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Applying Ethical Principles: Ethical Problems in Nursing Management

Analyzing ethical issues that healthcare professionals face requires adhering to relevant approaches and models to find adequate solutions. To assess a specific problem objectively, healthcare leaders should apply appropriate assessment models and communication principles to build productive relationships with all stakeholders. As an example of such an activity, a specific case study by Darr (2017) will be considered. Matt Losinski, the CEO of County General Hospital (CGH), is a key figure that has faced an ethical dilemma. In particular, the manager is concerned about a large number of patients in the hospital’s emergency department and, therefore, the high costs of providing medical services. Mr. Losinski has to solve this problem through interaction with the executive committee and come to an adequate solution to the existing problem. This is due to CHG’s inability to reimburse the full amount of annual expenses. It was a solution correct from the moral point of view because it considered the interests of various groups of people and benefited each of them. Using an appropriate ethical decision-making model can provide a solution to the current problem.

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Case Study Description

The selected case study illustrates the specific ethical dilemma to solve. Darr (2017) offers to review the situation when the CEO of CGH has faced while examining the costs that the hospital has incurred in providing emergency patient care. The problem is that individual patients seeking medical services did it repeatedly, but their cases were simple and did not require significant intervention. Simultaneously, the cost of the services provided by CGH was estimated at $2.7 million. Despite the government’s payments under the national Medicaid program, the share of fees did not cover all costs, and about $200,000 remained unpaid. As a result, CGH is experiencing a shortage of funds due to many patients seeking emergency care. In addition to the department itself, the CEO is involved in this problem’s solution and the executive committee that oversees all the facility’s financial activities.

As a theoretical concept that can describe the presented issue, the ethical decision-making model may be applied. According to Schwartz (2016), this methodology includes three key components that allow assessing a problem and analyzing its implications – moral awareness (“interpreting the situation”), moral judgment (“ethical decision making”), and moral intention (“determination”) (p. 758). The affordability of the health insurance program and the ease of accessing healthcare professionals have become the key factors contributing to the issue. Every citizen with insurance has the right to count on qualified assistance. The frequency of complaints does not matter, leading to high costs for assisting individual patients. As Louw (2016) notes, “ethical decision making can be defined as a complex process used by health care professionals to resolve ethical dilemmas” (p. 41). In this case, the model mentioned above may be utilized to assess the issue analysis principles.

When applying the ethical decision-making model, the CEO’s position can be analyzed in three steps. His awareness implies familiarization with the problem and the reasons for its occurrence. The moral judgment consists in assessing the issue based on the available information. Finally, the component of intention is revealed through the specific actions aimed at eliminating the problem, and the CEO’s solution to discuss the issue with the executive committee is relevant. This algorithm allows describing how any ethical dilemma can be dealt with, and the CGH case is appropriate for the given context.

Communication Approaches

The communication approaches presented in this case study are aspects to evaluate to determine how effectively the ethical dilemma was communicated to stakeholders. According to Darr (2017), Mr. Losinski used the standard principles of inter-professional interaction to discuss the issue with different parties. Specifically, the CEO of CGH contacted Mary Scott, his CFO, with whom he discussed the subject orally, and arranged a meeting with the executive committee with all top managers. As Skarbalienė et al. (2019) note, interaction through teamwork and critical thinking is an effective communication practice. One can remark that the CEO did not use all the available communication methods effectively: he did not raise the issue acutely to receive an objectively critical assessment. Simultaneously, the discussion with the executive committee was a productive approach to address this dilemma jointly.

To obtain an objective picture of the issue, relevant communication approaches should be observed. In particular, Louw (2016) argues that cross-cultural skills are useful attainments for gaining valuable feedback from stakeholders on a specific problem. In addition, the author notes that in addressing ethical dilemmas, verbal and non-verbal communication approaches can help by influencing different cognitive processes (Louw, 2016). Regarding the case study in question, informal communication with his CFO did not allow Mr. Losinski to obtain objective financial data related to emergency care costs. Moreover, this form of interaction is fraught with erroneous information, which is unacceptable for making responsible management decisions. Therefore, cross-cultural practices and mixed methods of communication are potentially effective practices.

