Introduction
Nowadays, the nursing profession is not simple since it not only enhances patient’s medical condition but also requires treating them with respect. To ensure a high-quality patient-centered care, the nurses have to understanding the importance of law and ethics when resolving the conflicts. Nonetheless, nurses and customers have to face a plethora of challenges during a new era of healthcare reforms. These difficulties and issues are associated with confidentiality, understanding of autonomy, required competences, and the alignment of ethical principles with the legal obligations. Simultaneously, the patients often experience problems with applying for healthcare plans and understanding the concept of the taxation system (Institute of Medicine, 2001). It could be said that dealing and overcoming these difficulties helps improve the overall quality of the healthcare and increase patients’ satisfaction with the treatment and medical assistance.
Consequently, the primary goal of the paper is to understand the main challenges and conflicts between ethics and new healthcare reforms such as Obamacare. In the first place, it is critical determine the historical nursing perception that cultivates the conflict between the ethical principles and nursing profession. At the same time, discussing the issues and confrontations mentioned above will contribute to acquiring the overall image of the current state of healthcare, the nursing profession, and its compliance with ethics and legislation. In the end, the conclusions are drawn to summarize the critical findings of the paper.
Historically Nursing Perspective that Conflicts Between Ethics and Nurse Profession
Over the decades, the nursing profession has been associated with a plethora of challenges. For instance, in the 19th century, the nursing education was entirely focused on the technical side and practical skills (Butts & Rich, 2015). Following these principles did not comply with the common understanding of the art of nursing, and it created a communicative gap between medical personnel and patients.
Nonetheless, at the end of the 19th century, a new school of nursing was developed, and it combined the concepts of science and nursing art (Butts & Rich, 2015). In this case, it created a viewpoint that the primary value of nursing is determination, but they had to obey the orders of physicians (Butts & Rich, 2015). Paying pivotal attention to the nursing-physician relationship cultivated a substantial gap between the patients’ expectations and the provided autonomy. To diminish the number of conflicting situations, the Code of Ethics was developed (Butts & Rich, 2015; Weiss & Tappen, 2014). It identified the major principles of the nursing profession, but it did not eliminate the actual need to face moral dilemmas. Overall, the modern codes establish the ethical direction that nurses have to pursue. Nonetheless, it does not cover the majority of issues, which do not comply both with the nursing profession and ethics.
Conflicts Between Ethics and Healthcare Reform
The core of the conflicts between ethics and law are focused mainly on the violation of ethical codes by governmental statutes. One legal right granted to a client that is enacted by the Health Insurance Portability and Accountability Act of 1996 is the right to confidentiality of Personal Health Information (PHI). Although legally speaking, all clients have the right to their confidentiality, in some circumstances, complying with requests for confidentiality may be detrimental to the patient. In that circumstance, the principle of no maleficence and beneficence conflicts with the right to autonomy as well as confidentiality. The nurses must carefully assess the possible consequences of breaching confidentiality, considering the risk of harm of not breaching which must be significant to justify ignoring the concept of autonomy. In cases such as these, is the violation of nonmaleficence acceptable in order to protect a client’s confidentiality, even if that decision led to a client’s death?
Other situations in which conflict can arise between ethics and law can be seen in the dichotomy between how the law defines autonomy and how ethics views autonomy. Autonomy, on an ethical basis, is described as respecting the rights and independence of all clients regardless of race, cultural history, or disease. However, legally speaking, informed consent must be given at all times prior to medical professionals providing treatment. This can lead to conflict in terms of age appropriate levels of consent. Nurses must respect the autonomy of a client – even that of a child – and yet the law directly states that certain treatments can only be approved through parental consent for adolescents under the age of 16. This law directly influences and violates the foundations of autonomy. Another subject that is a main source of conflict between ethics and law is the death. For example, a family which has requested a DNR for a client directly aggravates the principles of autonomy and no maleficence (Griffith, 2013, p. 7-9). The conflict truly lies on a nurse’s duty to his/her patient and the duty that is expected of her by her employer or direct supervisory physician. Published literature has established conflicting assumptions concerning whether patients can be carefully recognized and declined ED care based on non-urgent performances. Some studies have established that select non-urgent patients can be safely triaged out of the ED. However, other studies have confirmed that triage standards and prognostic models are insufficient to identify patients who may be carefully refused ED care.
In summary, we assume a great deal from our health care systems, in fact, than they can deliver. Consequently, some negotiation between numerous major health system goals is essential. Since we hold different views about which goals should take priority in cases of conflict, however, compromise solutions are difficult to achieve.
Nurses must become competent service providers with a deep understanding of not only their ethical responsibilities, but the significance of knowing their legal responsibilities. Conflict between ethics and the law is an inescapable factor of working within the medical profession and gaining experience is one of the many ways in which nurses can protect themselves and their clients. It is essential that a nurse’s actions are grounded on sound logic and legal judgement rather than prejudiced misconceptions, irrational thought patterns, or self-interest.
The nursing field has been confronted with ethical and legal dilemmas since its inception. This threatens the foundation of nursing principles and challenges the very basic values nursing is so respected for. The ethical commitment of nurses must be aligned to the legal obligations of the patients and their family members. Because of the issues faced within the nursing environment, nurses face moral distress when there is incongruence between the ethics of the nurse and the law behind each case. This paper analyzes the ethical and law dilemmas faced in the field of nursing.
