In February 2017 just a few months ago, a horrible fire broke out at a paint industry in the middle of the night on the outskirts of the New York City . The fire had only had two victims a fireman Frank Jeffers 32 year of age and a homeless man called Brent Damascus 58 years. The firefighter had respiratory difficulties that he obtained while trying to put out the fire. The homeless man was also a victim of the fire they both suffered the same injuries with the same intensity.
The two patients arrived at the hospital at the same time. As we all know working in the emergency room does raise a lot of ethical dilemmas. But with the two patients, all the medical history was available on time, this is because Mr. Damascus the homeless man was a regular visitor at the hospital, he suffered previously from asthma headaches and traumas, and he has no insurance. While the medical history of Mr. Jeffers arrived on time provided by his insurance company. Due to the effectiveness of getting medical history of the patients, the doctors and nurses at the emergency room did not have a hard time and restrains in deciding on the course of action to take.
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As much as the nurses had all they needed things started to take a turn for the worst and time was not on their side. They had to choose on whom to treat first despite the fact that they both had the same injuries and both their health’s were deteriorating at the same rate. The nurse’s dilemma was to either save the life of a 32-year-old fireman who had insurance a family and a home to go to and a 58-year-old homeless man. The doctors choose the firefighter and this is where all the ethical issues started to rain down on them. Members of the public and the press were disappointed that they did not value the life of a homeless man just because he had no insurance; other people condemned the hospital saying that they are a money making the institution and have no right to work in the health industry.
In the past, there were a lot of ethical issues in the emergency rooms that is why a patient protection and Affordable Care Act (PPACA) was passed in 2010 by President Obama under his famous Obamacare policies (Emergency Nurses Association, 2013) . The act brought a lot of debates about controversial topics on the emergency rooms; people had not really thought of the ethical issues that are faced in the emergency room (Emergency Nurses Association, 2013) .
However, the full impact of the healthcare policy has not been seen at a national level. The policy act of 2010 has 11 sections that affect directly the emergency rooms (Emergency Nurses Association, 2013) . There are few issues that have to be addressed that are the shortage of registered nurses, lack of access to health care and the legal pressures that doctors face on a daily basis. Emergency providers have the ability to influence how the 2010 act can be further amended and interpreted (McClelland et al., 2014). Without any doubt, the 2010 act was created with the patients in mind and they are fully represented, however, the policy does not view the nurses' point of view and the pressures they undergo.
The main issue that brings about ethical dilemmas in the emergency room is the triage process and the decision-making skills. Nurses are supposed to make rapid decisions and in a timely manner based on their experiences and knowledge. Simulations can be used to address the triage decision-making skills that are the thinking out loud technique. Hospitals and other health facilities should know that before placing a registered nurse in the emergency room, the nurse should be trained on the triage decision making process and have worked with an experienced professional before (Jesus, 2012) .
It is recommended that nurses should be trained using real-life triage cases and the decisions that were used in that setting; this will give the nurses equal experience as senior nurses (Jesus, 2012) . It is more advisable that the simulations should be followed by verbal protocols. If these steps are followed, it will result in a positive outcome on the side of the patient and the hospital credibility will be held high.
There are situations where the nurse is faced with an ethical dilemma and hospital policy. This is a very common occurrence in all hospitals. as much as the hospitals want to save lives they are a money-making institution that has to balance the books and ensure bills and salaries are paid, nurses in the emergency room are the ones who are left with the hard decision of making the choice of saving the life of uninsured patient at the expense of the life of a fully insured person. The decisions nurses face are unthinkable but they have to remain ethical (McClelland et al., 2014).
In society today, there are a lot of disparities and imaginary boundaries surround people that is the poor and the rich, white and black among several others, healthcare is faced with the same disparities, and it is of great concern. In healthcare, most of the disparities are not intentional but they are unconscious they are referred to as implicit bias (Jesus, 2012) . A lot of research has been conducted to prove that indeed implicit bias is the main contributing factor in health disparities.
The research did conclude that unrecognized bias against a certain ethnic group or race leads to communication barriers between the patients and the nurses hence making treatment decisions a little harder. In our case study, it is evident that the homeless man was a victim of disparity not of race but of class (Jesus, 2012) .
In conclusion, working in the emergency room is a very satisfying job since the nurses literally save lives on a daily basis. The challenges that are in the emergency room are a lot and would probably take a very long time before they are all fully sorted out.
References
Emergency Nurses Association, In Hammond, B. B., In Zimmermann, P. G., & Sheehy, S. B. (2013). Sheehy's manual of emergency care. S t . Louis, Mo.: Elsevier/Mosby
Jesus, J. (2012). Ethical problems in emergency medicine: A discussion-based review . Hoboken, N.J: Wiley-Blackwell
McClelland, M., Asplin, B., Epstein, S., Kocher, K., Pilgrim, R., & Pines, J. et al. (2014). The Affordable Care Act and Emergency Care. American Journal of Public Health , 104(10), e8-e10.
