Ethical Conflicts in Nursing vs. Financial Planning Compared

Introduction

The healthcare industry is increasingly faced with demands that it operate more like a for-profit business, with a careful eye on cutting costs. Reviewing managerial concepts intended for business organizations 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 Professionals (Duska, 2014). The article notes that financial planners are frequently faced with ethical dilemmas that place their own personal interests at odds with their clients' interests. For example, they may be instructed to "push" a particular product and told they can earn an additional commission bonus if they sell it, even though it is not in the client's best interest.

Firms often offer trips, bonuses, or reputation enhancement to planners who are highly aggressive in their sales approach. However, such aggressiveness 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 also has personal interests in securing employment, earning income (given that salary is largely commission-based), and serving the competing interests of the firm. These tensions create a structural conflict that no individual willpower alone can fully resolve.

Application to Healthcare Organizations

Nurses, too, frequently face dilemmas arising from the financial pressures of healthcare. As the ANA Code of Ethics for Nurses recognizes, "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).

Due to management pressures, nurses may feel compelled to recommend less costly treatments in order to keep costs down. Conversely, they may feel pressure to support more intensive treatments — even when unwarranted — so that the institution can generate additional revenue or justify the expense of new technology. Not all patients, particularly the elderly and those facing end-of-life care, wish to pursue the most aggressive therapy available.

"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 tied to specific care patterns before the needs of the individual patient are fully considered — or face sanctions if they advocate for treatments that management is trying to eliminate for cost reasons — it becomes difficult 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 emphasized 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 make ethical decisions solely the responsibility of individuals. Rather, the entire organization's approach must be redesigned so that acting ethically is straightforward, rather than a constant personal challenge for nurses.