Addressing Ethical Conflict in Healthcare

Addressing Ethical Conflict in Healthcare

Healthcare providers get faced with ethical dilemmas in their respective practice settings. In the nursing profession, for instance, there arise many circumstances that prompt nurses to resort to nursing ethics to resolve the ethical conflicts they face in various healthcare departments (Wood, n.d.). This article entirely focusses on a case study presenting with a moral conflict a nurse practitioner faced while at work. Aspects of this case study will call for conducting an overview reviewing of the relevant ethical principles – non-maleficence and fidelity. In this paper, there is also a highlight of the risks involved for not reporting the incident, the proposed leadership approach to deal with the issue, and possible approaches to improve making the best of the situation.

Nonmaleficence refers to the duty of a healthcare provider to cause no harm to others (Habib, 2019). In this case, the physician breached the ethical principle since he lied and left the nurse alone, thus putting the patients at risk to harm at the ED because no physician was left among the staff to attend the patients and lead an ED. Fidelity is a principle focusing on the ethical right of a healthcare worker to act in the best interests-ensuring faithfulness and keeping promises as a professional in providing high-quality care (Hsieh & Huang, 2017).  The physician’s interests and personal values superseded the interests of patients; thus, he could not advocate for patient wellbeing. By lying to the nurse, he failed to keep the promise made to her and the profession.

Possible Ethical Conflict Faced by Cindy

Cindy, the Advanced Practice Registered Nurse on duty, found herself facing a dilemma when her trustworthy colleague (a physician they had worked with for over ten years) in the Emergency Department lied to and abandoned her for several hours during a shift. Cindy did a follow-up and realized that her colleague had left for the airport contrary to the information she had concerning him visiting the cafeteria briefly for lunch. The incident made her acknowledge the abandonment by the physician. Being a nurse, it dawns on her that the nursing scope of practice could not enable her to lead and attend patients at the ED all alone. As a result, she gets torn between confronting and reporting the physician because the act predisposed the patients to potential safety risks or let go since he had been a diligent colleague in the practice setting. Besides, the uncertainties of being new in the nursing role, the cognitive status of the physician keeping in mind that he was suffering a breakup, contributed to the build-up of the conflict. Cindy felt the urge to report the behavior since it is a threat to patient safety but become reluctant because it would further negatively affect him psychologically.

Additionally, the organization’s management team and ethics committee would be faced with conflict in deciding the fate of their staff member. Based on the hospital policy, the physician is bound for a likelihood of job termination and increased chances of license loss following a report to the board of medicine. However, they may face a dilemma of whether to fire the physician or terminate him because it would potentially affect staffing. Such a dilemma termed as a competing obligation that involves protecting the patient on the one hand and protecting the staff on the other.

Nonetheless, Cindy, as a nurse, ought to consult the relevant bioethical dimensions by heeding the Code of Ethics for nurses as stipulated by the American Nurses Association (ANA). Being an APRN-prepared nurse, she ought to commission collaborative decision-making based on assessing his awareness of abandonment. Healthcare workers ought to honor the code of ethics, thus practice within the training, experience, and professional codes of conduct. The physician overlooked fidelity and non-maleficence as being part of the essential biomedical ethics of medical practice. Fidelity is the most critical ethical principle because it governs the rest (Dayton, 2018). Some of the risks following not addressing the issue from an organization standpoint include a likelihood to breach all other ethical principles and leading to poor delivery of services to patients. Moreover, the stakeholders of the organization would not get the opportunity to note the challenges among its employees that usually undermine the quality of care rendered to clients.

In a nutshell, Cindy has an obligation to patients by ensuring they get safe, competent, and high-quality care. Concurrently, she remains hesitant to confront the physician since she knows he needs the job. Therefore, she does not want to take a step that could call for his firing. Cindy also values their comradeship. The eventual loss of his job means that a staffing shortage in the ED gets apparent.

Possible Consequences of Reporting the Incident vs. not Reporting

Presenting the competing obligation conflict to the organization’s ethical committee prompts investigation into the matter. The committee would engage the physician in a probe session and talk as a way to assess awareness of breaching the concerned ethical principle. If proved guilty of patient abandonment, the physician would be terminated and further disciplinary actions taken by the board of medicine to consider stripping him off practice license. Such a fate might potentially affect the physician further, considering that currently, he is going through a divorce. Also, such can significantly affect staffing and lead to low staffing ratios before finding an appropriate staff for replacement. Another possibility would be fostering and encouraging further training and educating the healthcare workers on biomedical ethics and the associated legal dimensions in promoting high quality and patient safety.

