The nursing shortage has gained national attention, generating a television network special as well as a lengthy article in the NEW YORK TIMES SUNDAY MAGAZINE, ith much speculation as to causes and solutions. And, while some health care institutions are trying new and creative ways to attract nurses (such as the much-publicized work-everyweekend- have the-rest-of-the-weekoff plan developed by one Texas hospital), others are reducing their bed capacities or attempting to fill the gaps with overtime or temporary personnel.

The use of the phrase “health care team” raises a number of philosophical questions — the fundamental one being whether it is appropriate to apply the word “team” to groups of health care professionals. This column will argue that answering that first question affirmatively will raise other ethical issues. For example, team rhetoric, drawn upon metaphors of athletic teams, is deceptive in the context of health care and can lead to incorrect concepts of the ethical responsibilities of the health care team and its members. Specifically discussed here will be the normative conflict between an individual’s loyalty to the health care team and that person's responsibility to “blow the whistle” on team members who have acted improperly.

One way to answer these questions is to use a general definition of “team” to determine whether there are any “teams” in health care based on that definition. Alternatively, one could look at several uses of the term outside the context of health care, and then see whether the health care situation is sufficiently analogous to these uses to justify the use of the term.

Does a hospital have the right to prevent a qualified male nurse from working in its labor and delivery section? In Backus v. Baptist Medical Center, this question was answered in the affirmative by a United States District Court in Arkansas. The case, now on appeal, serves as an obstacle to professional nursing and an affront to the rights of female patients.

The plaintiff, Gregory Backus, is a registered nurse who, while employed by the defendant hospital, twice requested and was refused full time placement in its labor and delivery section. The refusals were based upon an unwritten policy that the hospital “did not employ male R.N.s in OBGI” positions because of the concern of our female patients for privacy and personal dignity which make it impossible for a male employee to perform the duties of this position effectively.”

Attorneys practicing in the area of drug-products liability occasionally encounter a case in which there is no question that the drug taken was defective or that misrepresentations were made concerning the drug, but it is impossible to identify the particular drug company that manufactured the product taken by the patient. This problem undoubtedly will be encountered more frequently in the years to come in light of the almost uniform repeal of antisubstitution laws, resulting in generic products being dispensed far more frequently now than in the past. A pharmacist will be unlikely to remember, years or even months later, which company’s product was used to fill a particular prescription. To resolve this problem, pharmacists in the future may have a duty to create and retain detailed records concerning which manufacturer’s products were used to fill specific prescriptions. Such records, if properly maintained, would eliminate problems encountered in many cases in which defective generic drugs were dispensed.