In their line of duty, perioperative nurses are bound to the duty of confidentiality and ethics. However, in executing their responsibilities, perioperative nurses find themselves in dilemma situations with regards to ethical issues and confidentiality concerns accompanying the sharing of patient’s health information (Ulrich et al., 2010). According to the Nursing and Midwifery Board of Australia (2010), ensuring confidentiality of the health information of a patient I at the core of nurses establishing and maintaining trusting relationships with patients, patient’s families, and other health professionals.
With no assurance regarding the confidentiality of their health information, patients could be hesitant to provide sensitive yet important information regarding their health status/condition that can help in provision of high quality care (Price, 2015). However, perioperative nurses are faced with dilemma in situations where they consider appropriate to share a patient’s confidential health information to his or her family member(s) or caregiver for purposes of ensuring the patient continue to receive quality and safe health care.
The ethical implication of this action is the violation of ethics duty by the nurse as well as the potential loss of trust in the nurse and other health professionals in the institution by the patient or family should it be discovered that such confidential information was shared.
According to the Nursing and Midwifery Board of Australia (2010), patients have an inherent right to autonomy, which allows for their informed consent or the withheld of this consent. The law of informed consent holds that patients have the right to withhold personal information unless it is required by law to provide such information; or make decisions concerning their own treatment (Taylor, 2014).
Thus, perioperative nurses have ethical and legal obligation to respect and protect patient’s right to autonomy by allowing the patients to make their own treatment decisions or not to provide certain personal information deemed confidential. However, nurses may find themselves in a dilemma in situations where protecting and respecting patient’s right to autonomy could result in harm to the patient (Olson & Stokes, 2016).
For instance, in situations such as multiple series of surgery or uneventful incidents, letting the patient make his/ her own treatment decisions or withhold important information to health care practitioners could result in self-harm or harm others altogether.
In such scenarios, the nurse or health professional might be compelled to violate the duty of confidentiality through such means as disclosing important information concerning the patient to the family or deciding on the suitable heath care for the patient through the help of family and other health professionals without patient’s consent. This could result in an ethical break that can have legal implications on the nurse or health professional involved (Simek, 2016).
References
Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards for Registered nurse. Retrieved from: http://www.nursingmidwiferyboard.gov.au
Olson, L., L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses with Interpretive Statements: Resource for Nursing Regulation. Journal of Nursing Regulation, 7(2), 9-20
Price, B. (2015). Respecting patient confidentiality. Nursing Standard, 29(22), 50-57.
Simek, J. (2014). Specifics of nursing ethics. Kontakt, 18(2), 64-68
Taylor, H. (2014) Promoting a patient’s right to autonomy: implications for primary healthcare practitioners. Part 1. Primary Health Care, 24(2), 36-41
Ulrich, C., M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M. & Grady, C. (2010). Everyday Ethics: Ethical Issues and Stress in Nursing Practice. Journal of Advanced Nursing, 66(11). doi: 10.1111/j.1365-2648.2010.05425.x
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Human Resources and Staffing Crisis at Blumberg’s Nursing Home
Ethics goes a long way in ensuring the organization achieves good public relations and good image as a means of acquiring public confidence. In the case of Blumberg Nursing Home, the actions of three employees were detrimental to its reputation and government regulations, requiring a change of tact by the administration in approaching future crises. It is requisite to formulate an effective way of replacing the erring staff, while setting policies and incorporating residents and staff views in the future running of the nursing home.
Staffing needs
There is an immediate need for a Director of Nursing, dietician, and a receptionist at Blumberg Nursing Home. A DON is important since she manages nursing activities, controls patient care, makes nursing policies and institutes short-term and long-term future nursing plans that ensure that the hospital meets stringent government standards (Bisk, 2016).
The DON also does financial and nursing budget needs, involves the hospital management in nursing care, evaluates nursing activities to ensure it is patient-centered, meets regularly with other members of the executive, and communicates with them regarding the nursing department. The hospital dietician also does several important tasks in the hospital such as teaching patients about nutrition, addressing patients’ healthcare needs, partially gets involved as a multidisciplinary team, and coordinates dietary changes among the patient.
Additionally, the medical receptionist is important for coordinating patient arrival and plan for care, gives patients information concerning their problems, organizes clerical and administrative activities and keeps inventory of office and medical equipments (Hicks, 2016). The receptionist also answers phone calls, registers new patients’ and coordinates their next treatment plan by notifying other members of the medical team.
Therefore, the DON, dietitian and the receptionist all are important for the general welfare of the hospital. However, due to the large administrative responsibility of the DON, the hospital should fill this position first. The nursing care is a very important part of hospital activities and requires a leader to coordinate all its activities effectively, including hiring a receptionist and dietitian, important in nursing care.
In addition, the receptionist should come second to aid the nursing staff in coordinating the activities of receiving patients and informing them of their treatment requirements. Since the receptionist helps in keeping office records and inventory of all the required equipments for administrative work in the hospital, it is imperative to have this staff member (Hicks, 2016). On the other hand, the hospital can outsource a temporary self-employed dietitian to coordinate dietary needs of the patients. Most dieticians have their own clinics and can always schedule hospital visits, as the plan of acquiring a permanent dietician is underway.
Policies for addressing unethical behaviorsin the workplace
Unethical behaviors in the work place can be detrimental to the overall running of the organization and can really hurt the organizations reputation. Each employee in the organization acts as an agent of the company, and whatever they do may be beneficial of disadvantageous to other employees. To avert future crisis and staff misdemeanor, a good policy ought to be in place. The first step is to have a robust human resource manager, either internal or hired externally, to provide trainings, procedures, and policies for tackling ethical issues (Goldfield, 2015).
