Ethical and legal decision-making dilemma involving an advanced practice nurse

Ethical and Legal Dilemma: Administration - Resource Allocation

Scenario:

Sarah, a Family Nurse Practitioner (FNP) and Director of Nursing Services at a rural community hospital, faces a difficult decision. The hospital is experiencing significant financial strain due to declining patient volume and recent cuts in insurance reimbursements. The administration has mandated budget cuts across all departments, including a 10% reduction in the nursing staff budget.

Sarah knows this cut will have a direct impact on patient care. The hospital is already understaffed, and further reductions will necessitate increased patient-to-nurse ratios. This will make it challenging to provide adequate care, potentially leading to longer wait times, increased patient stress, and higher risks of medication errors.

Ethical Principle and Law at Risk:

• Ethical Principle: Beneficence: This principle compels healthcare professionals to act in the best interest of their patients and to prevent harm. Reducing nursing staff would directly contradict this principle by compromising the quality and safety of patient care.

• Law: Nurse Practice Act: Each state has a Nurse Practice Act that outlines the standards of care nurses must uphold. Reduced staffing could make it difficult for nurses to meet these standards, potentially leading to violations. Additionally, depending on the severity of the consequences, it could be considered patient neglect, a civil offense.

Decision with Integrity:

Sarah prioritizes patient safety and ethical practice. Here's how she can address the situation:

1. Data-Driven Advocacy: Sarah collects data on current patient-to-nurse ratios, staffing levels in similar hospitals, and documented cases of adverse events related to understaffing. She presents this data to the administration, highlighting the potential risks to patient safety and potential violations of the Nurse Practice Act.
2. Exploring Alternatives: She proposes cost-saving alternatives to achieve the budget reduction target. These might include offering voluntary buyouts for senior nurses nearing retirement, exploring temporary staffing agencies for short-term needs, or implementing cross-training programs to increase staff flexibility.
3. Open Communication: Sarah maintains open communication with her nursing staff, explaining the situation and her efforts to advocate for resources. This fosters trust and empowers them to voice concerns.

Recommendations to Reduce Moral Distress:

1. Organizational Support Systems: Hospitals can create support systems for advanced practice nurses facing ethical dilemmas. This could include ethics committees, mentorship programs, or access to external resources for guidance.
2. Collaborative Decision-Making: Involving nurse leaders and staff in budget discussions and decision-making processes fosters a sense of ownership and reduces feelings of powerlessness.
3. Professional Advocacy: Professional organizations like the American Association of Nurse Practitioners (AANP) can play a vital role in advocating for policies that support safe nurse staffing levels and patient safety.

References:

1. American Nurses Association. (2018). Code of Ethics for Nurses with Interpretive Statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
2. National Council of State Boards of Nursing. (2023). Nurse Practice Acts. https://www.ncsbn.org/policy/npa.page
3. American Association of Nurse Practitioners. (2023). Nurse Staffing. https://www.aanp.org/

Sample Solution