Health Care System :: Health, Nursing, Denial of Coverage

Today's healthcare environment is increasingly complex, as issues compete for importance. As a consequence of this, nurses frequently face ethical dilemmas. In deciding the best course of action in such dilemmas, nurses can look for guidance to professional standards of conduct, such as those enumerated in the Code of Ethics of the American Nursing Association (ANA). According to Mahlmeister (1996), each nurse should own a copy of the ANA code, as this document can provide guidance on situations that nurses face on an almost daily basis. For example, consider a situation that may result from one hospital trying to institute policies concerning cost containment. In order to keep the cost down, the nurse in charge of a 7 bed unit (without a nurse's assistance) is expected under a restructuring plan to also work a second adult ward if there are fewer than three children on the pediatric unit during the night shift (Mahlmeister, 1996). This split shift leaves these pediatric patients unattended while the nurse is in the adult ward. The ANA Code of Ethics states that it is the nurse's responsibility "to safeguard the client and the public when health care and safety are affected by incompetent, unethical or illegal practice of any person" (Mahlmeister, 1996, p. 130). Even though this nurse was ordered by a manager to leave the pediatric setting, the nurse is personally accountable for his or her actions for any situation that may arise during this absence. Not only is this practice unacceptable professionally, but it is also problematic legalistically, as the nurse could be personally sued for any negative consequences to these patients (Mahlmeister, 1996). Therefore, it is the nurse's duty to recognize these unacceptable risks and exhaust all avenues available within the hospital to correct this requirement (Mahlmeister, 1996). Another problematic area of nursing concerns the denial of coverage that often ensues due to the advent of managed care organizations (MCOs). It is becoming increasingly more difficult to reconcile the needs of the patient in terms of quality care with what insurers are willing to pay for (Rushton, 1996). For example, Maria, a 10-year-old, is hit by a car while riding her bike. She is taken to the closest emergency room, which happens to be the Children's Hospital. She has a concussion, an open fracture of the left femur, a simple fracture of the left arm, and multiple abrasions (Rushton, 1996). The closest hospital that is part of Maria's MCO plan is an adult hospital without pediatric specialists, which is located more than 25 miles from present location. Health Care System :: Health, Nursing, Denial of Coverage Today's healthcare environment is increasingly complex, as issues compete for importance. As a consequence of this, nurses frequently face ethical dilemmas. In deciding the best course of action in such dilemmas, nurses can look for guidance to professional standards of conduct, such as those enumerated in the Code of Ethics of the American Nursing Association (ANA). According to Mahlmeister (1996), each nurse should own a copy of the ANA code, as this document can provide guidance on situations that nurses face on an almost daily basis. For example, consider a situation that may result from one hospital trying to institute policies concerning cost containment. In order to keep the cost down, the nurse in charge of a 7 bed unit (without a nurse's assistance) is expected under a restructuring plan to also work a second adult ward if there are fewer than three children on the pediatric unit during the night shift (Mahlmeister, 1996). This split shift leaves these pediatric patients unattended while the nurse is in the adult ward. The ANA Code of Ethics states that it is the nurse's responsibility "to safeguard the client and the public when health care and safety are affected by incompetent, unethical or illegal practice of any person" (Mahlmeister, 1996, p. 130). Even though this nurse was ordered by a manager to leave the pediatric setting, the nurse is personally accountable for his or her actions for any situation that may arise during this absence. Not only is this practice unacceptable professionally, but it is also problematic legalistically, as the nurse could be personally sued for any negative consequences to these patients (Mahlmeister, 1996). Therefore, it is the nurse's duty to recognize these unacceptable risks and exhaust all avenues available within the hospital to correct this requirement (Mahlmeister, 1996). Another problematic area of nursing concerns the denial of coverage that often ensues due to the advent of managed care organizations (MCOs). It is becoming increasingly more difficult to reconcile the needs of the patient in terms of quality care with what insurers are willing to pay for (Rushton, 1996). For example, Maria, a 10-year-old, is hit by a car while riding her bike. She is taken to the closest emergency room, which happens to be the Children's Hospital. She has a concussion, an open fracture of the left femur, a simple fracture of the left arm, and multiple abrasions (Rushton, 1996). The closest hospital that is part of Maria's MCO plan is an adult hospital without pediatric specialists, which is located more than 25 miles from present location.