Ethical Challenges in Healthcare Administration

Ethical Challenge Scenarios in Healthcare Administration

Scenario 1: You have withdrawn an offer at the last minute (due to poor references) to an ICU nurse manager candidate who has moved across the country to accept the job. The only way you will avoid a lawsuit is if she is hired somewhere else soon. A close colleague calls to ask you frankly why you withdrew the offer. What do you say?

This particular scenario seems like more of a legal issue than an ethical question. An ethical dilemma would be about whether to talk to the friend or not. It seems that there are a few separate issues with regard to the overall scenario. First, of course is the legality of talking to the friend at all. Why does she want to know? Did she recommend the employee? Next, what does an offer of employment mean? Another point to expound upon is that the company did not have to fulfill the offer of employment. A discussion of what a bad reference means is also needed. Finally, the ethical dilemma has several parts which need to be separated from the legal questions.

The response to the friend would matter only if the friend was not supposed to be party to a privileged communication. If the person doing the hiring were to talk to a trusted colleague about why they did or did not hire someone, they could be in for legal trouble (Long, 1997). Talking about confidential employment records with someone who is either not involved in the process, or has no reason to have that information, could not be told about the reasons for the rescinding of the offer of a job (Long, 1997). There could be sensitive reasons why this decision was made and the "trusted colleague" has no business knowing the extent of the references.

However, the case changes if the colleague does have a reason for wanting to know other than being nosy. It is permissible both legally and ethically to talk to her about the reasons then. The woman may have been a friend of hers or she may have been a former employee. She may have information about the person who gave the bad reference and now that there is something between the two of them which caused that person to give a bad reference. Whatever the reason, before anyone can divulge confidential information they have to be very careful regarding their legal culpability.

But, there are other issues than whether the person doing the hiring should tell the colleague about the references or not. Does an offer of employment mean that the person is guaranteed the job? This seems to be the overriding question. There was a verbal agreement between the two parties, but from the scenario it does not seem like there was any legally binding agreement drawn up between the two people that would make the offer binding (Yoder, 2008). This is the crux of the argument. A verbal agreement means absolutely nothing in a court of law.

An offer of employment is always contingent on the fact that the person who gets the job will pass both the scrutiny of any background checks that are required by the position and a predetermined probationary period. Probably the most important of these two is the fact that she may have had to go through background checks prior to having to an actual document drawn up for the hire. If the background checks were not critical to the hiring, then she would have been able to start employment at that time. After she was hired, the performance of the nurse would have been evaluated during the probationary period, and she may have lost her job then. A normal probationary period is approximately 90 days. Some employers require more and some less, but there is generally a period during which the employee's ability to perform the job is examined in more detail than can be learned from a resume or interview. After that time the actual period of employment begins. But, she did not even make it that far. Because the offer was rescinded due to the poor background checks, the nurse did not even meet the initial requirements of the job.

It also does not matter what the reason was for the offers being rescinded. Most states operate under an at will agreement. This means that a person can be fired from a job without cause and that the person can leave the job with no reason given. Of course, there have been many cases in which this has been challenged, and the unions do not like them very well either. At will basically means that if the person does not have good performance then they can be discharged without the employer giving them a reason. However, most employees will not fire an employee at will unless there is a very just cause for the firing. Since the woman was not hired by the company she does not even meet the requirements for this law to go into effect. Also, a union would probably not have been engaged if there was the possibility of a union being involved.

The next question with regard to this scenario is whether a reference should be a reason for an employer's not hiring someone. If the bad reference came from a manager at her previous place of employment, then she may have a case against them, but she does not have any case against the people who offered her a job (Baker, 2005). Most employers will not allow managers and supervisors to give out any references because they are afraid of the liability which is possibly implied by the poor reference. This does not mean that there is any law which forbids an employer from giving a bad reference, but the courts have also sided with employees most of the time when a wrongful termination case comes before them (Baker, 2005; Long, 1997). For this reason, employers are very cautious about giving references of any kind. They will generally tell a new potential employer the employee's job description and that is all.

Also, she could probably call on a union representative to help her fight that case if she was an employee. Unions are active in working for people when they are wrongfully terminated. But in this case she would have been a manager anyway, so the union avenue would not have applied.

The biggest conundrum in the scenario is why is there the threat of a lawsuit? It does not make any sense that there would be an impending lawsuit based on the fact that she moved across the country, of her own volition, to take a job that she had offered, but had not yet legally accepted. The fact that the person moved across the country has no bearing whatsoever other than that the person was inconvenienced to a high degree. This may cause her to file suit, but it would be a moot action because she has no legal grounds on which to pursue the case.

However, there are the ethics that are involved with the scenario. The woman had the expectation, supposedly, that she was going to have a job when she arrived in her new city of residence, and when she gets there she finds out that she does not. She had an ethical obligation to a former employer to be a good employee. Apparently, either she was not a good employee from the standpoint of that employee, or one of the people she worked with. Either way, because she failed in her original ethical obligations she is now without a job.

