Policies and Practices to Support Healthcare Issues
Organizational Policies and Practices to Support Healthcare IssuesQuite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.To Prepare:Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.Below is the questionPost an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.BELOW IS THE RESOURCESLearning ResourcesRequired ReadingsAmerican Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved fromhttps://www.nursingworld.org/coe-view-onlyNote: Review all, with special attention to “Provision 6” (pp. 23-26).Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved fromhttp://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.htmlMilliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved fromhttp://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html.Please make sure you use APA format with 4 references not more than 5 years old. CORE SKILL: recognizing COMPETING NEEDS — the assignment’s whole premise is that organizational goals, workforce needs, and patient needs pull in different directions, and that policy is how the tension is adjudicated rather than dissolved.
NAME THE TENSION EXPLICITLY. Generic examples: cost containment vs. adequate staffing; throughput/length-of-stay targets vs. patient readiness for discharge; productivity metrics vs. time for patient education; EHR documentation requirements vs. bedside time; antibiotic stewardship vs. individual clinician autonomy; patient satisfaction scores vs. appropriate refusal of unnecessary opioids or antibiotics (this last is a genuinely sharp example — tying reimbursement to satisfaction scores creates measurable pressure to prescribe things that aren’t indicated).
THE ETHICAL FRAME: this is DISTRIBUTIVE JUSTICE — allocating finite resources among competing legitimate claims. Use the four principles, and be precise about which two are colliding. Also name UTILITARIAN (greatest good for the greatest number, which is how population-level policy tends to reason) versus DEONTOLOGICAL (duty-based, which is how bedside clinical ethics tends to reason) approaches — and note that a policy can be defensible utilitarian-wise while producing a duty violation at the bedside. That is exactly what MORAL DISTRESS is: knowing the right action but being constrained from taking it. Jameton’s original formulation, and the concept of MORAL RESIDUE (the accumulated cost of repeated moral distress) are worth citing, because they explain why this is not merely an abstract problem — it drives attrition.
POLICY ANALYSIS STRUCTURE: identify the competing needs → identify a specific policy that addresses (or fails to address) them → evaluate whether the policy actually reconciles the tension or merely shifts the burden (usually onto frontline staff — an observation that earns marks) → identify ethical shortcomings → recommend changes with evidence.
ETHICAL SHORTCOMINGS TO LOOK FOR IN REAL POLICIES: policies that assign responsibility without authority; policies that hold staff accountable for outcomes they cannot control; policies that are unfunded (mandating an intervention without providing time or staff to do it); policies that create a reporting duty while punishing reporters (the death of just culture); and policies that ration implicitly rather than explicitly, which shifts an institutional decision onto an individual clinician at the bedside.
CITE: the ANA Code of Ethics (Provision 6 addresses the ethical ENVIRONMENT of the workplace, which is directly on point and underused by students), relevant professional standards, and empirical literature on the specific issue.
RECOMMENDATIONS: must address the competing need, not wish it away. Acknowledge what your recommendation COSTS and who bears it — a recommendation with no trade-off is a fantasy.
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