-Angela Quinn, RN, Member of Nurses Who Vaccinate
On February 13, 2014, Alaskan newspapers reported that a retired school nurse from Alaska plead guilty to a class A misdemeanor for forging signatures on her student’s immunization records. The school nurse forged a parent’s signature on a religious exemption form indicating that the student had not received the hepatitis A or B vaccines when in fact the student’s parents report that the student did receive both of them. The nurse reportedly destroyed the student’s original immunization record and forged her parent’s signatures on four documents.
The nurse’s attorney indicated that she filled out forms for parents if they were not filed on time and that he speculates “99.9 percent of all school district nurses in the state have done this.” While no harm was done in this situation considering that the student did not receive any vaccinations against the family’s wishes, an ethical concern has still been raised:
Was it okay for the school nurse to forge a document even though she knew that no harm would be brought to the patient?
The answer is no. It is not okay for a nurse to ever forge any documents for a patient even if she thinks it is a matter of life or death or that it will not change the outcome in any way. Forging a patient document not only violates the ethical rights of the patient but violates the legal rights of the patient.
The American Nurses Association’s Code of Ethics provision 3 calls upon nurses to protect the health, safety and rights of their patients. Not only is it unethical to forge any type of patient document, but it strips that patient of their right to make an informed, self-derived medical decision and robs the patient of their autonomy. We as nurses are patient advocates and we must honor, respect and protect the rights and privacy of our patients.
Nurses must practice with veracity and fidelity when providing patient care; we must honor their rights. We must also recognize that the care we provide must be beneficial to the patient according to the rights of the patient rather than the personal thoughts of beneficence on the part of the nurse. Even if the nurse knows that the patient will positively catch a vaccine-preventable disease and die, it is still never okay for a nurse to administer a vaccine or forge a document to do so without the patient’s explicit authorization. It is actually ethically-responsible in this situation to allow the patient to succumb to the illness rather than to violate his right to make his own medical decisions.
In this situation with the school nurse in Alaska, no physical harm was brought to the student. However, nurses take an oath of non-maleficence, which means they will do no harm to a patient. When the nurse chose to forge medical documents, she violated the ethical principles of the nurse-patient relationship and may have put the student in a situation to receive medical care against their own free will.
Angela Quinn is a registered nurse in New York City. She is passionate about public health, patient safety and patient education. Angela volunteers with organizations like Nurses who Vaccinate to contribute positively to the world of nursing.