Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders
Affiliation(s)
1 College of Business and Public Administration, Drake University, Des Moines, USA. 2 Professional Development, Unity Point Health—Des Moines, Des Moines, USA.
1 College of Business and Public Administration, Drake University, Des Moines, USA. 2 Professional Development, Unity Point Health—Des Moines, Des Moines, USA.
ABSTRACT
With the nursing profession continuing to face an array of ethical issues, the article reports the findings of a survey of members of the American Organization of Nurse Executives conducted in 2012 to determine the extent to which nurse leaders at different organization levels perceive various factors in their personal, professional and organizational environments to be helpful in resolving ethical dilemmas. After their personal values, nurse leaders perceive factors related to their organization to be more helpful than those related to their profession, including, among others, the American Nurses Association Code of Ethics. The two highest rated business-related factors deal with the absence of pressure to compromise one’s own ethical standards which suggests that one way healthcare organizations can assist nurses and their leaders is by neither explicitly nor implicitly pressuring them to go against their own ethical values. Other key factors related to the organization include formal organizational factors such as the existence of an ethics committee or a person to whom unethical activity can be reported as well as more informal factors related to organizational climate such as the actions and responsiveness of one’s immediate boss, the ability to go beyond one’s boss if necessary, the organizational culture, management philosophy, and management’s communication of appropriate ethical behavior. Comparison of the findings of the 2012 survey with those of a similar study conducted in 2000 indicated the four factors perceived as most helpful in both studies were identical with the same rank order and the top-10 factors were identical with some differences in ranking. Further analysis indicated the relative degree of helpfulness of the 17 help factors common to both studies was perceived by responding nurse leaders as quite similar overall. The authors also discuss the implications for the profession and the healthcare industry today and in the future.
With the nursing profession continuing to face an array of ethical issues, the article reports the findings of a survey of members of the American Organization of Nurse Executives conducted in 2012 to determine the extent to which nurse leaders at different organization levels perceive various factors in their personal, professional and organizational environments to be helpful in resolving ethical dilemmas. After their personal values, nurse leaders perceive factors related to their organization to be more helpful than those related to their profession, including, among others, the American Nurses Association Code of Ethics. The two highest rated business-related factors deal with the absence of pressure to compromise one’s own ethical standards which suggests that one way healthcare organizations can assist nurses and their leaders is by neither explicitly nor implicitly pressuring them to go against their own ethical values. Other key factors related to the organization include formal organizational factors such as the existence of an ethics committee or a person to whom unethical activity can be reported as well as more informal factors related to organizational climate such as the actions and responsiveness of one’s immediate boss, the ability to go beyond one’s boss if necessary, the organizational culture, management philosophy, and management’s communication of appropriate ethical behavior. Comparison of the findings of the 2012 survey with those of a similar study conducted in 2000 indicated the four factors perceived as most helpful in both studies were identical with the same rank order and the top-10 factors were identical with some differences in ranking. Further analysis indicated the relative degree of helpfulness of the 17 help factors common to both studies was perceived by responding nurse leaders as quite similar overall. The authors also discuss the implications for the profession and the healthcare industry today and in the future.
Cite this paper
Cooper, R. , Frank, G. and Shogren, C. (2014) Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders. Open Journal of Nursing, 4, 695-704. doi: 10.4236/ojn.2014.410074.
Cooper, R. , Frank, G. and Shogren, C. (2014) Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders. Open Journal of Nursing, 4, 695-704. doi: 10.4236/ojn.2014.410074.
References
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http://dx.doi.org/10.1007/s10551-012-1518-9 [2] Cowton, C.J. (2009) Accounting and Ethics Challenge: Remembering the Professional Body. Accounting and Business Research, 39, 177-189.
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http://dx.doi.org/10.1136/bmj.e1717 [11] Rose, L. (2011) Interprofessional Collaboration in the ICU: How to Define. Nursing in Critical Care, 16, 5-10.
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http://dx.doi.org/10.1093/bja/ael372 [13] Zwarenstein, M., Goldman, J. and Reeves, S. (2009) Interprofessional Collaboration: Effects of Practice-Based Interventions on Professional Practice and Healthcare Outcomes. Cochrane Database of Systematic Reviews, 8, Article ID: CD000072.
http://dx.doi.org/10.1002/14651858.CD000072.pub2 [14] Engel, J. and Prentice, D. (2013) The Ethics of Interprofessional Collaboration. Nursing Ethics, 20, 426-435.
http://dx.doi.org/10.1177/0969733012468466 [15] Robichaux, C. and Sauerland, J. (2012) Health Care Quality and Ethics: Implications for Practice and Leadership. Perioperative Nursing Clinics, 7, 333-342.
http://dx.doi.org/10.1016/j.cpen.2012.06.002 [16] American Association of Critical-Care Nurses (AACN) (2005) AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence.
http://www.aacn.org/wd/hwe/docs/hwestandards.pdf [17] Cooper, R.W., Frank, G.L., Gouty, C.A. and Hansen, M.M. (2003) Ethical Helps and Challenges Faced by Nurse Leaders in the Healthcare Industry. Journal of Nursing Administration, 33, 17-23.
http://dx.doi.org/10.1097/00005110-200301000-00005 [18] Kish-Gephart, J.J., Harrison, D.A. and Trevino, L.K. (2010) Bad Apples, Bad Cases, and Bad Barrels: Meta-Analytic Evidence about Sources of Unethical Decisions at Work. Journal of Applied Psychology, 95, 1-31.
http://dx.doi.org/10.1037/a0017103 [19] American Nurses Association (ANA) (2001) Code of Ethics for Nurses with Interpretive Statements.
