The situation at the healthcare institute on moral grounds is not sound at all. The aggravated situation is caused by the added financial stress that is faced due to the Affordable Care Act and changing reimbursement strategies. Human Resource in the institution is lacking due to the reason that we have not opted to recruit any further new graduate nurses in order to tackle the financial stress that the institution is facing. Morally the situation is worsened, as the institution will have to deal with the situation with the remaining registered nurses. Human Resource is not that much which can cater the need of all patients. This leaves the lives of patients in danger. Furthermore, the current staff will have to work above their duties to look after for almost every patient that is available which will lead to work overload and work related stress. This will be done due to the reason that the institution will be responsible for the safety of patients. They need someone to attend them consistently. So rather than appointing nurses to a few patients, medical staff will have to deploy nurses to all over the hospital to take care of the patients.
In accordance to the ethical analysis, patients will be the one who will be suffering the most due to this change. Even if any of the option is adopted, patients will be neglected. If the management opts for the first choice, then the patient, on which a particular nurse is assigned, will be neglected, as the nurse will have to float around the hospital to look for other patients. Similarly opting for the second choice will worsen the condition further as it will lead to the closure of a medical unit most importantly ICU’s surgical unit. Closure of this unit will aggravate the situation, as hospital will not be able to provide a primary facility to the patients. In accordance to the goals for an ethical healthcare system, the Americans need high quality, freedom of choice, affordability, and share of fellow citizens in providing healthcare facilities (Carayon and Gurses, 2008). Considering this, our healthcare institution will only be looking for affordability and neglecting other aspects. However continuing with the reduced number of nurses is a compulsion due to the reason that hiring an additional number of nurses can increase the cost, which again can reduce affordability.
As far as the scenario is concerned apparently, no other ethical remedy seems to be an obvious choice. However, implication of the two-mentioned course of actions can lead to a moral distress for the nurses as well. They will not be able to cater the needs of the patient morally. They will deviate from their moral behavior of providing primary attention to the assigned patient and look around for other patient. They cannot even neglect other patients, as it will also lead to a similar situation. Increased workload for nurses can affect a patient safety adversely (Sorrell, 2012). As in the case, it is apparent that there is around a five percent shortage of the nurses in the institution. With a limited resource, the management of the hospital will have to look for a plan. One option is that they can redesign the workload structure for the nurses by considering the first action plan that is to float nurses around the hospital (Epstein and Delgado, 2010). This will not even call for a problem from the surgery department, which would be affected severely if the second option is adopted. Therefore, it can be said that the second option of the closure of two units including an ICU surgical unit should not be adopted. Hospitals do require ICU surgical units as they are of the primary importance for the patient’s safety as well.
In an organization where ethical standards are under a strict monitoring, such decisions can be accepted wholeheartedly. If an appropriate workload structure is designed then things can be managed smoothly. Despite of the fact that around 95% of the 900 beds available will be occupied, and having a 10% shortage of the registered nurses, the institution with a better workload structure can manage things. An option that can be availed is to reduce the number of bedding facilities so that everything can be looked upon in accordance to the requirement. Nevertheless, to meet the business end of the organization, this institution should not opt for this strategy, as it will aggravate the already stressed financial situation.
In the current situation where the institution finds itself, the nursing leader’s decision-making can be informed through having a clear understanding of the Code of Ethics for Nursing. A nursing leader should be aware of the interests of the public and of self (Edmonson, 2010). A nursing leader should react to such a situation by developing a workload structure that best suits the available resource of nurses in the organization so that it can fill in the gap of low number of nurses avoiding a moral distress situation. Nursing leader should pursue the available nurses to take care of the patients and look after for their safety in the best possible way.
If I was a registered nurse in such a situation, then I would have faced a moral distress, as I would have known that taking care of the units in which I am assigned is important, but similarly I could have looked upon to other patients, as leaving them unattended was also not an option to look for.
Carayon, P, and Gurses, A. P., (2008) Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US)
Edmonson, C., (2010) "Moral Courage and the Nurse Leader" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 5.
Epstein, E.G., and Delgado, S., (2010) "Understanding and Addressing Moral Distress" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 1.
Sorrell, J., (2012) "Ethics: The Patient Protection and Affordable Care Act: Ethical Perspectives in 21st Century Health Care" OJIN: The Online Journal of Issues in Nursing Vol. 18 No. 1.