ethics work." So, we had started nurse-led ethics rounds in the SICU during COVID. It-

Carol Pehotsky (12:17):

Just a few things going on-

Georgina Morley (12:19):

Yeah.

Carol Pehotsky (12:19):

... in, in the span of that time-

Georgina Morley (12:20):

Yes.

Carol Pehotsky (12:21):

... when it comes to nurse ethics. Yeah.

Georgina Morley (12:22):

Yeah. We had previously done ethics rounds in the SICU and they kind of were on hold, and obviously a lot of things were on hold right at-

Carol Pehotsky (12:22):

Yeah.

Georgina Morley (12:30):

... the beginning of the-

Carol Pehotsky (12:30):

Yeah.

Georgina Morley (12:32):

... pandemic. But of course, you know, the pandemic was when nurses-

Carol Pehotsky (12:35):

Yeah.

Georgina Morley (12:35):

... needed ethics-

Carol Pehotsky (12:36):

The most.

Georgina Morley (12:36):

... the most.

Carol Pehotsky (12:37):

Mm-hmm.

Georgina Morley (12:37):

Yeah, for sure. So, we were like, "Right. Let's do this." So, we started the ethics rounds back up and yeah, gave the nursing team that space to kind of share and talk about the things that they were seeing. And yeah, I encouraged Dianna to apply for the faculty fellowship. And now she's actually associate director of the program as well. So yeah, she's fantastic. Great to work with.

Carol Pehotsky (13:02):

So, in a very short period of time, you have done some pretty amazing things for our nurses and created some pretty amazing spaces for them.

Georgina Morley (13:08):

Thank you.

Carol Pehotsky (13:09):

Alongside a little pandemic. (laughs)

Georgina Morley (13:09):

(laughs)

Carol Pehotsky (13:12):

So, can you talk through some of those things, obviously very impactful for any nurse, e- just some situations that were run into and the avenues that have been created for nurses to work through them?

Georgina Morley (13:24):

Yeah. I mean, the pandemic was so difficult in so many different ways, as I'm sure a lot of listeners-

Carol Pehotsky (13:32):

Mm-hmm.

Georgina Morley (13:33):

... experienced themselves. But what was also really interesting at that time was that all of the units were experiencing things in, like, very different ways. So, you know, there were some areas like our transplant areas where the nurses really felt like... The patients were, like, post-transplant and they were like, you know, "These patients have gone through these really thorough kind of psychosocial evaluations, and they now have this new organ, and now they're in hospital and they're isolated from their families. They're maybe having a few complications that are meaning they're having to stay with us for a little bit longer." They kind of had to take on that role of being the family member. And so there-

Carol Pehotsky (13:33):

Oh.

Georgina Morley (14:21):

... was this huge, like, emotional burden that they were experiencing because of the fact that we had to have strict visitation at that point.

Carol Pehotsky (14:21):

Yeah.

Georgina Morley (14:30):

We didn't want these immunocompromised patients to be exposed to COVID. So that kind of emotional labor, that kind of burden that the nursing team kind of took on, I think was something that we never would've necessarily thought about before that was occurring. So, I found myself adapting in different ways to different unit needs. So, in some of those units, we would kind of create that time for the nursing team to really just be like, "This is a lot. Like, this really just is so much. Like, I'm already worried about myself. I'm worried about my family. I'm worried about, am I going to get COVID and take it back to my family? Am I going to, like, transmit it to the patient?" Just so many different things happening. So, we really just wanted to create space for that to be acknowledged because I think it wasn't necessarily being acknowledged day to day. So that was really, I think, one of the big things that I provided during the pandemic, was just kind of being that person that people knew they could come and talk to and just talk through, like, "Why are we restricting visitation?"

Carol Pehotsky (15:36):

Oh.

Georgina Morley (15:37):

And I'm like, "Okay. (laughs) Like, at this point, we still need to limit interaction." And as the rules were changing, as the guidelines were changing, I think people, you know, were constantly trying to make sense of why things were changing. And it was obviously just such an uncertain time that I think people were really struggling, understandably.