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
[1] Craft, J.L. (2013) A Review of the Empirical Ethical Decision Making Literature: 2004-2011. Journal of Business Ethics, 117, 221-259.
http://dx.doi.org/10.1007/s10551-012-1518-9 [2] Cowton, C.J. (2009) Accounting and Ethics Challenge: Remembering the Professional Body. Accounting and Business Research, 39, 177-189.
http://dx.doi.org/10.1080/00014788.2009.9663359 [3] Shafer, W.E. (2002) Ethical Pressure, Organizational-Professional Conflict, and Related Work Outcomes among Management Accountants. Journal of Business Ethics, 38, 263-275. [4] Hussain, A., Rivers, P.A., Glover, S. H. and Fottler, M. D. (2012) Strategies for Dealing with Future Shortages in the Nursing Workforce: A Review. Health Services Management Research, 25, 41-47.
http://dx.doi.org/10.1258/hsmr.2011.011015 [5] Gage, L. (2012) Transformational Governance: Best Practices for Public and Nonprofit Hospitals and Health Systems. Center for Healthcare Governance of the American Hospital Association, Chicago.
http://www.americangovernance.com/resources/reports/transformational-governance/ [6] Needleman, J. and Hassmiller, S. (2009) The Role of Nurses in Improving Hospital Quality and Efficiency: Real-World Results. Health Affairs, 28, w625-w633.
http://dx.doi.org/10.1377/hlthaff.28.4.w625 [7] Raso, R. (2013) Value-Based Purchasing: What’s the Score. Nursing Management, 44, 28-34.
http://dx.doi.org/10.1097/01.NUMA.0000429001.54893.bb [8] Rau, J. (2013) Nearly 1500 Hospitals Penalized Under Medicare Program Rating Quality.
http://www.kaiserhealthnews.org/Stories/2013/November/14/value-based-purchasing-medicare.aspx [9] Ryan, A.M. (2013) Will Value-Based Purchasing Increase Disparities in Care? New England Journal of Medicine, 369, 2472-2474.
http://dx.doi.org/10.1056/NEJMp1312654 [10] Aiken, L.H., Sermeus, W., Van den Heede, K., et al. (2012) Patient Safety, Satisfaction, and Quality of Hospital Care: Cross Sectional Surveys of Nurses and Patients in 12 Countries in Europe and The United States. British Medical Journal, 344, 1-14.
http://dx.doi.org/10.1136/bmj.e1717 [11] Rose, L. (2011) Interprofessional Collaboration in the ICU: How to Define. Nursing in Critical Care, 16, 5-10.
http://dx.doi.org/10.1111/j.1478-5153.2010.00398.x [12] Reader, T., Flin, R.K., Mearns, K. and Cuthbertson, B. (2007) Interdisciplinary Communication in the Intensive Care Unit. British Journal of Anaesthesia, 98, 347-352.
http://dx.doi.org/10.1093/bja/ael372 [13] Zwarenstein, M., Goldman, J. and Reeves, S. (2009) Interprofessional Collaboration: Effects of Practice-Based Interventions on Professional Practice and Healthcare Outcomes. Cochrane Database of Systematic Reviews, 8, Article ID: CD000072.
http://dx.doi.org/10.1002/14651858.CD000072.pub2 [14] Engel, J. and Prentice, D. (2013) The Ethics of Interprofessional Collaboration. Nursing Ethics, 20, 426-435.
http://dx.doi.org/10.1177/0969733012468466 [15] Robichaux, C. and Sauerland, J. (2012) Health Care Quality and Ethics: Implications for Practice and Leadership. Perioperative Nursing Clinics, 7, 333-342.
http://dx.doi.org/10.1016/j.cpen.2012.06.002 [16] American Association of Critical-Care Nurses (AACN) (2005) AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence.
http://www.aacn.org/wd/hwe/docs/hwestandards.pdf [17] Cooper, R.W., Frank, G.L., Gouty, C.A. and Hansen, M.M. (2003) Ethical Helps and Challenges Faced by Nurse Leaders in the Healthcare Industry. Journal of Nursing Administration, 33, 17-23.
http://dx.doi.org/10.1097/00005110-200301000-00005 [18] Kish-Gephart, J.J., Harrison, D.A. and Trevino, L.K. (2010) Bad Apples, Bad Cases, and Bad Barrels: Meta-Analytic Evidence about Sources of Unethical Decisions at Work. Journal of Applied Psychology, 95, 1-31.
http://dx.doi.org/10.1037/a0017103 [19] American Nurses Association (ANA) (2001) Code of Ethics for Nurses with Interpretive Statements.
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf