Self-Regulation and Emotional Intelligence
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Foundation for Effective Leadership and Management Ethics, Law, and Advocacy
UNIT II
70
Ethical Issues
… when organizations and their leaders become fixated on the bottom line and ignore values, an environment conducive to ethics failure is nurtured.
—J. G. Bruhn
… All my growth and development led me to believe that if you really do the right thing, and if you play by the rules, and if you’ve got good enough, solid judgment and common sense, that you’re going to be able to do whatever you want to do with your life.
—Barbara Jordan
CROSSWALK
thischapteraddresses:BSN Essential II: Basic organizational and systems leadership for quality care and patient safety BSN Essential VIII: Professionalism and professional values
BSN Essential IX: Baccalaureate generalist nursing practice MSN Essential II: Organizational and systems leadership MSN Essential VI: Health policy and advocacy
MSN Essential IX: Advanced generalist nursing practice AONE Nurse Executive Competency III: Leadership AONE Nurse Executive Competency IV: Professionalism QSEN Competency: Patient-centered care
LEARNING OBJECTIVES
The learner will:l define ethics and ethical dilemmas
l compare and contrast the utilitarian, duty-based, rights-based, and intuitionist frameworks for ethical decision making
l identify and define six different principles of ethical reasoning
l use a systematic problem-solving or decision-making model to determine appropriate action for select ethical problems
l describe the limitations of using outcome as the sole criterion for the evaluation of ethical decision making
l distinguish between legal and ethical obligations in decision making
l describe how differences in personal, organizational, subordinate, and patient obligations increase the risk of intrapersonal conflict in ethical decision making
l demonstrate self-awareness regarding the ethical frameworks and ethical principles that most strongly influence his or her personal decision making.
l role model ethical decision making congruent with the American Nurses Association (ANA) Code of Ethics and Interpretive Statements and professional standards
4
Unit II examines ethical, legal, and legislative issues affecting leadership and management as well as professional advocacy. This chapter focuses on applied ethical decision making as a critical leadership role for mangers. Chapter 5 examines the impact of legislation and the law on leadership and management and Chapter 6 focuses on advocacy for patients and subordinates and for the nursing profession in general.
Ethics is the systematic study of what a person’s conduct and actions should 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 should be, not necessarily what they are. Ethics is a system of moral conduct and principles that guide a person’s actions in regard to right and wrong and in regard to oneself and society at large.
Ethics is concerned with doing the right thing and with being a certain kind of person, in terms of conduct and character (Gallagher & Hodge, 2012).
Applied ethics requires application of normative ethical theory to everyday problems. The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, therefore, provide the foundation and filter from which ethical decisions are made. The nurse-manager, however, has a different ethical responsibility than the clinical nurse and does not have as clearly defined a foundation to use as a base for ethical reasoning.
In addition, because management is a discipline and not a profession, it does not have a defined purpose, such as medicine and the law; therefore, it lacks a specific set of norms to guide ethical decision making. Instead, the organization reflects norms and values to the manager, and the personal values of managers are reflected through the organization.
The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions. Society helps define the purposes of various institutions, and the purposes, in turn, help ensure that the institution fulfills specific functions. However, the specific values and norms in any particular institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. In reviewing this set of complex interactions, it becomes evident that arriving at appropriate ethical management decisions is a difficult task.
Not only are nursing management ethics distinct from clinical nursing ethics, they are also distinct from other areas of management. Although there are many similar areas of responsibility between nurse-managers and non-nurse-managers, many leadership roles and management functions are specific to nursing. These differences require the nurse-manager to deal with unique obligations and ethical dilemmas that are not encountered in non-nursing management.
In addition, because personal, organizational, subordinate, and consumer responsibilities differ, there is great potential for nursing managers to experience intrapersonal conflict about the appropriate course of action. Multiple advocacy roles and accountability to the profession further increase the likelihood that all nurse-managers will be faced with ethical dilemmas in their practice. Nurses often find themselves viewed simultaneously as advocates for physicians, patients, and the organization—all of whose needs and goals may be dissimilar.
Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals.
To make appropriate ethical decisions then, the manager must have knowledge of ethical principles and frameworks, use a professional approach that eliminates trial and error and
focuses on proven decision-making models, and use available organizational processes to assist in making such decisions. Such organizational processes include institutional review boards (IRBs), ethics committees, and professional codes of ethics. Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions involved in management ethics are shown in Display 4.1.
LEADERSHIP ROLES
1. Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings.
2. Accepts that some ambiguity and uncertainty must be a part of all ethical decision making.
3. Accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making.
4. Demonstrates risk taking in ethical decision making.
5. Role models ethical decision making, which is congruent with the American Nurses Association (ANA) Code of Ethics and Interpretive Statements and professional standards.
6. Clearly communicates expected ethical standards of behavior.
7. Role models behavior that eliminates theory–practice–ethics gaps.
MANAGEMENT FUNCTIONS
1. Uses a systematic approach to problem solving and decision making when faced with manage- ment problems with ethical ramifications.
2. Identifies outcomes in ethical decision making that should always be sought or avoided.
3. Uses established ethical frameworks to clarify values and beliefs.
4. Applies principles of ethical reasoning to define what beliefs or values form the basis for decision making.
5. Is aware of legal precedents that may guide ethical decision making and is accountable for pos- sible liabilities should they go against the legal precedent.
6. Continually reevaluates the quality of personal ethical decision making, based on the process of decision making or problem solving used.
7. Recognizes and rewards ethical conduct of subordinates.
8. Takes appropriate action when subordinates use unethical conduct.
DISPLAY 4.1 Leadership Roles and Management Functions Associated with Ethics