Abstract
Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.
Highlights
Responding to significant pressures for increased cost control imposed on hospitals by managed care organizations through selective network contracting during the 1990s [1] [2], healthcare organizations (HCOs) subsequently undertook a number of reengineering and restructuring initiatives aimed at lowering the cost of delivering care [3]-[5]
A growing body of research indicates that interventions can and are being developed successfully to accomplish both goals simultaneously [13]-[16]. While these efforts would continue to be challenging to the nursing profession, recent studies suggest that cooperation of nursing professionals and their organizations in efforts to improve quality of care, safety and patient satisfaction and enhance nurses’ work environments may have very promising effects for patients, nurses and their organizations
Despite the general decline in the extent to which the common ethical issues studied in 2000 were perceived by nurse leaders as presenting problems for HCOs today, the findings in Table 3 emphasize the continued importance of ethical issues related to failure to provide quality care at the present time
Summary
Responding to significant pressures for increased cost control imposed on hospitals by managed care organizations through selective network contracting during the 1990s [1] [2], healthcare organizations (HCOs) subsequently undertook a number of reengineering and restructuring initiatives aimed at lowering the cost of delivering care [3]-[5]. Respondents to both studies attributed these outcomes primarily to economic constraints established by the organizations that led to conflict between organizational and clinical ethics The outcome of this conflict saw numerous proposals by the nursing profession to improve the quality of care overwhelmed by the strength of HCOs’ seemingly unconditional focus on cost control. After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction.
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