There is also an ethical consideration on the part of the hiring manager who offered the job in the first place (Hindera & Josephson, 1998). That person should have made sure that this person was qualified, in all ways, for the employment before it was offered. Because the hiring person did not check everything before the offer was given, that individual should face some censure. However, ethical dilemmas do not often end up in court. The person doing the hiring may have learned the lesson that you need to check all of the facts before an offer of employment is made, but that does not matter to the nurse who moved all the way across the country.

The third person who needs to understand ethical considerations is the trusted colleague. Ethics demands that certain information be kept confidential. Demanding that the hiring manager tell the reasons for the rescinding of the offer is in poor ethical taste. One colleague should not put her interest over the rights of another. Meaning, when the friend demanded that the hiring manager tell why she had dropped the offer, the colleague had crossed a boundary. Of course, she did not have to be heeded, but just asking for the information crosses ethical lines.

In the end, the woman who traveled across the country is without the job she was offered. She now has to find another job quickly. She can sue, but the possibility of ever receiving any compensation is extremely remote. The ethics of the situation demand that the hiring manager review how people are hired. An offer should never be made until after the entire hiring packet is reviewed. This would have saved the entire problem from happening.

Scenario 2: You are in the final stages of buying land for a new project. Your CEO has been advocating for a purchase on Grand and Broad Street. You have just learned that the CEO, two key physicians and a board member are partners in the land at Grand and Broad. What do you do?

The dilemma is supposedly clearly stated that one person is trusted to find a site on which to build a new project, some people connected with the firm are advocating for a prime site, and the individual making the selection is stuck between choosing the correct site for the project or following the leanings of the boss. This would seem to be a simple case, but it is not. The CEO in this dilemma may have the best interest of the firm in mind. He may have bought the land with the others from the firm in order to offer it for a project at a later date. All of the information is not given in the dilemma scenario, so no assumptions can be made. The scenario has to be examined from every possible angle, both legal and ethical, to determine what the best possible outcome is for the person trying to find a site for the new project. The first question is who is in charge? In this case it would be the person determining which site will be selected. Next, it needs to be ascertained whether the site at Grand and Broad is the best for the upcoming project or not. The scenario also says that the person doing the bidding is in the final stages of determining the site. If the CEO has just recently started talking about his reference, what does that imply? Someone may also need to talk to the CEO about the ethical dilemma that is presented here, and help him understand how this will look whether there is any misconduct or not (Emig, Greer & Zach, 2003). The dilemmas within this scenario will all be discussed on both legal and ethical grounds

When a person is given the responsibility of finding land for a new site, they must already have the individual authority to either take an offer or refuse same. This authority allows them to take as many bids for a job, or search for the best land to acquire, based on the needs of the organization. The trust that the board of directors gave to that person is the inviolable pact. If the land is chosen for any reason other than it is the best based on all criteria, then the searcher are in legal hot water. The source of the land does not matter if it is searched for honestly and all possible sites are given the same chance. There would be other sites for the project manager to choose from and these would have other sellers. The questions that would have to be asked are: What is the best location for the new project site? Why is that particular location, or locations, desired? Are there adequate utilities to the site that will render it easy to use? Without a thorough knowledge of all the requirements for the desired site it would be impossible for the project manager to find the correct place.

However, having said that, if the land at Grand and Broad is the best possible location for the new project, then it should be purchased. There is a dilemma regarding the CEO and the other members of the staff who have an interest in the property. The property at Broad and Grand could be just as good as any of the others, but it is not without problems (Robinson, Jackson, Franklin & Clayton, 2010). Of course, it would need to be properly documented why this was the best possible place to construct the project. The paper trail would have to be above board, so that if a lawsuit does come from one of the other sites you have the legal standing to make the case that you were not swayed in any way by urging from the CEO. The legal aspects of this transaction could be very dicey, so making sure that all bases are covered in that aspect would ensure, for all parties involved that there is not an issue.

If there is undo pressure from the CEO, then the person buying the property has legal recourse. It is the same if a person is sexually harassing you and tells you that unless you do certain things they are not going to promote you. Or you will get certain perks on the job for sexual favors. A person cannot be harassed by an employer to make them do anything that would be illegal or seem unethical. If the piece of property is the best site at the best price, but the CEO is applying undo pressure, then the property should still not be considered. The scenario just says that the CEO has been advocating for this certain property. The person making the selection needs to find ot why this piece of property is the perfect one. It seems that the location is the reason that they want to purchase this, but there could be other factors, besides their financial interest, that make this a particularly desirable place.