Carol Pehotsky (15:57):

The, the end of life piece, obviously, was very hard. But that, the transplant thing I really didn't think about. It's, they're not end of life, but there's still an incredible burden there about, yeah, being everything to everybody.

Georgina Morley (16:09):

Yeah. A-

Carol Pehotsky (16:09):

On top of the, the worried that everybody had.

Georgina Morley (16:11):

Yeah, and I think it, there was this sense that these people have, they've demonstrated that they have a good support system, that's, you know, we've set them up-

Carol Pehotsky (16:20):

Mm-hmm.

Georgina Morley (16:20):

... for, for success post-transplant. But now they're being... Like, we're purposefully separating them from their support system, so how is that right? And that's a very valid question.

Carol Pehotsky (16:33):

Yeah.

Georgina Morley (16:33):

Like, and I think that's one of the unique things about the ethical challenges that nurses encounter, is that because nurses are with the patient all day, they're in the bed space, the way in which a nurse encounters those kinds of ethical issues is so intense because of that proximity that nurses have to patients. So yeah, it was a lot of discussion, but I think really part of that was, like, sense-making and really trying to-

Carol Pehotsky (16:34):

Okay.

Georgina Morley (16:59):

... like, okay, what am I experiencing? So, I was trying to be that resource-

Carol Pehotsky (17:04):

Yeah.

Georgina Morley (17:04):

... essentially, in lots of different ways and with lots of issues that I wouldn't have necessarily thought that they would occur.

Carol Pehotsky (17:11):

Right. Certainly, with the ebbing of a pandemic, none of those big ethical dilemmas (laughs) went away. So, knowing that care is getting more complex and there's plenty of moral distress out there, what are some themes that you're seeing? And knowing that you're part of a now small army, not an army of one, what sort of things are you and the team working on to mobilize additional nurses to help?

Georgina Morley (17:36):

Yeah. So, the Nursing Ethics Program, we have a few kinds of different goals and aims and threads. So, one piece of it is continuing to do the empirical research work.

Carol Pehotsky (17:46):

Mm-hmm.

Georgina Morley (17:47):

I work a lot with Nancy Albert, really because we want to understand the ethical challenges that nurses encounter. But it's also, you know, not only kind of capturing the issues, but also providing, like, recommendations. Because I think what we do a really good job of in ethics is capturing complexity, but then not necessarily giving the recommendations that also-

Carol Pehotsky (17:47):

"Now what do I do?"

Georgina Morley (17:47):

Exactly.

Carol Pehotsky (18:13):

Because yes, it is complex-"

Georgina Morley (18:15):

Yeah.

Carol Pehotsky (18:15):

"... but what do I-"

Georgina Morley (18:16):

Yeah.

Carol Pehotsky (18:16):

"... do with it?"

Georgina Morley (18:16):

Exactly.

Carol Pehotsky (18:17):

Yeah. (laughs)

Georgina Morley (18:17):

Like, "Oh, yeah, thank you for telling me that that's really, really difficult."

Carol Pehotsky (18:20):

Sure. (laughs)

Georgina Morley (18:21):

So, I'm, I have this real deep commitment to when we do encounter these ethical issues, also providing, like, recommendations. I think almost all of the papers that I publish will have some kind of recommendation in there around, like, things that we can do and directions that we can take to try and address that issue.

Carol Pehotsky (18:40):

Mm-hmm.

Georgina Morley (18:40):

So, one thread is, you know, the research piece. The other huge thread from the Nursing Ethics Program is our educational programs. So, we have the faculty fellowship, which is really for nurses who have either a master's or a terminal degree. So, the idea is that we are able to create some dedicated time within their role for them to carry out a nursing ethics project. So, the idea is that it really should have a positive impact either on patient care or on nursing practice. But then also, it's for career development too, so thinking about getting nurses publishing, getting nurses doing podium presentations, poster presentations. So really, we try to kind of add that academic thread as well. And then we have our moral spaces program.