Having a robust human resource manager is requisite for effective reporting of unethical behavior, and for company to have and maintain proper policies. The task of the HR manager shall involve communicating to employees the organization’s expectations and making clear to them how their bad demeanors can affect the entire organization.
An effective way of combating unethical behavior is creation of codes of ethics. The codes of ethics aids in communicating the organization’s values, and establishing means of creating boundaries for what is appropriate (Goldfield, 2015). These codes of ethics are simple and succinct, contained in the mission statement, value statement, and employee handbooks. The codes of ethics for Blumberg hospital shall have a protocol where employees can report unethical behaviors to the human resource manager or a senior manager far removed from the role.
This aids in bringing seriousness to the issue and creating trust in employees (Goldfield, 2015). A dedicated anonymous hotline is also useful in reporting such cases. Additionally, the protocol shall ensure no victimization to any employee who reports such cases. The policy shall also entail empowering the employees through training, yearly bonuses and public acknowledgement, in order to ensure the code becomes effective (Goldfield, 2015). The hospital shall have to review the code on a yearly basis y having the employees read and sign over a form, to encourage adherence to the standards.
The organization can have punishment procedures for unethical employees who may not adhere to ethical standards. These may include demotions, suspension, denying leaves, or firing them, but as a last resort whenever warnings and summons do not work (Mack, 2016). The organization can also fight ethical misdemeanors through protection of whistleblowers, rewarding ethical employees, and having a dedicated panel or person who shall offer unbiased approach to enforcing ethical standards in the organization.
Leadership roles
The aftermath of an unethical crisis within a business offers an opportunity for the administrator of the organization to exercise decisions that aid in boosting staff morale and that of the residents. According to Lisa Quast (2011), the administrator of an organization ought to lead by example. By incorporating good ethics in one’s behaviors makes the employees avoid unethical situations at work.
The administrator can constantly echo the need to act ethically within the organization, by encouraging employees to follow the codes of ethics every time. Quast (2011) adds that reinforcing ethical behavior and punishing unethical behaviors aids in warning employees, and coercing them towards adhering to code of ethics.
The administrator can further show good leadership skills by listening to the unethical employees’ explanation of their action. Having good listening skills helps in getting valuable feedback from the erring employee. This can also provide an opportunity to remind and enforce codes of ethics to an employee who may err because of being overconfident (Quast, 2011). The administrator can also bring back confidence among his juniors by showing calmness and confidence that makes other employees increase in morale.
The confidence shows that the decision taken was appropriate and the administrator is in charge. The administrator can also use his character and competence as part of good leadership skills to encourage the employees and inspire them (Trevino & Brown, 2004). Instead of punishing erroneous employees, the administrator can re-inspire confidence in them by reminding them of their value to the organization, and its expectation of them. The unethical employees have new challenges to spur their recovery and show support to them.
The administrator of Blumberg hospital can show management skills by exercising his authority effectively. The administrator can demonstrate his integrity by ensuring adherence to the codes of ethics by all employees (Quast, 2011). A high integrity leadership communicates straightforwardness to the employees. The administration should be consistent in rewarding ethical employees and punishing the unethical ones, but at the same time taking time to encourage employees adhere to codes of conduct (Kurucz & Wheeler, 2013).
However, despite the need to warn and lead unethical employees into recovery, it is imperative that the employees understand the severity of their actions. In the case of Blumberg hospital, a drunk DON, who also happens to be a senior member of the executive, sends a wrong leadership message to the entire nursing fraternity. This communicates to the other nurses that they too can behave unethically without undergoing any punishment. A drunken receptionist can give wrong information to patients and may talk inappropriately to the hospital clientele.
According to Goldfield (2015), it is imperative to inculcate good communication framework within the organization to ensure employees grow satisfactory with the management decision. The administrator can do this by often calling for meetings to highlight to the employees the recent happenings, the reasons for taking such decisions, and the expectation of the management to the employees in assisting to averting a future crisis.
This helps to communicate the urgency, and the dire need of the employees to maintain high work standards and ethics for the benefit of the organization. Additionally, Trevino and Brown (2004) suggests that the administration can train and encourage the lower leadership levels who interact with the employees on a higher levels, to show high levels of integrity and support for other employees. By maintaining a culture of professionalism and high work standards, the hospital can avoid future crises occurring from employees acting unethically.
How to use the Quality Indicator Survey
The Quality Indicator Survey is a computer-generated survey meant for assessment of long-term care to ensure nursing homes licensed by the Medicare and Medicaid meet the federal guidelines (Lin & Kramer, 2013). The survey entails two processes meant to assess certain regulations within nursing homes to ensure they follow the federal laid standards. Factors such as deficiencies, current complaints, and adherence to standards can undergo review to assess the suitability of a nursing home to its intended purpose.
The surveyors does this, while at the same time ensuring the federal set guidelines are followed to the later. The first stage of the survey involves interviewing residents, reviewing clinical records and observing the residents (Lin & Kramer, 2013). The data gathered goes into a computer system, which analyses it using special software and gives a feedback. The second stage of the survey entails using investigative tools to do an in-depth analysis and systematic review of the causes of certain discrepancies and the completion of essential and non-essential tasks.
According to Lin and Kramer (2013), the QIS can help a hospital to gather information concerning the perception of the residents towards it and their expectations in terms of the type and quality of services offered. Therefore, the administration of the Blumberg hospital can use the QIS survey to learn of the perception, requirements and recommendations that the residents deems imperative for the efficient running of the institution.
