Introduction: organization and the interviewees’ background; statement of the problem
Ethical conflicts play a critical role in nursing practices. Many specialists believe that managers tend to underestimate or overview these problems (Toren & Wagner, 2010). Practice shows that unjust allocation of funds, discrimination on the part of the senior management and moral distress prevent nurses from fulfilling their duties efficiently, and has a negative impact on the health care service (Huber, 2014).
In order to analyze the relevant problem, one has interviewed two representatives of the Ottawa Civic Hospital. The first interviewee takes the position of the Chief Financial Officer (CFO), and his duties include efficient budget allocation and the principal decision making. The second interviewee is an accounting manager responsible for monitoring hospital financial performance and foreseeing possible risks. Both interviewees have taken their positions for the past ten years and agreed on the fact that an ethical problem is acute in their organization. Therefore, they tried to provide a detailed description of the activity performed to resolve it.
To begin with, the interviewees pointed out a series of measures carried out to improve the ethical environment. Thus, a new Code of Ethics was introduced three years ago. The distinguishing feature of this Code is that it is a set of rules that refers to the entire workforce instead of the nursing department only like its precedent. Another step was the foundation of a formal ethics committee responsible for monitoring the level of the moral and ethical standards within the hospital. Thus, nurses can address the relevant part in case any moral conflict occurs. Finally, in order to eliminate the problem of voicelessness, the front office obliged nursing managers to participate in all the decision-making procedures and to report regularly on the current set of things in the nursing department.
The interviewees note that the lack of a connection between the financial and the nursing departments is a critical problem. One needs to note that this question is widely discussed by modern scientists. Hence, some of them believe that the lack of representatives of the nursing workforce has a negative influence on the corporate ethical climate (Pauly, Varcoe, Storch, & Newton, 2009).
Meanwhile, the interviewees claim that the activity aimed at improving the ethical environment in the organization is not finished yet. Thus, among the potential steps, the health care workers point out the increase the amount of money invested in the long-term care, the improvement of the workloads system, and the reformation of the decision-making mechanism in order to make it more decentralized. The interviewees explained that such a wide spectrum of aims is determined by a many-sided character of the ethics concept.
Their intention to decentralize the decision-making system is aimed at raising the level of equally within the personnel. One needs to note that the relevant measure is believed to be an effective tool for the equalization of the staff and the senior management (Corley, Minick, Elswick, & Jacobs, 2005).
The interviewees likewise described the potential risks they expect to meet. Thence, among the difficulties they foresee, the most problematic task is to improve the efficiency of the Code of Ethics so that its rules are equally obeyed by the nursing department and the senior management. The interviewees believe that no significant changes might occur in the department unless they start from above. One needs to note that the relevant assumption is commonly supported by various specialists who believe that the ethical behavior is to be primarily demonstrated by leaders (Gaudine & Beaton, 2002).
Another problem the interviewees predict is the transformation of the budget allocation system. The hospital representatives note that it is highly problematic to replace the quantitative financial approach by the qualitative policy, even though they agree that this measure is essential. Finally, the CFO adds that one of the potential challenges is to set a reliable connecting between the management and the nursing department so that the latter can regularly report on the current needs and problems.
Moreover, the interviewees provided some statistics regarding the measures performed throughout the past year. According to the data, the organization spent 50,000 dollars on the initiatives connected with the ethical problem resolution. The major part of the money, 35,000 dollars was contributed to the implementation of the formal ethics committee. 10,000 and 5,000 dollars were spent on the leadership training and the monitoring activity correspondingly. The relevant measures have been performed within the department of 3000 of nurses, where each nurse serves from 5-10 patients a day. The sum of the investment comprises 1/12 part of the total hospital budget.
According to the collected data, one might conclude, that the most critical aims are the reformation of the workload system, the resolution of the voicelessness problem and the strengthening of the interconnection between the departments. As well as the interviewees, many analysts suggest that the success of the problems’ resolution highly depends on the managerial approach (Dunham-Taylor & Pinczuk, 2006). Therefore, the measures described by the interviewees seem to be efficient and reasonable.
Corley, M.C., Minick, P., Elswick, R.K., & Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381-390.
Dunham-Taylor, J., & Pinczuk, J.Z. (2006). Health Care Financial Management for Nurse Managers: Merging the Heart with the Dollar. Sudbury, Massachusetts: Jones & Bartlett Learning.
Gaudine, A.P., & Beaton, M.R. (2002). Employed to go against one’s values: nurse managers’ accounts of ethical conflict with their organizations. Canadian Journal of Nursing Research, 34(2), 17-34.
Huber, D. (2014). Leadership and Nursing Care Management. Saint Louis, Missouri: Elsevier Health Sciences.
Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009). Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics, 16(5), 561-573.
Toren, O., & Wagner, N. (2010). Applying an ethical decision-making tool to a nurse management dilemma. Nursing Ethics, 17(3), 393-402.