Effectiveness of the Approach Used

To resolve the problem, Mr. Losinski reached out to the key stakeholders who could suggest options for its resolution. In general, as Aitamaa et al. (2016) state, addressing an ethical dilemma requires analyzing two undesirable alternatives, and each of them can exacerbate the situation. Concerning the case study presented by Darr (2017), solving emergency department overuse may have two potentially undesirable outcomes. First, worsening patient outcomes may occur due to reduced access to medical services to save the budget. Second, too high costs are inevitable because the state does not cover all the expenses. Each perspective has negative implications that need to be addressed.

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The measures that the CEO of CGH took may be described as partially correct. The meeting with top managers is a logical solution since cost overruns require joint addressing at the highest leadership level. However, Mr. Losinski’s interaction with his CFO through friendly communication cannot be called an objective decision. The CEO began with an individual solution to the problem, which was biased in the context of the issue that arose. Healthcare professionals can learn several valuable lessons through the analysis of Darr’s (2017) case. First, organizational management issues cannot be solved by oneself to avoid crucial mistakes. Second, informal communication is unacceptable in the case of an ethical issue that affects different stakeholders. These nuances can make it possible to find a potentially adequate solution to the moral dilemma.

Proposed Solution

To address the issue, both potential perspectives should be considered thoroughly. According to Falkenström et al. (2016), a healthcare manager needs “to take responsibility for decisions in conflicts of interest (COI) and ethical dilemmas” (p. 18). In Darr’s (2017) case, the interests of both patients and CGH are crucial to take into account. A potential solution is to increase control over the emergency department’s activities to accept patients with a real need for urgent care, excluding minor complaints. Thus, the emergency department staff will be less busy, and the clinic will allocate fewer costs. Therefore, the proposed solution will make it possible to improve the quality of professional collaboration. CGH employees will communicate more efficiently and perform their immediate responsibilities productively if financial and other aspects do not distract them. In addition, if annual costs are reduced, more opportunities for developing the clinic’s resource base will appear.

In addition to these advantages, there are also ethical benefits of this solution. First, it helps considering beneficence for those who need help the most. It also allows medical staff to work in terms of nonmaleficence because, excluding minor complaints, they do not harm people. Second, this solution helps CGH doctors working autonomously, making decisions according to the chosen strategy. Third, this way of working with people is a manifestation of justice since the hospital will help those who need it the most.


The ethical decision-making model can help define the principles for evaluating the ethical dilemma discussed in the case study in question and address specific challenges due to an objective guiding decision. The CEO of CGH made the mistake of interacting informally with his CFO, but contacting the executive board was the right step. Cross-cultural communication skills and mixed methods of interaction are valuable means of resolving the issue discussed. As a potentially effective solution, increased control over the activities of the emergency department is proposed. This measure can help reduce annual costs and, at the same time, improve the quality of organizational work through continuous inter-professional collaboration.


Aitamaa, E., Leino-Kilpi, H., Iltanen, S., & Suhonen, R. (2016). Ethical problems in nursing management: The views of nurse managers. Nursing Ethics, 23(6), 646-658. Web.

Darr, K. (2017). Cases in health services management (6th ed.). (K. Darr, T. J. Farnsworth, and R. C. Myrtle, Eds.). Health Professions Press.

Falkenström, E., Ohlsson, J., & Höglund, A. T. (2016). Developing ethical competence in healthcare management. Journal of Workplace Learning, 28(1), 17-32. Web.

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Louw, B. (2016). Cultural competence and ethical decision making for health care professionals. Humanities and Social Sciences, 4(2-1), 41-52. Web.

Schwartz, M. S. (2016). Ethical decision-making theory: An integrated approach. Journal of Business Ethics, 139(4), 755-776. Web.

Skarbalienė, A., Skarbalius, E., & Gedrimė, L. (2019). Effective communication in the healthcare settings: Are the graduates ready for it? Management: Journal of Contemporary Management Issues, 24, 137-147. Web.

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