The actions of the DON, the dietitian and the receptionist might be an opportunity for the hospital administration, to check whether the breaching of the hospital codes of conduct has been persistent, and whether some of the employees have offered poor services. The employee staff can take the survey to echo to the administration their recommendations and desired mode of treatment in case of future crises. It is vital to ensure training of the codes of ethics to the employees during its implementation.
Conclusion
The Blumberg nursing home staff crisis is solvable by hiring a new Director of Nursing as a more urgent plan, so that the DON can assist in hiring the best receptionist and dietitian who are instrumental in the activities of the nursing care. The hospital administrator requires good leadership and management skills such as listening, integrity, and understanding the employees. Good procedures should exist to ensure unethical behaviors undergo punishment, while at the same time rewarding those acting well. The Quality Indicator survey is useful for the hospital administrator to assess and implement changes that shall ensure future adherence to the hospital’s codes of ethics.
Goldfield, B. (2015). A Proactive Approach to Addressing Unethical Behavior in the Workplace. (Updated 20 January 2015). Retrieved from: https://www.entrepreneur.com/article/241924. (Accessed 5 December 2016).
Kurucz, E. C., Colbert, B. A., & Wheeler, D. (2013). Reconstructing value: Leadership skills for a sustainable world. University of Toronto Press.
Lin, M. K., & Kramer, A. M. (2013). The quality indicator survey: background, implementation, and widespread change. Journal of aging & social policy, 25(1), 10-29.
Treviño, L. K., & Brown, M. E. (2005). The role of leaders in influencing unethical behavior in the workplace. Managing organizational deviance, 69-87.
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Physicians may be confronted with an ethical dilemma where they must decide whether or not provide treatment for themselves, family members, or others close to them(CPSO, 2016). Whereas it may be the physician’s best intentions to provide treatment in this context, there is a growing body of literature indicating that personal or close relationships have the potential of compromising the emotional and clinical objectivity of the physician. This paper examines the process of using ethical principles in decision-making and meeting the Nursing Practice Core Ethics Competencies.
The first step in approaching ethical decision-making is to state the ethical dilemma. It is important for the physician to identify the components of the situation presenting a potential ethical dilemma. In the case scenario, Mrs. ABC’s mother should have first identified the ethical dilemma presented by her undertaking to treat Mrs. ABC. The physician should be able to identify the issue objectively without the influence of subjective perceptions, values or attitudes specific to the issue.
Upon identification of the ethical dilemma, the physician needs to connect ethical theory to the dilemma in practice. Beauchamp and Childress’s ethical theory is often regarded as one of the basic foundations for discussions of this nature. This theory is grounded in four major principles: justice, beneficence, non-maleficence, and autonomy. Justice involves appropriate, equitable, and fair treatment of patients.
Beneficence supports the use of positive steps for benefitting others, which involves the balancing of benefit, risk and costs. Non-maleficence encompasses the intent not to inflict harm. Lastly, autonomy is a principle which requires a professional or client to have the capacity to self-determination in his/her engagement in decision-making (Nagy, 2015).
Exploring an ethical dilemma requires a physician to examine the issue and see the manner in which each of the principles relate to it. In some cases, this examination alone clarifies the issue enough that the resolution of the dilemma becomes obvious to the physician (Forester-Miller & Davis, 1995).
Ethical consideration in the process of research plays an imperative role in promoting research authenticity. Three of the most common qualitative research ethical dilemmas are discussed below.
Conflict of interest
This dilemma arises when financial or personal considerations threaten to compromise objectivity and professional judgment, thus leading to bias during qualitative research. Conflict of interest may emerge from interpersonal relationships, academic interests, financial partnerships, association with particular organizations, and multiple roles within organization among other incentives that may compromise the researcher’s integrity or respect for policy (Quimby, 2012). Conflict of interest has the potential to imperil the integrity of research and impact on participants’ protection. It may also distract the researcher.
Research with vulnerable and protected populations
This refers to research that involves obtaining information from individuals who are incapable or relatively incapable of safeguarding their own interests. Examples include children, mentally disabled, handicapped, institutionalized, very sick, racial minorities, economically disadvantaged, prisoners and neonates (Henry, 2012). This ethical dilemma is based on the Belmont Report on ‘respect for persons and justice,’ which puts two ethical convictions: that individuals need to be dealt with as autonomous agents, and that individuals with diminished autonomy and who require protection have a right to protection.
Self as subject
This dilemma represents a situation in which the researcher is involved in the research as a subject. This rises ethical concerns over whether the researcher can be objective in analyzing information that directly relates to them or whether they will be biased based on their experiences (Wang, 2016). In the case of self-experimentation, the ethical issues emerging include why the researcher does not want other people to benefit from the research and whether the issue of consent is a matter of concern. This is not directly applicable in my research, given that I am not a subject in the study.
Ethical issues in my study
In my study, ethical issues that may arise include privacy, where the respondents may want to keep their involvement in the study confidential. To counter this, I will ensure confidentiality is promoted throughout the research (Leew, Hox & Dillman, 2012). I will also give respondents an opportunity to choose between conducting the interview at work or in a different setting. The second ethical issue is informed consent. This concerns the willingness of the respondents to be involved in the research. Before the commencement of the research, I will ensure that the respondents have agreed to participate, by way of signing a consent form.
Identify and explain any legal implications that exist for failure to adhere to a standard of care
Standard of care in nursing refer to the general guiding frameworks on how a nurse /he should do or not do during delivery of care in their professional capacity. Deviating from nursing standards can results into serious legal implications. For instance, Ivan a newborn baby developed brain injury due to complications during delivery that led to spastic quadriplegic cerebral palsy. The mother labor was induced and they were discharged without monitoring their progress.