How do Nurses Negotiate Conflicts (CHILUFYA CLARK)
Nurses have historically been challenged with ethical and legal dilemmas that have required the proactive and firm actions of nurses who all share the core values of service and compassion for patient care. Ethical challenges that arise from healthcare reform, such as the recent Obamacare program, threatens the foundation of nursing principles and challenges the very basic values nursing is so respected for. More specifically, nursing challenges arise when patients pose questions as to the confusion they are confronted with when applying for healthcare services under the Obamacare plan and how the tax credits worked (Institute of Medicine, 2001).
When patients are directed to Q&A section of the Obamacare plan page, it appears that there is a multitude of different ways that people can apply for the Marketplace Insurance. They can fill out the application online, do it over the telephone, or even meet with someone in their community if they would rather have a one on one discussion to help explain the process (Institute of Medicine, 2001). That seems to cover all the bases to make the process as easy as possible for anyone, but does it really?
Nurses are constantly approached by patients who are worried about the tax credits attached to the plan and nurses find themselves constantly negotiating these conflicts in their communities. Tax credits are a determined dollar amount that will be applied to the insurance premiums. The amount will be determined based on the income level of the patient’s home, and whether or not anyone in the household has any insurance from a job, Medicaid, disability, or Medicare (Institute of Medicine, 2001). This predetermined amount is then paid to the insurance company so that the monthly bill will be discounted from the Marketplace set price.
As a nurse in the community, it is encouraging to be able to be a guiding voice for our patients where the abilities of negotiating such conflicts, comes forefront. Currently, young adults of low income, single mothers, the disabled, and children represent 17.6% of the population that are covered by either Medicaid or CHIP. It is unfortunately; however, that adults without dependent children still represent the largest portion of uninsured. This is primarily due to the fact that many adults many not have children to qualify for Medicaid (Nies & McEwen, 2015).
Nurses also confront various forms of legislative reform in their daily practice, and do so with caution and care. For example, value based purchasing (VBP) is a pay-for-performance approach to reimbursement, in which hospital reimbursement is tied to how they perform compared to other facilities (Hebda & Czar). This piece of legislation and approach is directly connected to nursing outcomes. In addition, patient readmission rates and hospital acquired conditions are also connected with the work nurses perform and whether the hospital receives reimbursement for services rendered (Hebda & Czar). Facing the reality of diminishing reimbursements, hospitals are seeking ways to maximize their returns with fewer resources. From multiple IV sticks, to justifying an observation patient staying six hours after having discharge orders, thorough nursing documentation plays a key role in maximizing reimbursements from CMS as well as private insurers. Due to the issues faced within the nursing environment, nurses must deal with these conflicts by providing consistent, fair, and compassionate care across all healthcare settings.
Conclusion
The paper reveals that the nursing profession is complicated, as it requires the nurses to overcome a plethora of issues and obstacles when facing ethical conflicts. Since the 19th century, nursing has been viewed an occupation that created a connection between patients and medical personnel. However, following the concepts of the Code of Ethics did not ensure that all the moral issues would be diminished.
The new era of Obamacare shifts new challenges due to controversial notions in the modern ethics and healthcare reform. For example, the breach of confidentiality is one of critical aspects in the current healthcare ethics. Thus, the nurse has to face a dilemma whether or not it is relevant to exceed their duties to report the client’s confidential information due to the patient’s death. Simultaneously, the conflict of interests is present in the concept of autonomy, as according to the regulations a nurse has to respect the decision-making of a patient disregarding his/her age. In turn, today, the nurses have to resolve the conflicts related to value-based purchasing, the insurance process, the costs of insurances, and taxation. In this instance, the primary matter that the nurses have to emphasize is ensuring the alignment of their actions with the Code of Ethics and legislation. Overall, these findings can be actively used as a basis for the enhancement of healthcare reforms and assist in eliminating the gap between ethics and legal regulations.
References
Butts, J., & Rich, K. (2015). Nursing Ethics: Across the Curriculum and into Practice. Burlington, MA: Jones & Bartlett Learning.
Griffith, R. (2013). Law and Professional Issues in Nursing. Transforming Nursing Practice Series. Edition 3. SAGE Publications.
Hebda, T., & Czar, P. (2012). Consumer education and informatics. In Handbook of informatics for nurses & healthcare professionals. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academies Press, 2001). Web.
Lewenson, S. (2015). Right or Wrong: Policy, Legal, and Ethical Issues and Decision-Making. In Decision-Making in Nursing: Thoughtful Approaches for Leadership (Second ed.). Burlington, MA: Jones & Bartlett Learning.
Nies, M., & McEwen, M. (2015). Community Public Health Nursing: Promoting the Health of Populations. St. Louis, MO.
Pope, T.M. (2011). “Legal Briefing: Healthcare Ethics Committees.” The Journal of Clinical Ethics 22, no. 1 (Spring 2011): 74-93.
Weiss, S., & Tappen, R. (2014). Essentials of Nursing Leadership and Management. Philadelphia, PA: F.A. Davis Company.