Lesson 3: Ethics Ethical and Legal Responsibilities and the Role of the Nurse Leader as Advocate

Ethics, ethics, and more ethics....Sometimes it feels as though we're beating a dead horse. Professional Standards of Nursing was nothing but 16 weeks of the ANA Professional Code of Ethics. Nursing in Health Systems Policy tackled the ethics (or lack of there of) involved in the making of health policy. And now, here it is again. Ethics in leadership. And you know what? I learned something new. Well, I don't know that I really learned anything new, it's more like I had to think about ethics in a new light.

Ethics, according tot he definition in the book, is "the systematic study of what a person's conduct and actions ought to be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships ought to be, not necessarily what they are" (pg 68).  Ethics of a profession arise out of the purpose of that profession. For example, in nursing our goal is to protect life and our code of ethics evolved out of that goal. The point the book brought out is that management is a discipline and not a profession, so the previous rule does not apply. Instead, the ethical obligations of someone in management are tied to the purpose of the organization for which they work, which is tied to the function is aims to fill in society, and is further tied to the societal constraints placed upon it. Further evidence, or tick marks, under the "Why Somer doesn't want to be management" column.  Red tape frustrates me. I have a difficult time understanding the management aspect of nursing that is more concerned with budgets and cost cuts over what is best for a patient. I realize that to receive compensation and reimbursement from insurance companies, certain parameters must be met. I have a difficult time when those preset parameters are not what is in the patients best interest. I disagree, due to my personal ethics, that keeping a patient in the hospital for 3 days, when they are ready to go home on day 2, is right based on the fact that that is what insurance will pay for. This is why I could never be management.

As I thought about myself in a management position, or rather the reasons why you would never find me in a management position (I know. I know. Never say never.) I considered the type of ethical framework that is most congruent with my personal code of ethics. I feel, after considering each option, that I rely on a intuitionist's ethical framework. I feel that each case should be considered case-by-case to determine the goals, duties, and rights related to each individual situation. In my opinion, this ethical framework does not work with the role of a manager in nursing. From what I've learned, management requires more of a utilitarian approach to provide the greatest good for the greatest number of people...while saving the greatest amount of money, if I might add that in there.

So, I learned a lot from this reading...and this was just from Chapter 4. Chapters 5 & 6 had a lot of thought provoking information a well, but quite frankly, I'm just too tired to get into that.