In this case, medical negligence claim can be made against obstetrician for failing to adhere with the recommended nursing care standards of monitoring them for at least 48 hours before discharge. The legal implications of violating the standard of care, the nurse will be suspended as his case is investigated. If the investigations indicate that he is guilty, then his practice license can be revoked or judgment awards hefty fines and penalties to be given to the patient directly affected (American Nurses Association, 2013).
Identify and explain the key elements of malpractice
The four key elements of malpractice include duty, breach of duty, damages and causation. Duty refers to what patient is owed. This includes safe environments and quality care. Breach of duty refers to scenarios where duties owed to the patient is neglected (Legal Information Institute, n.d.). In this context, the obstetrician did not monitor the child’s health status as required by the facility nursing standards.
Damages are the consequences due to breach of duties. In this context, patient brain injuries due to medical negligence are the damages that should be claimed. Causation generally refers to what led to the series of events. This is the most difficult element to prove in malpractice lawsuit (Buppert, 2014). In this case, causation was lack of patient monitoring soon after delivery.
Compare the differences in malpractice policy options
Health policy is a trade-off among three dimensions of cost, quality and access. There are 3 general categories of medical malpractice including claims – made coverage, claims paid coverage and occurrence coverage. Claims made coverage are the most common because their premiums are based on healthcare provider past and current experiences. Therefore, the premiums paid are lower. Claims paid policy and occurrence coverage premiums are higher and are not flexible enough to allow a healthcare provider increase liability limits like claims made coverage policy (Reising, 2012).
References
American Nurses Association. (2013). nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.
Buppert,C.(2014). Nurses practitioner business practice and legal guide. Jones and Barlett publishers. Burlington
Legal Information Institute. (n.d.). Requirements for and assuring quality of care in skilled nursing facilities, 42 U.S.C. § 1395i–3. Cornell University Law School. Retrieved from http://www.law.cornell.edu/uscode/text/42/1395i-3
Reising, D. L. (2012). Make your nursing care malpractice-proof. American Nurse Today, 7(1), 24–28.
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Identify and explain any legal implications that exist for failure to adhere to a standard of care
Standards of care in nursing refer to the general guiding frameworks on how a nurse /he should do or not do during delivery of care in their professional capacity. Deviating from nursing standards can results into serious legal implications. For instance, Ivan a newborn baby developed brain injury due to complications during delivery that led to spastic quadriplegic cerebral palsy. The mother labor was induced and they were discharged without monitoring their progress.
In this case, medical negligence claim can be made against obstetrician for failing to adhere with the recommended nursing care standards of monitoring them for at least 48 hours before discharge. The legal implications of violating the standard of care, the nurse will be suspended as his case is investigated. If the investigations indicate that he is guilty, then his practice license can be revoked or judgment awards hefty fines and penalties to be given to the patient directly affected (American Nurses Association, 2013).
Identify and explain the key elements of malpractice
The four key elements of malpractice include duty, breach of duty, damages and causation. Duty refers to what patient is owed. This includes safe environments and quality care. Breach of duty refers to scenarios where duties owed to the patient is neglected (Legal Information Institute, n.d.). In this context, the obstetrician did not monitor the child’s health status as required by the facility nursing standards.
Damages are the consequences due to breach of duties. In this context, patient brain injuries due to medical negligence are the damages that should be claimed. Causation generally refers to what led to the series of events. This is the most difficult element to prove in malpractice lawsuit (Buppert, 2014). In this case, causation was lack of patient monitoring soon after delivery.
Compare the differences in malpractice policy options
Health policy is a trade-off among three dimensions of cost, quality and access. There are 3 general categories of medical malpractice including claims – made coverage, claims paid coverage and occurrence coverage. Claims made coverage are the most common because their premiums are based on healthcare provider past and current experiences. Therefore, the premiums paid are lower. Claims paid policy and occurrence coverage premiums are higher and are not flexible enough to allow a healthcare provider increase liability limits like claims made coverage policy (Reising, 2012).
References
American Nurses Association. (2013). nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.
Buppert,C.(2014). Nurses practitioner business practice and legal guide. Jones and Barlett publishers. Burlington
Legal Information Institute. (n.d.). Requirements for and assuring quality of care in skilled nursing facilities, 42 U.S.C. § 1395i–3. Cornell University Law School. Retrieved from http://www.law.cornell.edu/uscode/text/42/1395i-3
Reising, D. L. (2012). Make your nursing care malpractice-proof. American Nurse Today, 7(1), 24–28.
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John is a 62 y/o attorney presents to the clinic with complaints of erectile dysfunction. For the past two years, he has refused lab work. He is a heavy smoker and has not had chest X-ray or ECG in the last 3 years. He takes HCTZ 25 mg po daily. His BMI is BMI 29 and the vital signs are normal. He has agreed take Prevnar vaccine.
In this case, the main goal is to identify the barriers that cause noncompliance and risky healthy lifestyle. The first step when dealing with this patient is to establish a therapeutic alliance. This will help assess patient factors that could be triggering non-adherence. Through this interactive discussion, I asked John why he refused lab work for the past two years. He hesitated, and then he said that he cannot afford them. He said that he has always wanted to tell the healthcare provider but always feels embarrassed. The patient stated that if he could afford them he would take them as requested.
