Remember in grade school when one kid acted up in class and the teacher made everyone stay after school? How fair was that anyway? Sometimes everyone stayed mad at the kid for a day or two, or more, depending on how much he was a troublemaker. But if he was popular, other kids often covered for him, leaving the teacher totally clueless about what really was going on. Then everyone but the teacher had some fun!

Consider patients like the one that won't take his meds just because his toes seem "funny," even though he can't tell you why ("Uhm, I just sort a feel like I have a toe spasm coming on, and I think it's because of that anti-seizure stuff you make me take"). Your careful nursing assessment shows no abnormalities. But this is gonna cause you a whole lot of extra documentation time because your VP of Nursing just started this spiffy new POOP Program (Prevent Obvious Overmedication Problems) because of a little Quality Indicator report that the hospital med error rate is 2.43% above the national benchmark for the third month in a row (although errors on your particular unit are way down). The "trickle down" effect is hitting you like Chinese water torture: Twice as much work for every itsy bitsy thing out of the ordinary on the Medication Administration Record (MAR). Maybe it would be better to just chart like the patient took the med and forget it. But you don't...though who needs more hassles.

I'm pretty sure the patriarch Abraham never took NCLEX, but I think he had some terrific moments demonstrating critical thinking skills (and others, not so much). Remember when God and a couple of his angel buddies stop by Abraham's tent for dinner and they all wind up taking a stroll down Sodom and Gomorrah way? God mentions to Abraham that he has plans to blow Sodom and its inhabitants to smithereens due to a recent unfavorable public opinion poll: ". . . their sin is very grave . . . according to the outcry that has come to Me" (Genesis 18:20, ESV).

Abraham asks God, "Will you indeed sweep away the righteous with the wicked? Suppose there are fifty righteous within the city? Will you sweep away the place and not spare it for the fifty righteous who are in it? Far be it from you to do such a thing, to put the righteous to death with the wicked, so that the righteous fare as the wicked! Shall not the Judge of the earth do what is just?" God concedes. Point to Abraham (Genesis18:22-32).

So what if the guys at S&G are just five short in the righteousness department, Abraham asks, acknowledging that, though he is but dust, he's on a roll ("Will you destroy the whole city for lack of five?"). He manages to strike a pretty awesome deal: If just 10 good guys step up to the plate, the cities get saved.

Things don't look good in Sodom, however. So God's advance men try to save Abraham's nephew Lot and his family. Yes, the very same Lot who attempts that same night to appease a sex-crazed mob by sacrificing his own daughters ("Okay, okay, girls, you're still virgins, so what? Guys, let's just open the door real fast and toss the gals out.") Yet God "remembered Abraham," remembers his promises! Lot, the poster-boy for dysfunctional families, is saved as the cities are destroyed (Genesis 19:4-38).

Abraham's questions encompass one of the most compelling ethical concerns Christians face: What is righteousness? This encounter with God of Abraham, Lot, and an evil populace is fraught with human confusions about righteousness.

Struggling, underfunded care delivery organizations meet daily destructive, dysfunctional dilemmas. Well-meaning yet troubling plans and programs disadvantage and dishearten both patients and nurses caught up in their implementation, who are challenged by ethical tests of compliance and noncompliance. Just like Lot's house, frenzied mobs are beating on the doors of the American healthcare system. And yet...and yet...every day within these stricken settings, nurses do remarkable things...when they don't lose heart and remember God's promises of righteousness.

To explore more on this topic, find discussion questions online at http://links.lww.com/NCF-JCN/A34.