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Ethically speaking: Conflicts of interest come in all shapes and sizes

Blake is a family nurse practitioner who manages an employee health and wellness program for a large construction company. His boss made it clear that, while he values employee health, his top priority is making a profit. His boss knows only too well that workplace injuries and illnesses have a major impact on a company’s bottom line, and he is always pushing Blake to focus more on preventing workplace injuries. Blake often feels conflicted between his commitment to workers’ health and his boss’s emphasis on productivity.

Today his challenge is Ronald Dawson, a 46-year-old father of three that Blake is seeing for high blood pressure and diabetes management. Ron tells Blake that his wife, who is deployed to Afghanistan, is scheduled for leave next week, and he desperately wants to take at least two days off to maximize their time together.

Finances are a major issue for the Dawson family. Ron needs this job and can’t just call in sick without having an excuse. He begs Blake to write a note documenting medical need for the absence. Blake knows and likes Ron, has great sympathy for his situation and understands why he wants to spend as much time as possible with his wife. Blake knows that trying to hold the family together during his wife’s absence has not been easy for Ron.

What the Code of Ethics says:

Provision 2 of the American Nurses Association’s Code of Ethics states, “The nurse’s primary commitment is to the patient, whether an individual, family, group or community.” In this instance Blake wants to acquiesce to Ron’s request — and he believes his time with family will be invaluable — but he knows his boss would never approve the absence. Blake is experiencing a conflict of interest. His professional responsibilities and compassionate interests are in conflict with his need to be a successful employee who implements his boss’s vision. He decides to consult with NP colleagues who offer different recommendations.

Colleague 1

“Our code states that the nurse’s primary commitment is to the patient,” he said. “Lie, if you need to lie, but get him the days he needs. His health is more important than your boss’s approval. Too bad your boss wouldn’t be sympathetic to this line of reasoning.”

Blake likes this advice but isn’t comfortable lying even to secure Ron’s best interests. Blake always has believed a good end doesn’t justify use of the wrong means.

Colleague 2

“The Code of Ethics also states the ‘nurse owes the same duties to self as to others,’” the colleague said. “If you want to keep this job, I think you have to tell Ron that, as much as you would like to help him, your hands are tied. You can’t lie for him just so that he can enjoy time with his wife and family.”

This smacks to Blake of self-interest. “I think I would be putting my own interests and well-being ahead of Ron’s,” he said. “I just need to think this through and make sure that I’m not considering giving Ron special treatment simply because I like him as a person. I don’t want to be unfair.”

Colleague 3

“I don’t think you are lying if you approve a medical need for a two-day absence,” the colleague said. “This company doesn’t give ‘mental health days,’ but I am sure you could make the argument that this time with family will go a long way to reducing Ron’s stress and high blood pressure. I wouldn’t have any trouble approving that.”

Blake concurs with this line of reasoning. “I guess the downside of this could be my getting a reputation as a soft heart,” he said. “If Ron talks about this and everyone starts wanting mental health days, I’ll have a real problem on my hands. I have to admit that there are probably lots of our workers who would benefit from some approved leave and I wonder if I am being unfair by acceding to Ron because I know him and his situation.”

All three NPs concur their advanced practices present new ethical challenges on a daily basis — perhaps not of the “to pull the plug or not” variety, but still with direct impact on human lives and well-being.

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By | 2014-05-17T00:00:00-04:00 May 17th, 2014|Categories: National|0 Comments

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