The real-life situation relating to faith and leadership
Decision-making and different ethical thinking, problem-solving, human relations and values
Nurses focus on the physiological, psychosocial, as well as spiritual aspects of persons during times of illness and in good health. Nurses fall in Grossman and Valiga’s (2009) definition of leaders for they play critical roles in people’s lives. They assist in maximizing health and quality of life with a caring approach while treating the person holistically. In nursing, ethical codes serve as guidelines for nursing actions by setting standards and moral obligations that nurses must follow while measuring their own personal values. By these guidelines, nurses are held accountable to the codes of ethics within the nursing practice.
The ethical principle of beneficence addresses the moral obligation to act towards the common good of others by providing the best care to those who entrust their lives to us as nurses. Another ethical principle is fidelity, which refers to faithfulness, particularly the duty to honor commitments made to others (Wheat, 2009, p.1063). Nurses begin their career with a promise to themselves, the profession of nursing, and more specifically to those in their care regardless of the planned specialty. By choosing the practice of nursing, one must promise to abide by the professional code of conduct otherwise; s/he stands a chance of practicing unethically.
As a certified school nurse working in the third-largest public school in the nation, my major responsibility in the first six weeks of a given school year is to ensure that students are up-to-date on immunizations and physical exams. Therefore, I verify immunization and Physical Exams (PE) records and enter them in the database to bring the district to compliance as mandated by the state law. In order to receive funding from the state, public schools must meet at least 80 percent medical compliance by 15 October of every school year. Another major responsibility of school nurses is to collaborate with parents for signed consents for medical treatment and organize a care van with the neighboring health clinics to provide medical services on the school grounds. Once all medical records are entered into the district’s database, students that are still missing immunizations are excluded from school until parents provide a proof before the aforementioned deadline. The 80 percent medical compliance does not seem like a difficult task in many communities; however, in certain parts of the city, especially those with low socio-economic rates, getting parents to comply with the law is not always as easy as it may sound. Nevertheless, regardless of the pressure to meet the 80 percent compliance in a bid to secure funding, I usually ensure that I observe all ethical obligations and remain on course without engaging in illegal or unethical activities to garner the required percentage, as Maxwell (2005) requires of leaders. Therefore, this task calls for leadership skills rooted in one’s faith as highlighted in this paper.
The situation, implications of faith, and key aspects of leadership
Vision, Values, and developing people
In one school year, without entering the PEs and immunizations and physical exams in the district’s database, my assigned schools were showing over 80 percent medical compliance. I contacted my colleagues and was amazed that they too could not identify why their schools were medically compliant without data input. I further contacted my nurse manager in the central office and she did not seem to know who was behind the high numbers of medical compliance either. Initially, she thought it was a computer glitch and once data entry was complete, the problem would be rectified. Several months passed and the district nurses had no answer to who falsified the medical records until our first district nurses’ meeting where it was revealed that district administration hired laypersons to falsify immunization and PE dates to increase our district’s compliance rates to ensure state funding. This was contrary to my faith and ethics and after several hours of discussions, a committee was formed to investigate further the mastermind behind the altering and falsifying of students’ medical records. After the final report confirmed our initial knowledge, several senior staff members lost their jobs and the district superintendent promised us that such a scenario would never happen again.
Analysis and presentation of the agency’s decision-making process
The decision to falsify students’ records by altering them transcended my understanding and capabilities. Falsifying medical documents for any reason is not only unethical but also illegal. Medical records are legal documents that can be used in a court of law; therefore, there are several ethical and legal issues involved in the safekeeping of medical records (Mercer & Tino, 2011, p. 43). The persons who decided to falsify the documents showed irresponsibility and acted callously without consulting district nurses to establish a better plan. According to Beeler et al. (2011), the incidence of unethical conduct in academia and the sciences is prevalent. Several reasons underscore why persons may choose to ignore ethical decision-making such as the aforementioned case; for instance, the primary reason the central administrators chose to falsify medical documents was due to monetary gains. They did not envision losing their job by the actions they chose. Beeler et al. (2011) suggest that a person’s understanding of ethical decisions might not “promote the growth of ethical expertise” (p. 110), even within competent leaders unless it interferes with their personal values.
What aspects would you change today after reflecting on the experience?
The outstanding change that I would effect today after reflecting on the experience is to hire more nurses in the district school. The aforementioned case would not have occurred if the district had more nurses. In previous years when my school was struggling to get 80 percent medical compliance, I partnered with neighborhood public health clinics to set up a clinic at the school site to provide necessary immunizations and PEs to the students out of compliance. Planning and getting the necessary services takes the majority of my time away from writing individualized education plans (IEPs). The district is required to hire more school nurses; instead, it decided to hire non-nurses to falsify documents. If the district nurses remained silent, it would have meant that we condoned what upper management did, and thus as a nurse advocate, I stood up for what was right rather than remaining silent. Given my faith and ethics coupled with my leadership skills, I could not condone falsified information
School nurses are leaders that bring significant health services within the educational setting. They have a pivotal role in promoting primary health services. As the only health care expert in a school building, they provide clinical knowledge to school administrators, staff, students as well as parents. That said, given an opportunity to bring our school district’s medical compliance up to par, I would partner with community healthcare providers, collaborate with school staff, and communicate with parents to meet our district’s medical compliance. As a leader, I will help develop a plan that addresses strategies for our goal of meeting medical compliance.
References
Beeler, K., Antes, A., Wang, X., Caugron, J., Thiel, E., & Mum, M. D. (2010). Assessing ethical problem solving by reasoning rather than decision-making. Ethics Behavior, 20(2), 110-127.
Grossman, S. C., & Valiga, T. M. (2009). New leadership challenges: Creating the future of nursing (3rd. ed.). Philadelphia, PA: F. A. Davis.
Maxwell, J. (2005). Developing the leader within you. Nashville, TN: Thomas Nelson Publishing.
Mercer, S. E., & Tino, A. (2011). Falsifying medical records: A systems approach investigation. Journal of Nursing Regulation Online, 2(3), 41-43.
Wheat, K. (2009). Applying ethical principles. British Journal of Nursing, 18(17), 1062-1063.