Ethical Issues - Clinical Research

Alabama Nurse, Dec 2004-Feb 2005 by Bross, William

Over the past several issues, we have reviewed various ethical processes, the role of administrative ethics in how we practice, and the role of Ethics Committees in our jobs. Ethical issues will continue to present a challenge to all health care settings in the coming years. As health care professionals, we must all develop our own internal strategies to integrate the ethical theories and principles into our environments. This goes for us in whatever our role might be, not only as managers or administrators, but as staff persons or persons related indirectly with the health care arena. We have seen an explosion in the number of ethical issues that we will face in our careers, many due to the rapidly changing health care environment and technologies. I expect that the number and complexity of the issues confronting us and our patients will continue to grow and our involvement in the decision-making process and counseling functions will become more critical. While we have reviewed some common and controversial ethical topics, keep in mind that we have just scratched the surface.

In the most recent issues, we touched on issues related to death and dying. In this issue, I would like to explore ethical situations that several of you have asked me to address concerning conflicts of interest. These are often seen among the Employer / Employee relationship.

Employer / Employee Conflicts of Interest

Many of you might not be aware of this term. There are many definitions out there, the classic definition focusing on the presence of some personal interest that runs counter to the interests of the organization. As defined by the 1993 Code of Ethics of the American College of Healthcare Executives, "a conflict of interest may be only a matter of degree, but exists when the health care executive: is in a position to benefit directly by using authority or inside information, or allows a friend, relative or other to benefit from this, and uses authority to make a decision to intentionally affect the organization in an adverse manner". (American College of Healthcare Executives. Code of Ethics, Section 111.) You might be thinking, how does this apply to me, or does it apply to me?

Several years ago, I might have thought the same thing, but the workforce in healthcare has changed a great deal in the past years. Now, for example, a nursing manager might be employed in decision-making roles with more than one facility. Consider the impact of traveling nurses and those nurses employed in staff roles in several facilities in the same city. Finally, consider a nurse that is working both in healthcare and also in another setting. Let's look at each of these in more detail.

Managers in Multiple Facilities - In this scenario, a nurse manager or officer of a company, is employed by more than one entity with similar interests. For example, what if I manage a nursing unit for Hospital X, but also manage a unit part time on the weekends for Nursing Home Y. What if the Nursing Home really wants the business from the hospital and knows that you could help? What if they are pressuring you to help and you know the hospital has its own nursing home facility?

Staff Nurses Working Various Facilities - We see this scenario more frequently today. As nurses, we have skills that are in great demand, and frequently work with several employers. In the role of staff nurse, a conflict of interest might not be obvious, or detrimental, but it might exist just the same. When you work for an organization, are you not agreeing to adhere to the mission of that organization and support that organization? What if you work for Hospital A, and also work for another facility, Hospital B, and you like the working conditions better over there. What if you tell co-workers at Hospital A they should go to Hospital B instead? This might be considered a conflict as you are causing harm to Hospital A. I am not suggesting that nurses do not work for more than one organization, because I think it is good to do this, it brings new ideas and approaches to other facilities. I just want you to be mindful of what is and is not done. I would not hide the fact that I work for another organization. Keep in mind, too, that you may have what I call a " primary employer ". Make sure that your second job does not interfere with your primary job. I managed in several facilities over the years, and managed hundreds of nurses, and sometimes this did become an issue.

Employment in Nursing and Another Field - While not as common as the other situations, this scenario is emerging more today. Many nurses are entering fields in addition to their roles as nurses. Consider an individual that works for Hospital A and also opens a staffing business or home health agency - there is the potential for a conflict of interest. I worked for a period of time in hospital management and law, and had to disclose this conflict.

Identification of a Potential Employer / Employee Conflict

It is important to identify any potential conflicts that might be present and disclose these to the appropriate persons. This might be as simple as letting the Human Resources Department know of other employment. Please review whatever policies are in place at your facility. Managers or Executives might be required to sign formal disclosure documents. Whatever the situation, if you think here might be a potential conflict, seek advice as to how to handle this.