The nursing diagnosis for this patient is noncompliance related to challenges to access financial support as evidenced by the patient verbal statements that he cannot afford the procedures. In this context, I notified the hospital social worker to help the patient set for medication financial assistance. In addition, I discussed with the patient on the importance of taking these laboratory tests in improving his health, and in identifying underlying issue that is causing his erectile dysfunction (Kleinsinger, 2011).
It is important to empower patients with enough information regarding their health condition and the treatment recommendation and in a format that format that is clear to understand. Although the patient has the right to refuse treatment, the healthcare provider must inform them on the risks associated with refusal of care. Most providers will dismiss habitual non compliant patient because it increases risks for professional liability exposure.
However, in my opinion it is important to assess the patients the underlying factors. To defuse the negative emotions associated with shame and sense of failure by non compliant patient, the healthcare provider should provide non-accusatory and problem solving stances (Kleinsinger, 2011).
Advanced Practice Leadership Paper from an Ethic of Care
Advanced Practice Leadership Paper from an Ethic of Care
Background Information
In the US, there are about 2.9 million nurses, making the nursing field the biggest workforce in healthcare. Nurses practice in several environments such as nursing homes, health facilities among others. This is an advanced practice leadership paper that looks and mobbing and nurse turnover from an ethic of care. Mobbing refers to psychological attacks that contribute to unethical strategies and systematic oppression of individuals so as to reduce performance, coping skills while forcing them to leave their profession (Wang, Cheney & Roper, 2016).
Healthcare is a stressful sector in comparison to a reduced number of nurses, increased nursing duties, inadequate continuing education opportunities, insufficient support from management and mobbing among nursing experts. Historically, respect was at the foundation of nursing, nonetheless, trends of incivility interfere with the environment with cases of horizontal and vertical aggression continues to rise.
Moreover, compounding the rise in mobbing is the difference in age among the nursing personnel. Peterlin, Pearse & Dimovski, (2015) demonstrate that less young graduates are joining nursing practice while more than a half of the practicing nurses are almost retiring in the near future.
This paper also presents a discussion of leadership elements to a nurse practitioner with about ten years of advanced experience in the ambulatory unit and the relationship with nurse executive in a large health facility. The nurse practitioner has applied for full-time work for diabetic foot management. The nurse practitioner has the necessary information for the need or more nurse practitioners to create awareness on diabetic foot exams to patient’s complaints.
The nurse practitioner presents this proposal to the nurse executive who is aware of this incidence as it was already verified and endorsed by the Ambulatory Care Director, however, the nurse executive does not the need to recruit more nurse practitioners. This is because the nurse executive believes that education is part of the nurse practitioner’s role, as such, she has to integrate foot exam in her current work. The nurse executive validates this by alleging that there are inadequate resources.
Additionally, the nurse executive has other priorities while the nurse practitioner is aware that she will be in charge of diabetic foot patients without more staff (Thomas & Rowland, 2014). Patients are already scheduled and the nurse practitioner is not provided time to see new diabetic patients, which makes it intricate for a nurse practitioner to provide an adequate education. Furthermore, a patient develops a severe foot infection that contributes to lengthy hospitalization and leg amputation. The nurse practitioner issued by the patient, and in turn, feels unappreciated and leaves the institution.
Ethic of Care versus Ethic of Justice Perspectives
Ethics refers to right or wrong action in accordance with a person’s responsibility, outcomes, and commitment to the wellbeing of other individuals (Peterlin, Pearse & Dimovski, 2015). The advanced practice leadership between nurse practitioner and nurse executive is a type of mobbing and is illustrated in the perspective of ethics of care and justice. According to Morrow, (2012), ethics of justice is the fairness and mutual agreement of individuals in fair circumstances.
In addition, Morrow presents sections of nursing practice and ethical elements such as bullying, lack of commitment and perceived arrogance. Much as the nurse executive has to distribute resources, the aspect of fairness of ethics of justice can be utilized to justify resource allocation. Conversely, ethics of justice is the fair, verifiable and equal treatment of individuals (Langlois et al. 2014).
In this advanced practice, the nurse practitioner is not given the necessary resources to effectively carry out further duties contributing in harm to patients. Perceived arrogance from nurse executive and inadequate commitment to new programs are major aspects of advanced practice dynamics. To ensure ethics in nursing practice, nurse leaders should promote not only honesty but also integrity and transparency.
Thomas & Rowland, (2014) states that ethics of care involves nurturing and developing harmonious associations from a holistic and need-based perspective while taking into account the requirements of others. The delivery o holistic care has been linked to nursing practice. So as to effectively understand the needs o patients, it is important to care and be sensitive and see patients as whole individuals. Additionally, it is necessary to offer care to nursing experts and considering them as whole people. Delivery of care brings into perspective a variety of activities beyond individuals as well as biological scope (Langlois et al. 2014).
For instance, Thomas & Rowland, (2014) presents cases of horizontal and lateral hostility including humiliating actions among nurses, aggressive and disparaging characters, downgrading other nurses through actions, depression confidence in duties and diminishing self-worth. Nurse practitioner not given the required support may experience mobbing and lateral aggression.
Therefore, mobbing must not be tolerated in advanced practice leadership or even perpetuated among nursing leaders. As nurses are cared for they develop qualities o their mentors while embodying them in their practice. This cycle o mobbing in nursing should be prevented and it is in the nursing leadership that it should first occur. Leaders should train new leaders with care, empathy and holistic management of staff and patient can result in stable nursing force while stopping nurse turnover. This is likely to lead to a culture based on ethics of care.
