Ethical Conflicts in Nursing

Applying "Ethical conflicts for new financial planners" to nursing

The healthcare industry is increasingly faced with demands that it operate more like a for-profit business with a careful eye upon cutting costs. Reviewing managerial concepts intended for business organizations in general can be useful for healthcare institutions such as hospitals, provided the need for quality is not forgotten. This can be seen in the article "Ethical conflicts for new financial planners" from the Journal of Financial Service Providers (Duska 2014). The article notes that financial planners are frequently faced with ethical dilemmas that place their own personal interests at odds with the client's interests. For example, they may be instructed to 'push' a particular product and are told they can benefit from an additional bonus on their commission if they sell it, even though it is not in the client's interest.

Firms often offer trips, bonuses, or even simply reputation enhancement if planners are highly aggressive. But this may not be financially appropriate for the client or the client may simply be risk-averse. The financial advisor is supposed to place the client first but he also has interests in securing his own job; making money (given that his salary is largely commission-based); and also he must serve the additional, competing interests of the firm.

Application to healthcare organization

Nurses too often face dilemmas regarding the financial pressures of healthcare. "Nurses are frequently put in situations of conflict arising from competing loyalties in the workplace, including situations of conflicting expectations from patients, families, physicians, colleagues, and in many cases, healthcare organizations and health plans. Nurses must examine the conflicts arising between their own personal and professional values, the values and interests of others who are also responsible for patient care and healthcare decisions, as well as those of patients. Nurses strive to resolve such conflicts in ways that ensure patient safety, guard the patient's best interests and preserve the professional integrity of the nurse" ("Conflict of interest for nurses," 2011). But due to management nurses may feel pressured to 'push' less costly treatments to patients, to keep costs down. Conversely, they may feel a need to support more intensive treatments, even when unwarranted, so that the institution for which they work can have the additional 'business' or even justify the existence of expensive new technology. Not all patients, particularly the elderly and those facing end-of-life-care, wish to purchase the most aggressive therapy.

"Situations created by changes in healthcare financing and delivery systems, such as incentive systems to decrease spending, pose new possibilities of conflict between economic self-interest and professional integrity" ("Conflict of interest for nurses," 2011). When nurses are given bonuses to incentivize providing care in a specific fashion before the specifics of the individual patient are considered or if they are faced with sanctions if they suggest actions management is trying to decrease from a cost-cutting perspective, it is difficult for them to view patient care objectively. "Incentives tied to financial targets are examples of features of healthcare systems that may present such conflict. Conflicts of interest may arise in any domain of nursing activity including clinical practice, administration, education, or research" ("Conflict of interest for nurses," 2011).

Conflicts of interest may intensify when nurses with managerial responsibilities must balance their roles as caregivers and as administrators. It is stressed that "Nurses should disclose to all relevant parties (e.g., patients, employers, colleagues) any perceived or actual conflict of interest and in some situations should withdraw from further participation" ("Conflict of interest for nurses," 2011). However, organizational design theory stresses that it is not enough to leave ethical decisions the responsibility of individuals: rather, the entire organization's approach must be redesigned so that to act ethically is easy, versus a constant challenge for nurses

Discussion

Analyzing organizations holistically for incentives that can result in ethically questionable decisions is essential. That is why the article on ethical conflicts for financial planners is so relevant to nursing: it shows that the problem is not specific to nursing or to healthcare but is common to organizations as a whole. There must be "alignment of all other important organization design elements for process environment (e.g., management style, reward systems, performance metrics, people practices, organizational culture)" to optimize ethics, not just efficiency (Hernaus 2006: 3).

Opinion of the article

I found the article on financial planning particularly interesting and relevant to nursing as a point of comparison because it underlined the extent to which conflicts of interest can be rife in the healthcare profession. While people are apt to be on their guard regarding the conflicts of interest financial planners may experience in regards to clients, they tend to hope that their healthcare providers make decisions purely with their best interests at heart. This may not always be the case and patients need to learn to be their own best advocates and nurses need to be mindful of their own potential conflicts of interest.