This article describes the challenges and complexities of making ethical resource allocation decisions on health. It introduces the ethical perspectives of decision making as concerns resource allocation and accountability in nursing administration. While the concept applies to all nurses, this area is of more concern, particularly for nurse administrators.
Based on my specialization as a Nursing Administrator, this paper shall create a legal and ethical dilemma used in making a decision that is involved in the practice of advanced nursing in the field of the nursing administrator. Advanced practice nurses in the field of administration experience unforce able situations and conditions that require the skills in decision making involving moral and ethical consideration. According to scholars, there exists several administrative, ethical dilemma like the quantity of life, treatment maintenance vs. withdrawal, pro-life prochoice, and non-euthanasia versus euthanasia exist. The ethical dilemma that is based on experience within the hospital deals with consent that is informed with the right of the patient to refuse. Administration dilemma involves the patient’s autonomy; human rights informed consent, including informed refusal. According to ( Cohen, & Erickson, 2006) informed consent involves a situation where the patient is fully informed and participates in choices that revolve around his health. However, informed refusal involves a situation where there is a rejected treatment with an understanding of the risks involved.
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Case Scenario
Mr. John is working as a nursing administrator in one of the busy clinics in town. The clinic is known to attract a sizeable Hispanic population in the area. The availability of interpreter services in the hospital has attracted such a large number of Hispanic clients. Interpreters are available from an institution which serves many clinics in the area. Since the clinic in which Mr. John is working is among the busiest in the area, the families with Hispanic origin have to wait for long to get the services due to lack of enough interpreters. As a nursing administrator, Mr. John requested the management to hire more interpreters, a request that was declined.
This is a case which highlights the inequalities concerning the allocation of resources. Unfortunately, the Spanish-speaking patients have to wait for long to get medical attention in the clinic. Besides, there may be other important factors which have not been considered in this case, which shows the impact of inequality in allocating resources. Healthcare allocation should take into account the needs of the local community. The principle of justice should have been the guiding factor for the management who established the health facility. The idea of making decisions based on the availability of resources is not as easy as it may seem. In an ideal world, there would not be cases of limited resources. However, in reality, healthcare resources are and will always remain scarce. Therefore, healthcare resource distributions are based upon either explicit or implicit criteria or considerations. As the population of the US increases, the strain on these scarce resources has led to the need for policymakers, providers, as well as the government to make the best decisions that concern every individual.
Nursing Administrator Code of Ethics
With the ever-rising cost of healthcare, third party players are increasingly becoming less willing to underwrite the cost of different procedures. Both the managers and the physicians are facing ethical dilemmas which were unheard of initially. When there is limited availability of resources, there comes a need for appropriate distribution of such resources. As nursing administrators, we are facing several ethical decision dilemmas to make in our daily activities. Hiller (1996) claims that six ethical principles should guide health care leaders. These include justice, beneficence, truth-telling, respect for persons, non-maleficence as well as utility. (Beauchamp & Childress) Also claims that the fundamental principles which guide decision making in the medical ethics field are justice, autonomy, and beneficence. Therefore, as a nursing administrator, I am endowed with all the mandates to make the right decisions for the benefit of all. However, there comes a time during which I face challenges while making specific decisions.
Ethical and Legal Violations
Based on this scenario, the clinic does not take into account the needs of the community. This may call for ethical and legal concerns from the local residents. The fact that the institution takes a while to serve Hispanic patients, it puts their lives in danger. It shows that the clinic is not equipped with resources to handle emergency issues. Such a scenario poses decision making challenges to administrative nurses since they are the ones required to make such decisions. These situations may spiral up and end in media, legal, as well as legislative institutions. This is always true, especially on the current and emerging technological procedures.
This case may end up in court as a violation of patient rights through discrimination. Such a situation may draw the attention of the National Association for the Advancement of the Colored People Legal Defense and Education Fund, which traces back between 1956 and 1967. Through this body, overt discrimination in hospitals and other professional organizations are tasked with the role of ensuring equality in serving the patients. Simkins v Moses H. Care Memorial Hospital (1963) was a landmark case which challenged the expansion of the segregated hospital care through the use of the public funds. Also, Cypress v Newport News Hospital Association (1967) meant that the application guidelines for the federal governments should force hospitals open up education programs, patient admissions, and privileges to all the physicians and citizens.
Decisions with Integrity
The production and acquisition of such resources as drugs, health personnel, knowledge, and equipment have consequences which force decisions based on the allocation of resources. From the public health, the need for fair distribution and equitable access to quality health has to take priority over the individual goals (Powell, Engelke, & Swanson, 2018). Healthcare managers and policymakers may have to ensure that there are enough facilities to create a wide range of choices for the community.
As more integrated health care delivery systems are established, nursing administrators will increasingly become strained by ethical issues on administration. Some of the notable challenges include ethical issues concerning conflict of interest, pressure on the cost of containment, choices on the quality of care, as well as restraints on expenditures. The principles of beneficence, justice, as well as autonomy, will attain increased significance. If healthcare aims at achieving profit, as is the case in most institutions, then the ethical dilemma between the earnings and the interests of patients will continue being a problem.
Recommendations
Perhaps the impact of the myriad of problems on making difficult decisions by administrative nurses may be softened by rational and imaginative strategies. The decisions concerning scarce resource allocations must be made in line with the principles of justice, autonomy, and beneficence ( Suhonen et al.2018) . These decisions about the distribution of limited resources may even be more complicated in the future. As a result, nursing administrators and other healthcare leaders should ethically and diligently explore such issues.
References
Black, B. (2016). Professional nursing-E-book: Concepts & challenges . Elsevier Health Sciences.
Cohen, J. S., & Erickson, J. M. (2006). Ethical dilemmas and moral distress in oncology nursing practice. Clinical journal of oncology nursing , 10 (6).
Kim, K., Han, Y., & Kim, J. S. (2015). Korean nurses’ ethical dilemmas, professional values and professional quality of life. Nursing ethics , 22 (4), 467-478.
Powell, S. B., Engelke, M. K., & Swanson, M. S. (2018). Moral distress among school nurses. The Journal of School Nursing , 34 (5), 390-397.
Suhonen, R., Stolt, M., Habermann, M., Hjaltadottir, I., Vryonides, S., Tonnessen, S., ... & Scott, P. A. (2018). Ethical elements in priority setting in nursing care–a scoping review. International journal of nursing studies .