The application from an ethic of care dynamic Scholars has widely discussed humiliating actions among nurses, aggressive and disparaging characters, downgrading other nurses through actions, depression confidence in duties and diminishing self-worth. Other mobbing strategies include withholding promotion, isolating nurses from team activities.
The ethics of care is used to describe these factors in the present healthcare environment. Demeaning behaviors involves criticizing a nurse in front of others. Verbal disrespect of a nurse is a common type of mobbing. For instance, while this is evident in the interaction between experienced nurses and new RNs entering nursing practice, the new RNs need not only support but also guidance.
Instead, they are subjected to criticism nurses that disagree with these actions and do nothing to prevent it are also committing demeaning actions. A person committed to fostering ethics o care aims at fulfilling other individuals’ needs to ensure harmonious associations (Wang, Cheney & Roper, 2016). The executive nurse belittled the needs of nurse practitioner that contributed in harm to the patient as well as lost o experienced nurse practitioner. Aggressive and disparaging acts lead to physical harm and psychological bullying.
Gossiping is the prevalent type of mobbing leading to psychological distress among nurses. Much are nurses are ready to embrace change, negative words drain their energy (Turkel, 2014). Nurse to patient ratio is another element used to mob nursing experts by distributing a disproportionate number of patients or each nurse. For instance, the executive nurse undermined the need or diabetic foot assessment and awareness, which created workplace setting or nurse practitioners that in turn undermined the executive nurse’s confidence and self-esteem.
Conclusion
In nursing practice mobbing is common. As a psychological attack, it is not only unethical but also one that affects nurse performance and retention. Nurse leaders and staff should comprehend the perspective of ethics of care and ethics of justice to acknowledge and combat mobbing among nursing staff. Additionally, nurse leaders must not condone mobbing instead they should adopt robust and ethical nursing principles.
Some of the tactics of mobbing discussed include demeaning behaviors, humiliating actions among nurses, aggressive and disparaging characters, downgrading other nurses through actions, depression confidence in duties, withholding promotion, and isolating nurses from team activities. Nurse leaders’ should utilize ethics of care as the basis or deal with issues associated with patients and nursing staff. Nurse leaders should also regular training for all nursing staff to be able to identify mobbing and ensure a supportive, equal and holistic workplace setting.
References
Langlois, L., Lapointe, C., Valois, P., & de Leeuw, A. (2014). Development and validity of the ethical leadership questionnaire. Journal of Educational Administration, 52(3), 310-331. doi: http://dx.doi.org/10.1108/JEA-10-2012-0110
Morrow, M. R. (2012). Fairness and justice in leading-following: Opportunities to foster integrity in the first 100 days. Nursing Science Quarterly, 252, 188-193.
Peterlin, J., Pearse, N. J., & Dimovski, V. (2015). STRATEGIC DECISION MAKING FOR ORGANIZATIONAL SUSTAINABILITY: THE IMPLICATIONS OF SERVANT LEADERSHIP AND SUSTAINABLE LEADERSHIP APPROACHES. Economic and Business Review for Central and South – Eastern Europe, 17(3), 273-290. doi:http://dx.doi.org/10.15458/85451.4
Turkel, M. C. (2014). Leading from the heart: caring, love, peace and values guiding leadership. Nursing Science Quarterly, 272
Wang, Y., Cheney, G., & Roper, J. (2016). Virtue ethics and the practice-institution schema: An ethical case of excellent business practices. Journal of Business Ethics, 138(1), 67-77. doi: http://dx.doi.org/10.1007/s10551-015-2579-3
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Ethical Dilemmas Faced by Senior Managers in Manufacturing Companies
Ethical Dilemmas Faced by Senior Managers in Manufacturing Companies
Introduction
In a perfect and ethical world, business organisations and their employees are envisaged to always be engaged in doing the right things. However, it is unfortunate that in the real world of business ventures, ethical dilemmas have become a common occurrence in determining many decisions taken by these organisations (Frisch and Huppenbauer, 2014 p. 24). According to Brown and Corder (2011), dilemmas are problems or situations where an individual or an organisation has to make a difficult or challenging choice between diverse options either, and ethical dilemmas are problems or situations where a choice has to be made between an immoral and a moral act.
Senior managers must often deal with pressures to deliver and help the companies they work for succeed irregardless of their decision choices and personal temptations to uphold business ethics by ensuring that they only decide to choose moral actions whenever faced by an ethical dilemma (Schwartz, 2016 p. 757). As a result, senior managers working in manufacturing companies are likely to often face numerous issues that conflict between the business interests, professional ethics and ethical business practices, and this makes it important for them to rely on ethical theory in order to arrive at the best ethical solutions to such issues (Marques, 2012 p. 5).
Part 1: Breaking Down the Case Study Problem to Expose the Ethical Conflict
As a senior manager in the company, it is important to breakdown the problem caused by the business practice provided in the case study for the purpose of exposing the challenge faced in making an ethical decision, which is necessary to enable a moral action to be taken in order to solve the issue.
A consideration of the business practice presented in this case study; it is undoubtedly evident that this is scenario of scandalous dumping of hazardous children’s sleepwear garments which have been treated with TRIS, a potentially carcinogenic agent. This is an unethical business practice that has been common in corporate circles without the knowledge of consumers, and only occasionally attracting the attention of conscientious citizens.
This is because most cases of dumping, especially to underdeveloped countries are performed quietly, in which the products move unnoticed from the countries they are manufactured and not authorised for sale to underdeveloped countries where such bans do not exist.
For instance, after it was found that TRIS used as a fire retardant in clothes could possibly cause cancer and sleeping clothes for children that had been made from clothing materials treated with TRIS were not allowed for sale in the UK, the manufacturing company decided to dump its huge stock to countries that are less developed in Asia, Latin America and Africa.