We cannot rule out the possibility of not reporting the case. In such circumstances, the repercussions are substantially remarkable to healthcare. Healthcare professionals have the responsibility of contributing towards reconciling conflicts they face themselves or from their colleagues. Failure to report or take any action about the occurrence by Cindy constitutes overlooking fidelity as an ethical principle in health care practice. One of the consequences of such a move is potentially predisposing the patients to harm soon further. Ignoring will probably make the physician believe that he had done no wrong now that a code blue was never activated in his absence. Chances of recurring would increase, considering that the physician works with other staff unaware of the incident during different shifts; thus, potential negligence. To a great extent, it could lead to failure of the physician to report for work, thereby leading to poor patient outcomes.

Description of a Leadership Approach to Help Cindy Navigate the Situation

As an APRN-prepared nurse leader, Cindy would possibly utilize some strategies for conflict resolution. Working in the healthcare field, as a nurse, prompts using relevant leadership theories and styles with a positive impact on patient care and teamwork with colleagues and other professionals. Such should be appropriate in resolving conflict brought about by an ethical dilemma. The application of the democratic leadership style is necessary for this scenario. Arriving at the proper ways to navigate through and solve the ethical dilemma would entirely be based on building appropriate professional relationships with staff members starting with the physician and the hospital’s ethical committee.

The democratic style of nursing management is critical in probing on the matter, thus gathering input from the physician and colleagues. The technique also encourages open communication, thus facilitating honest feedback (Posnick, 2017). Therefore, Cindy would rely on this style to affect a relationship built on trust and accountability of the physician’s action of lying to her. Besides, employing the strategy would enable the disclosure of the cause of breaching fidelity and non-maleficence ethical principles- whether it is a lack of awareness of his incompetence or negligence from the physician’s part. The style gets critical when improving a process is a priority, such as in this case, where conferring to ethical principles of healthcare is mandatory.

Making the Best out of the Situation

Cindy, a DNP-leader, could utilize an ethical dilemma to promote productivity for the healthcare practice setting. In any case, nurses remain stewards in ensuring collaboration, safe, and quality care services are given to patients. Therefore, following this case, Cindy would act on the frontline in advocating for the application of the ethical principles of healthcare by all healthcare workers. Another step would involve designing a policy regarding continuous medical education (CME) sessions and further training on the issues critical to the medical profession, such as ethical principles and ways to deal with moral conflicts. She would also encourage conducting education drills on the application of the knowledge and the clinical environment, including healthcare policy knowledge and knowledge of and dedication to patient safety. From the incident, she can capitalize on increasing awareness professionalism by highlighting individual and professional accountability on issues related to healthcare and observe the relevant ethical principles of the medical profession (Thistlethwaite & Spencer, 2018).

A DNP-leader, further, focuses on more advocation for their patients, exhibit competence in effective communication and relationship-building, lead other healthcare professionals and ensure professionalism (Waxman, Roussel, Herrin-Griffith & D’Alfonso, 2017).  There are several possible strategies worth applying to improve team synergy and collaboration following the incident. Ensuring the building of trusting relationships with staff and other professional members is critical in facilitating honesty among members, thus promote a culture of openness, avoiding lying. Creating a culture of effective communication in the facility is one of the first steps towards resolving and managing conflict. As a leader, the assertion of views ought not to be done through judgment or threatening means as they hinder communication channels.

Further, a proper communication channel and relationships act as facilitators in creating and communicating a shared vision (Waxman, Roussel, Herrin-Griffith & D’Alfonso, 2017). Such is fundamental in influencing positive behaviors, which in turn leads to upholding high professional standards. In turn, confrontation of inappropriate professional or unethical incidences remains timely done. Medical staff relationships are also enhanced through such a strategy, thereby improving synergy and collaboration and cohesiveness. Eventually, the chances of resurfacing of ethical conflicts would remain low.

Summary

In summary, the case study highlights some of the ethical conflict situations healthcare workers, more so nurses face in their practice settings. Probing into the issue revealed that fidelity and non-maleficence as the bioethical principles were breached by the physician. The nurse, Cindy, was faced with a competing obligation dilemma about the incident. She should ensure patients receive safe and quality care, whereas she remains hesitant to report him being a friend who needs that job because of the likelihood to get fired. Consequences of reporting the incident include the firing of the physician and an imminent loss of his practice license, bankruptcy, psychological torture, and affected friendship. Staffing ratios would also get inadequate but act as an awakening call on enlighten to remind the healthcare workers on the essence of bioethical principles. Failure to report could lead to future negligence and lead to adverse patient outcomes.

Democratic leadership style demonstrates useful in navigating through and solving the ethical conflict. The article also illustrates how as a DNP-leader, Cindy could rely on education policies to increase awareness on the issue, application of the knowledge, and the clinical environment, including healthcare policy knowledge and knowledge of and dedication to patient safety. Also, she could call for professionalism in accountability and observing medical ethics. Regarding the aspect of improving team synergy and collaboration, the paper puts forward effective communication and team-building to minimize the occurrence of turbulence and recurring incidents involving ethical conflicts.