Carol Pehotsky (19:26):

Okay.

Georgina Morley (19:26):

So that is an ethics education program for clinical nurses and assistant nurse managers. We started that a couple of years ago. We're on our second cohort now, so next year will be our third cohort. But yeah, it is a small group. We have applications each year and we bring on... The first year we had 20 nurses, and then this past year we had 25 nurses.

Carol Pehotsky (19:48):

All right.

Georgina Morley (19:50):

We'll probably have 25 next year, I think, hopefully.

Carol Pehotsky (19:53):

(laughs)

Georgina Morley (19:54):

And it's a seven-month program, and we meet once a month, and we provide foundational ethics education with the idea being that we're empowering nurses to address the ethical issues that they encounter. Because I think nurses are generally pretty good at seeing them, but then it's, "What do I do now? Like, how do I actually move this forward? How do I actually advance this in the right kind of direction? How do I ask some of those questions?" I think that can always be pretty challenging, too, so.

Carol Pehotsky (20:25):

Yeah.

Georgina Morley (20:25):

And we really want to empower nurses. There's some decent evidence kind of growing now that ethics education's actually one of the most promising ways to address moral distress. So yeah, we're really trying to harness that piece. We do also have moral distress support programs as well. We developed our moral distress reflective debriefs in 2019. So Cristie Horsburgh, who's one of the other staff ethicists in the center and also associate director of the Nursing Ethics Program, she and I collaborated with Laura Longbrake from the employee assistance program from Caring for Caregivers.

Carol Pehotsky (21:05):

Yes.

Georgina Morley (21:05):

And we developed our moral distress reflective debriefs. We were all passionate about creating a dedicated time and space for nurses to come and talk about their experiences of moral distress, and something that was actually really oriented to the nursing team.

Carol Pehotsky (21:06):

Yeah.

Georgina Morley (21:24):

Because I think we have various other kinds of mechanisms for people to, like, make sense of their experiences. Like, I think about when we have M&Ms, like, that's something that I think the docs can generally get to, but nurses can't.

Carol Pehotsky (21:24):

(laughs)

Georgina Morley (21:39):

It's so difficult-

Carol Pehotsky (21:40):

Yeah.

Georgina Morley (21:40):

... to move away. So, we really wanted to create something that we would schedule for the nurse. It's unit-based, and it's really dedicated for them. Although, I will say, we provide them to all different caregivers, so we've done debriefs for physician groups-

Carol Pehotsky (21:40):

Mm-hmm.

Georgina Morley (21:56):

... for residents, for fellows, for multidisciplinary groups, for pharmacists. Any caregiver who would like a debrief for their team can reach out and we will provide one. But it does tend to be nurses who request them the most, I would say. So, we work with the nurse manager or whoever is requesting the debrief to identify a time and a space that works best for that team. We go to the unit or to the conference room, wherever it is that they have identified as the best kind of closest space on the unit for people to meet. And we're there for an hour and we facilitate discussion and reflection and an opportunity for people to make sense of the moral distress that they've experienced and the ethical issues that they've experienced. We have just started an anonymous survey, really, it's for quality purposes, but it's the first time that we've started getting some actual, kind of concrete feedback, and so far, people are saying that they've found them really helpful. So next year, we will be doing some more kind of empirical research looking at the debriefs.

Carol Pehotsky (23:01):

And as a customer testimonial, you know, your team came down to the OR because we were having some issues in COVID around differing care and doing surgery on a patient with COVID versus the whole essential, non-essential, and that's not for us to decide, but knowing that some people were having to differ care weighed heavily. So, on behalf of our teams, thank you for the support you provided. So, we have listeners who are from outside Cleveland Clinic. Hopefully, we have nurses and nursing students and all sorts of folks who have been so excited listening to us for the last 20 or so minutes. If they want to learn more, if they're like, "Wow, we need this in our hospital," what advice would you give them?