Although the bottom-line motive of dumping is always profit, products that are hazardous are usually dumped to solve varied problems. For non-manufacturers including the brokers, wholesalers, retailers, exporters and importers, the problem is generally just a matter of inventory. However, for the manufacturers who have invested capital in tools, machines, personnel, dies, assembly plants and land; the problem is not that simple.
Thus, they often embark on dumping millions of manufactured units to underdeveloped countries because they have been banned from sale in countries where they have been manufactured either because they are substandard or hazardous; through a process which often involves voluntary withdrawal of the product and closing up shop.
According to Edwards and Kirkham (2014), there is need to always comply with these principles of ethics which clearly demonstrates ethical dilemmas faced by senior managers of business organisations that often involve complex situations that commonly lead to an apparent mental conflict about making choices between moral imperatives. Often, a decision to obey one option commonly results in the transgression of another (Elm and Radin, 2012 p. 315). As a result, ethical dilemmas sometimes referred to as ethical paradoxes from a philosophical perspective are mostly invoked in an attempt of improving a moral code or an ethical system to solve the paradox, or refuting it (Dion, 2012 p. 6; Shah and Amjad, 2016 p. 58).
For instance, the principle of beneficence which is also closely related to the concept on universal love provides guidance to the decision maker in order to ensure that he/she makes the decision to do what is good or right guided by the principle of loving neighbours as oneself (Perle, 2014). This prioritisation of doing what is good which is anchored on ethical theory allows a possible solution that is acceptable from an ethical perspective to be developed and implemented for an ethical dilemma (Eisenbeis et al., 2015 p. 637).
This principle of beneficence stipulates that, it is essential in any action to strive to achieve the greatest amount of good through ethical theories because the most good is always beneficial to the people; hence, the principle of beneficence is associated with the utilitarianism (Hollingworth and Valentine, 2015 p. 458).
Similarly, the principle of least harm which is also associated with utilitarianism deals with problems or situations in which no particular choice among the possible options appears beneficial; this forces the decision maker to embark on seeking to make a choice likely to cause the least harm and the fewest number of people (Huhtala et al., 2013 p. 255).
Snellman (2015) reiterated that justice ethical principle or respect for basic human rights requires a decision maker to be focused on ensuring that their actions are fair to the people involved. As a result, there should be consistency between ethical decisions and the ethical theory unless justifiable extenuating circumstances exist in the case (Susong et al., 2013). A consideration of the problem presented in our case study from the perspective of the principles of beneficence, least harm and justice; it is undoubtedly clear that, there is an ethical dilemma between either destroying the TRIS treated textiles leading to loss of revenue or exporting the huge stock of these hazardous garments to underdeveloped countries where they were not banned (Shin, 2012 p. 301).
Based on the background set in the principles of ethics discussed above, it is possible to use ethical theories in order to make sure that the best and ethical action is taken to solve the problem or situation observed in the business practice under consideration. For instance, the Kantian ethics which is a form of deontological ethical theories is closely related by the rights ethical theory and it states that, for any action to be good it must be based on goodwill and a duty of the moral law. Thus, through the Kant ethical theory one believes that other people should be free or even forced to take similar actions that are good in similar situations (Marques, 2012 p. 5).
This means that this ethical theory can be used to make sure that obligations and duties of employees are followed to without violating the basic rights of other people such as liberty, life and the pursuit of happiness. As a result, the course of action should cause the least harm and to the fewest number of people (Huhtala et al., 2013 p. 255). In addition, the utilitarian ethical theory which is closely related to the Aristotle Virtue ethics requires that the action taken, to be the one that brings the highest level of benefits and this can help to enable an ethical decision is made to take the best and morally correct action by demonstrating wisdom, integrity, courage and compassion.
Therefore, based on these ethical theories the best action to be taken and that is correct in terms of ethics and morals would be to destroy the remaining garments and also recall all the exported garments manufactured using the clothing materials that had been treated with TRIS, a flame retardant that had been found to cause cancer. Therefore, since these garments have been banned for sale in the domestic market because of their potential hazardous human health impacts; destroying the remaining stocks and also recalling the exported stocks for destruction would achieve the greatest good to customers while causing the least harm and to the fewest number of people as stipulated in both utilitarian and rights ethical theories (Shin et al., 2015 p. 45).
Additionally, the Kantianism ethics which is a form of deontological ethical theories can also be used to ensure appropriate policies and frameworks to prevent this scenario occurring in future are formulated based on the stipulated obligations and duties of a senior manager; and ensure that they are strictly followed without violating the basic rights of other people (Martinov-Bennie and Mladenovic, 2015 p. 191).
Part 2: Implementation of the Best and Ethical Action to Solve the Discussed Issue
As a senior manager in the company, it is important to make sure that the best action in terms of correct ethics and morals is taken to address the problem or challenge caused the business practice that has been carried out by the company. This is because the company which manufacturers sleeping garments for children had sold huge stocks of its hazardous clothes made from clothing material treated with TRIS, which can cause cancer countries that are less developed in Asia, Latin America and Africa because they were already prohibited for sale in the UK.
As a result, it is not known the number of children likely to develop cancer in underdeveloped countries considering that several millions of sleepwear garments treated with the flame retardant agent had already been exported to these countries after they were banned from sale in the domestic market. Thus, there is need to systemise, defend and recommend concepts outlining right and wrong business practices that are unethical in order to determine the best moral standards through implementation of the best action in terms of ethics and morals in order to solve the problem (Weiss, 2013).
