Nursing and Ethics - Administrative Ethics

Alabama Nurse,  Jun-Aug 2004  by Bross, William

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In previous issues, we have seen the impact that the individual has in the ethical decision-making process and how it is important to adopt a process to use when addressing ethical issues. Additionally, we have reviewed the role of the nurse in the clinical research process. From this, we have realized the importance of an organization developing its own set of values and principles, an ideology or framework that its employees are expected to follow. Ethical codes are developed to support and police a profession. Now we need to examine the area of administrative ethical issues and decision-making processes and the impact that they have on the health care setting. As managers, or persons in position, we must identify what additional responsibilities are expected when facing these new issues. We must also develop or adopt a framework to resolve these ethical issues. Many times, the organizations that we work for often use ethics committees and / or review boards to assist in addressing ethical issues.

Administrative ethics range from conflict of interest concerns, which we will discuss in this issue, to governing body issues and medical staff relations, to our duty to the patient. As you can see, some aspect of administrative ethics can be addressed by staff at all levels.

Administrative ethics are likely to affect patients as groups rather than as individuals and will affect the way in which the manager relates to the organization, peers, and the community. On the other hand, biomedical ethical issues usually affect patients as individuals. Biomedical ethical issues are very specific to that individual. The example of the Florida tube-feeding case is an example of this type of issue. Though they are different, each of these types of issues relate to one another. While the focus differs, they must all be addressed to maintain the highest level of patient care within the facility.

The adherence to professional standards occurs on various levels including the individual health professional, the professional groups, and the health care institution itself. We have focused previously on the individual and the role of the professional organization, now just as important is the role of the health care organization. Health care organizations use a variety of tools to ensure that quality care is being delivered within the facility: Many of these committees arose out of the recognition of the need for business ethics as well. Business ethics concepts include issues such as integrity, honesty, benevolence, and the duties employees and organizations have to each other. These same ethical concerns apply to health care settings. Additionally, health care focuses on the respect of the individual, emphasizing fidelity and confidentiality.

Inherent in the role of health service professionals is the fact that they are often held to a higher responsibility than other professions. By this I mean that society recognizes that the sick person, or person in need, holds a special status that needs additional protection and support. Think about this; the role of the nurse has a great added responsibility in this regards. You are dedicated to your profession beyond words. I have known many persons that entered the field of health care that were not able to make the transition. Health care presents a different standard that you are held accountable to, and if it is not followed, the health of your patients will suffer.

Fortunately, there are various groups to help guide us through the decision-making process in issues facing you on a daily basis. There is the highest level, which consist of governmental agencies to oversee Medicare and Medicaid, and National Committees appointed by Congress to address specific issues that arise. These are important measures, but they often do not address local needs or issues within your facility. At the state level, licensure boards serve to promote quality. However, there must also be facility level groups to address issues.

Think about your particular facility. Within your individual facility, you will see various groups including:

Utilization Review - a committee which ensures that hospital resources are employed to provide the best possible care at the most effective price. How do you think that this is measured? Many times it is measured by care outcomes and satisfaction. Think about what other things are measured or monitored in your facility.

Credentials Committee - also called a Peer Review Committee, with its primary goal of examining and certifying persons that apply for staff privileges at your facility. Committees of this type must be extremely careful that they do not deny a person the opportunity to practice in the facility without cause.

Continuing Education Programs - think about the importance of this group in educating employees about and maintaining the quality of patient care. While the state boards require a certain amount of professional training each year for its members, is this really enough? I propose that internal education is far more important and necessary than that required by state agencies. We can address and assist in the continuing education of our employees to make sure the highest level of care is delivered.