Georgina Morley (23:40):

Look to see what your local resources are, because often there are ethics resources, they're just not always as well-known as they ought to be. Like, I'm still surprised, even though our center has existed for like 20 years, I'm still surprised when people are like, "Oh, we have a center for bioethics?"

Carol Pehotsky (23:57):

Oh, gosh, yeah. (laughs)

Georgina Morley (23:58):

"We have an ethics consultation service?"

Carol Pehotsky (24:00):

Sure do. (laughs)

Georgina Morley (24:01):

I'm like, "Yes, we really do." So I would say, you know, dig deep and look for those services and reach out to them, because yeah, I think all of the ethicists that I know are so eager to help others and to educate others about the services that are available that they're going to be more than willing to have that chat. If you don't have, like, a formal ethics consultation service, then look for an ethics committee, because most hospitals will at minimum have an ethics committee, and yeah, I'm sure there'll be somebody on that committee that's really passionate about getting nurses involved. So, I would say look for your local resources.

Carol Pehotsky (24:40):

And check the literature because there's published information out there.

Georgina Morley (24:44):

Yep, there sure is.

Carol Pehotsky (24:45):

E- excellent. Well, thank you so much for sharing your expertise with us. I- really fascinating work that, gosh, we could spend all sorts of time (laughs) talking about. Before we wrap up though, I want to ask a few fun questions so our audience can get to know you a little bit as an amazing human being as well as a subject matter expert. So, Georgina, first question for you, what's something you wish you knew as a brand new nurse?

Georgina Morley (25:08):

Mm. Yeah, another good question. (laughs)

Carol Pehotsky (25:09):

(laughs)

Georgina Morley (25:13):

I think one of the things that I continue to be surprised by is kind of that gap between the training that you receive as a nurse, and then the reality of clinical practice.

Carol Pehotsky (25:25):

(laughs)

Georgina Morley (25:26):

And I think that, you know, and there's literature that describes this-

Carol Pehotsky (25:26):

Oh, yeah.

Georgina Morley (25:29):

... as well. Yeah, I'm always surprised by that huge learning curve that exists there. So, I guess I wish that somebody had said, "There are these challenges that are going to arise. Like, you're being taught the ideal state, and that, you know, you're going to be in a system, you're going to be in an organization full of humans, full of very idiosyncratic humans."

Carol Pehotsky (25:55):

(laughs)

Georgina Morley (25:55):

"And, you know, learning how to navigate that is such a huge part of nursing. But you'll learn how to do it and you'll be great at it."

Carol Pehotsky (26:04):

It'll be okay.

Georgina Morley (26:05):

Yep.

Carol Pehotsky (26:05):

Yeah.

Georgina Morley (26:05):

And it will be okay. (laughs)

Carol Pehotsky (26:06):

I love it. So, listen up, nursing students.

Georgina Morley (26:06):

(laughs)

Carol Pehotsky (26:08):

That's great advice. All right. Last question then. What's something about you that surprises people?

Georgina Morley (26:15):

Okay. That I'm not from Australia.

Carol Pehotsky (26:18):

(laughs)

Georgina Morley (26:20):

Everybody's always like, "Are you from Australia?" And I'm like, "No. (laughs) Do I sound Australian?" So no, I'm actually, I'm from England, so. Not that I'm offended in any way to be from Australia, I love Australia, and I love those Aussies, but no, I am from the UK.

Carol Pehotsky (26:37):

A- m- us stupid Americans.

Georgina Morley (26:38):

(laughs)

Carol Pehotsky (26:39):

We don't know our accents, sorry. I'm, on behalf of all of us, I apologize. (laughs)

Georgina Morley (26:42):

It's no problem. (laughs)

Carol Pehotsky (26:42):

Thanks so much for joining me today. (laughs)

Georgina Morley (26:46):

Thank you. Thank you for having me.

Carol Pehotsky (26:51):

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(27:26):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.