When a company employees at all levels are faced with ethical dilemmas, ethical theories are important in providing a foundation for decision-making, especially when ethics are at play since they inform or guide the viewpoints from which business organisations or individuals make decisions to take moral or immoral actions (Albert, Reynolds and Turan, 2015; Annas, 2015; Crews, 2015).
The ultimate goals of using these ethical theories as guidance in making business decisions include least harm, beneficence, justice, and respect for autonomy (Bedi, Alpaslan and Green, 2016 p. 518). The need to ensure that a quick resolution of the discussed problem or challenge is achieved by implementing the best action in terms of ethics and morals in order to solve the problem is threefold because it involves the following:
1) this is a form of dumping because the stocks sold to underdeveloped have already been banned from sale in domestic market for reasons well known to the manufacturer;
2) the children’s sleepwear garments are made from textiles treated with TRIS which is likely to cause cancer; and 3) the hazardous garments are specifically manufactured for children who cannot decide what is good or bad for them.
Thus, the appropriate ethical theories should be employed in order to make decisions emphasising on the aspects of an ethical dilemma imperative to them, which is critical in ensuring that a correct resolution or course of action that is most ethical is implemented according to the guidelines stipulated in the ethical theories used (Shaikh and Reich, 2011 p. 745).
In particular, the ethical theories likely to be used in determining the best action in terms of ethics and morals to ensure that the issue under consideration is addressed all levels such as individual level, organisational level, industry or sector level and institutional level include Kantianism ethics which is a form of deontological ethical theories, utilitarianism, Aristotle Virtue ethics and respect for basic human rights (Shah and Amjad, 2016 p. 57).
As a result, a consideration should be taken in order to decide the most appropriate approach of implementing the best action to solve the problem, and which is correct both ethically and morally. However, the best actions chosen to solve the issue should be implemented at different levels such as individual level, company level, industry or sector level and also the level of institutions.
At individual level and my role as a senior manager in the company, I would ensure that the action taken to solve the problem is the best one in terms of ethics and morals; which I would push for its quick implementation in order to achieve the highest level of benefits are delivered to customers while causing the least harm and to the fewest number of people as stipulated in the Kantianism ethics in deontological ethical theories, utilitarian ethical theory, Aristotle Virtue ethics and respect for basic human rights.
For instance, I will recommend a recall and destruction of all the garments made from the textiles treated with TRIS which is carcinogenic that had already been sold to underdeveloped countries to ensure that the hazardous garments the least possible number of children which would subsequently lead to a significant reduction of the number of children who could have developed cancers as a result of this scandalous and unethical business practice.
As a senior manager working at the company’s top management level, I would always adhere to what is ethical as stipulated in my obligations and duties in order to promote protection of innocent people by convincing decision-makers and the company board to avoid these unethical business practices, which are a threat to health and well-being of people living in countries that are less developed.
Therefore, as a senior manager with passion for ethical business practices, my personality involves making very consistent decisions based on the obligations and duties set for my position. I will make a reference of my previous workplace and make substantial examples with reliable referees for the decision makers to confirm; then plead with them to adopt my proposal by encouraging them to weigh between the money to be made from the sales of the hazardous stocks and the far reaching health implications likely to be caused by those garments to innocent children in underdeveloped countries.
As they ponder on which option makes sense to them, I will also make them aware of the fact that, those children never chose to be born in their respective countries and it is our responsibility not to harm due to our greediness for money by deliberately selling to them things we know are harmful.
At organisational level, I will develop more systemic changes in organisation culture in addition to proposing a collaboration framework between the company and other stakeholders. For instance, I will formulate and facilitate implementation of the company guidelines and standard operating procedures that would prohibit dumping of potentially hazardous products to the underdeveloped countries in future.
This will help to ensure that, a ban on a particular harmful or substandard product in developed countries is universally applied even in the underdeveloped countries which may have not enacted a policy to ban such products due to the potential human health risk they pose. In order to achieve compliance with this course of action, I will push for a framework for collecting overseas data and highlighting findings of the negative human health impacts directly associated to the TRIS treated garments, and subsequently provide an opportunity for the affected people to seek reparations or compensation in confirmed cases.
Furthermore, I will strive to establish a corporate social responsibility (CSR) for the company in collaboration with other stakeholders including non-governmental organisations and other companies in the sector in order begin development projects as well as creation of awareness and empowerment in affected communities.
At industry or sector level, I will strive to ensure that I provide my recommendations on the appropriate policy changes that would be applied in the general oversight of the usage of chemicals in the sector through proper examination of their classes rather than considering them individually, conducting sufficient health safety research, proper product labelling, assessment of alternative materials and methods, as well as ensuring formulation of stronger and stringent regulations. This is an imperative and ethical course of action because it will provide a harmonised platform to address the challenges facing the sector presently and in future.
At institutional level, which includes engagement with national and global non-governmental and governmental organisations I will liaise with stakeholders and donors to organise a conference among scientists, policy makers, as well as manufacturers with interests in flame retardant chemicals and apparel sectors in order to give them a chance to evaluate the challenges they face and learn from past adverse or difficult experiences so that they can be enabled with ability to take more swift actions to control or limit use of chemicals that may be potentially hazardous.
Conclusion
In conclusion, it can be clearly observed that through the arguments and discussions developed throughout the essay that ethical theories can play an important role to ensure that ethical business decisions are made followed by moral action, especially when a problem caused by a conflict between business interests and ethics arises. Implementation of the actions to solve the problem has been considered at individual level, organisational level, industry or sector level, as well as institutional level.
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