I frequently am asked business-related questions that fall in the gray area between ethics and legality. Although ethics and law are separate domains, the issues we face in healthcare often intersect these areas. While the American Nurses Association Code of Ethics is the standard of ethical conduct, often nurses are confronted with issues that go beyond these principles.
Historically, healthcare ethics concerned patients' rights, including the right to be part of their healthcare decision-making. As nurses expand their scope of responsibility, we find ourselves faced with ethical decisions not involving only patients' rights and professional issues, but also issues relating to business and economic factors. Many ethical dilemmas involve the potential conflict of interest between the needs and interests of the patient and the desire of the practitioner to make more money.
Ethical vs. Legal Conduct
To begin with, it is helpful to distinguish between ethical conduct and legal conduct. For nurses and other medical professionals, behavior that might be considered unethical does not necessarily have to be illegal, but most illegal acts are always unethical. A nurse's behavior, if guided by moral imperatives, should ethically reach a level of responsibility and decision-making that stands apart from legal considerations.
Simply put, ethical standards govern our behavior and are based on honesty, responsibility and fairness. In this age of decreasing reimbursement, increased competition and higher business costs, it can be a challenge to maintain an ethical and profitable professional practice, even for nurses who are employed within large organizations. There may be situations when you conclude the needs of your patients or your community exceeds your capacity to provide uncompensated or under-compensated care. Other nurses have determined that in certain situations, the rules and regulations of third-party payors may be at odds with what the patient needs and in conflict with their professional judgment.
Here are a few points to keep in mind:
1. Never forget that the welfare of the patient always has to be your first priority, regardless of the amount of direct or indirect payment you receive, compensation from your employer or time you need to spend with the patient.
2. Always answer the question, "Is what I am doing best for the patient?" in the affirmative. Our patients trust us to make the best decisions possible on their behalf.
3. In any business-to-business relationship or collaboration, make sure all parties have shared ethical beliefs. Relationships with referral sources, vendors or other personnel should not involve receiving unearned profits from the relationship.
Maintain the moral courage to say no to:
improper use of personnel, especially nursing assistants and licensed practical nurses, students and volunteers in a therapeutic setting;
improper use of treatment codes to "up code" for maximum reimbursement;
treating patients who do not fall in your area of expertise instead of referring them to a colleague;
providing excessive services if you practice in a fee-for-service setting; and
accepting financial incentives to cut corners or reduce the service you provide.
Share your ideas about ethics with your clinical and non-clinical staff. Many practices and clinics develop their own code of ethics and conduct above and beyond what is mandated by the ANA, The Joint Commission, state boards of nursing, advanced practice certifying agencies and other accrediting and professional regulation organizations.
Values add value to your nursing practice. A nurse manager who has a reputation for integrity and honesty is a practice manager who maintains long-standing referral sources and demonstrates staff retention and longevity. You only get to earn a reputation once, so remain grounded in ethical awareness!
Scott Weber is assistant professor of health and community systems and coordinates the nursing education graduate program at the University of Pittsburgh School of Nursing.