The CEO should realize that he or she can get into legal trouble because they have an interest in the property. Of course, that person would understand the possible legal ramifications of their interest in the property. But, it is the duty of the person making the selection to advise them of the problems. If the company selects the property and everything is above board, then the other property owners can still say that there was undo favor given to the CEO and other staff members. They could go to court and claim that their properties were not given the chance that the CEO's was. It does not matter whether they are correct or not. Perception, in many cases, is reality. When the case does go to court, the law would be sympathetic to the other people. The burden of proof would be in the company who placed the bid on the property. The other property owners would not have a difficult time in making the case that there was collusion of some sort, even if it there was nothing illegal done.

The thing to do is look at all the properties that have the requirements that you need for the project. Then find the property that is going to give the company the best financial deal. If that is the property on Grand and Broad, then it should be purchased no matter who owns it.

Ethically, the dilemma is what the person selecting the property thinks. A little bit of introspection needs to happen on their part. What is their reason for selecting a certain property? It would be just as wrong if they did not select the property that the CEO is advocating for if the only reason they did not select it is because he had an interest in it. The person selecting the property should be clear, within himself or herself, that the reason for selecting the property chosen was because that was the best possible solution for the company's project needs.

They could also talk honestly to the CEO and the other people involved separately to see what their reasoning is. They could tell the person selecting the property, individually, that they think that the Grand and Broad property is the best and why they think so. It would be up to the selecting agent to determine if they were being truthful or not.

Another point to make, is that the CEO should not have put an employee into this position in the first place. The ethical thing to do may be to ask that the company hire an outside firm to do the property selection. The interest of the company is the primary concern, so if this is the best decision for all parties then that is what should be done. Having an outside realty firm make the selection would take away the possibility of influence. When the CEO put an employee into the position of deciding for or against him, he forced the employee into a situation that was too difficult.

The employee has to think of what the ramifications of the decision could be. As mentioned before, if they choose the property, there could be court action. If they do not choose the property, then the CEO may think they did not do so because of his involvement. That employee could then face possible termination because he or she did not choose the CEO's property.

In summation, the ethical problems are not all obvious from an initial reading of the scenario. On the surface, it would seem that the person should just choose another property, but that would not be correct. They could look at all of the properties and choose the best one. That would seem like the best scenario. But, probably the best answer to the dilemma would be for the person to divorce himself or herself from the project, and allow some outside firm to make the selction.

Scenario 3: Your CEO asks that you fire your CNO, who you have just given a good performance appraisal. After much debate, the CEO finally reports that the medical staff wants him fired because he is gay. What do you do?

The easy answer is that you do not fire someone due to their sexual orientation. The healthcare organization would definitely be facing a lawsuit because of that action. The other party would also, very likely, win. Civil rights legislation has seen to that (Chung, 2001). On the ethical side, it is wrong to fire someone for who they are or choose to be. As long as he is doing his job to the best of his abilities, there should be no reason to terminate them from the company.

However, to accurately assess this problem this scenario should be broken down into several components.

First this person was given a good performance review (Meier & Hicklin, 2008). Sometimes people will receive a good review, regardless of their actual performance, because the reviewer only sees what they do in microcosm. Many people will act a certain way around their subordinates and another way around the people whom they are subordinate to. The good performance review should be examined to see why it was given (Meier & Hicklin, 2008). How did they rate in the different categories and is there any reason why this person should be fired? The review should be examined carefully to make sure that it was accurate. Many times a person will also fill out a separate review for themselves saying what they believe their performance was (Long, 1997). If the company has such a document that employees fill out, then it should also be examined.

Most performance appraisals have several different levels of performance. "Good" is generally in the middle of the hierarchy, so there could have been some reasons why even you did not believe that this person was performing to the level that you believed that they should have been. Since every evaluation comes with a comments section for the various categories, look at what the different comments were. If the CNO made comments on the evaluation, check those also.

The second question is what initial reason did the CEO give for wanting the person fired. The scenario says "after much debate." This means that the CEO had many other points of debate before they finally admitted the real reason. Looking at the first part of the response, it could be that the person does have some flaws that would make it necessary to look at terminating them. There could be valid reasons for the termination, but the reason given is not one of them.

Another possible avenue to explore is what are the laws in the state, and at the hospital, with regard to firing someone (Yoder, 2008)? It initially seems, at least to the person asked to do the firing, that they are being fired without any cause until it is find out that the CEO does have a reason to fire the person (although a discriminatory one.) If the hospital has a union that protects this employee, which it probably does not because he is management, then they could get involved for wrongful firing. Also, the employee could go to the labor relations board and request a hearing about the matter. If the firing was explained to the board as well as it was to the person doing the firing, then the CNO has a case for wrongful termination just based on the fact that a good reason was not given. The employee could also have signed an at will clause if that is a law in the state. This would allow there to be a termination of employment without cause. There is also the possibility that the CNO had a contract which does not allow them to be fired without cause, in which case they would have to be told the reason for the action.