Unit 2 Assignment MCO and ACO GSutton-Pasco

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Unit 2 Assignment: Ethical and Legal Decision-Making Dilemma Guyla J. Sutton-Pasco Purdue Global MN506 Health Policy, Ethical, and Legal Perspectives of The Health Care System Michael Palacio, NP April, 24, 2024 1

Unit 2 Assignment: Ethical and Legal Decision-Making Dilemma In advanced nursing there are many ethical and legal decision-making dilemmas that a nurse can face especially that of a nursing administrator weighting the health care need of patients versus allocation of resources. It is important to define the dilemma to have a better understanding while considering the main principles of ethics: autonomy, beneficence, justice, and non-maleficence. It is also important to understand the federal and state laws regarding this dilemma and the adherence to those laws pertaining to liability. Then the nurse should look at the relevant codes of conduct and how those are reflected in the dilemma while defining the ethical principle it may affect. Once this is done, it is important to construct a decision and make recommendations that will resolve the dilemma to ensure moral distress is resolved ( Westrick, 2013) . Ethical and Legal Decision-Making Dilemma The ethical dilemma in this situation is regarding a nurse administrator determining the health care need for patients versus resources that can be allocated for those needs to be met. For this example, we will utilize the need of dialysis machines in a rural hospital that typically does not see patients for this, however if a dialysis patient came in for emergency care and needed dialysis the machine it would be needed. Although it can be a life saving resource for patients with dialysis, the odds in rural areas are that most dialysis patients would not need this machine unless it was a true emergency as typically, they have programs already set up to receive dialysis on a regular basis. Legally speaking per Centers for Medicare & Medicaid (CMS) hospitals in the United States hospitals are not required to have a dialysis machine but are strongly encouraged. This presents less legal implications for an advanced practice nurse or provider who was working in an emergency room but does not necessarily ensure patient’s best care is being 2

met. It also reduces the legal implications for the nurse administrator. With these ethical and legal dilemmas being presented, one could see how a nursing administrator must deal with if it is a good healthcare allocation for a rural hospital to obtain a dialysis machine (CMS, 2023). Relevant Codes of Conduct In emergency rooms and advanced practice nurse or physician, will deliver emergency care, intensive care and critical care services for patients arriving at times unknown to the unit. In reviewing codes of conduct for nursing there are several codes of conduct that this dilemma can apply to. One of the main ethical guidelines in nursing pertaining the administrator nurse is determining if this is a cost-effective allocation of resources is to consider improvement of community health. Essentially, they should ask themselves would this dialysis machine help improve community health if there was even one dialysis patient that it was used for? Another code of conduct to consider is to have attention the medical health at the local level with goals to achieve optimal health for those individuals they serve. Also, in the nursing profession especially as a nursing administrator is importing to within their own limits attempt to provide a safe and health promoting environment for patients. With this consideration, what would be the best option for a rural dialysis patient if they couldn’t make it to a more populated hospital for treatment? Along side this the answer comes in another ethical principle or code of conduct to have nursing educators and administrators employ the maximum efforts to update their scientific knowledge and promote ethical knowledge and conduct within this a nurse administrator should make sure those resources were available and allocated to them. By applying these codes of conduct a nursing administrator in this situation could employ valuable insight on whether it was cost effective to have a dialysis machine ( Zahedi, et al, 2013). 3

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Ethical Principle The two primary ethical principles that could be presented because a hospital does not have a dialysis machine would relate to beneficence and non-maleficence primarily. Beneficence to do good to patients would in fact be counteracted by a nursing administrator not providing a dialysis machine to patients in their emergency room. The other non-maleficence meaning to do no harm is also related because by not having a dialysis machine harm could come to patients. Regarding legal issues again there is no law stating rural hospitals have to have a dialysis machine however it could be considered negligence if a provider or nurse practitioner is not able to perform proper treatment to their patients. The only change of this would be if the patient refused treatment which is their right (Stewart, etal, 2013). Construct a Decision and Recommendations For the nursing administrator to construct a decision, the recommendations for possibilities of treating patients who need dialysis and what would other options be for them in this situation. One recommendation is to have rural hospitals join in the local area to share a dialysis machine to reduce the cost burden on one hospital. Another recommendation could be opting to just have air emergency services that could quickly and efficiently get a patient to a urban hospital that is likely to have a dialysis machine but again there would be cost concerns. The other recommendation is a larger more complex process, but the hospital could consider reaching out to patients with dialysis, training and educating a nurse to perform dialysis, and offer their own in-house treatment at the hospital for those rural patients to help reduce the cost and cover any expense of the machine. It has been shown many dialysis patients seek care closer to their rural community so it could also potentially be of profit for the nurse administrator to consider. In the end this decision would seem the most profitable and less capable of causing 4

beneficence or non-maleficence while also reducing the legal implications of neglect if a provider or nurse practitioner was unable to provide the care a dialysis patient truly needed in an emergency ( Scholes-Robertson , et al, 2022). Conclusion Ethical principles and legal implications must be considered when dealing with complex dilemmas in health care related to the nurse administration providing potential healthcare needs and allocating resources justly in their organization. It is important to look at nursing codes of conduct and ethical principles when considering the right choice. It is also even more important to understand if there are legal implications related to their decisions especially because a nurse administrator your decision ends up being the one looked to and respected with your staff and organization. The key is to look at the ethical and legal implications while considering recommendations that could change how things could be performed and see if that truly benefits not just the staff, organization but the individuals they are caring for (Westrick, 2013). 5

References CMS. (2023). Fact sheets calendar year 2024 end-stage renal disease (ESRD) prospective payment system (PPS) final rule (CMS-1782-F) . CMS.gov Centers for Medicare & Medicaid Services. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2024-end- stage-renal-disease-esrd-prospective-payment-system-pps-final-rule-cms-1782-f Nagappan, A., Kalokairinou, L., & Wexler, A. (2024). Ethical issues in direct-to-consumer healthcare: A scoping review. PLoS Digital Health, 3(2), 1–18. https://doi.org/10.1371/journal.pdig.0000452 Rawlings, A., Brandt, L., Ferreres, A., Asbun, H., & Shadduck, P. (2021). Ethical considerations for allocation of scarce resources and alterations in surgical care during a pandemic. Surgical endoscopy , 35 (5), 2217–2222. https://doi.org/10.1007/s00464-020- 07629-x Scholes-Robertson, N. J., Gutman, T., Howell, M., Craig, J., Chalmers, R., Dwyer, K. M., Jose, M., Roberts, I., & Tong, A. (2022). Clinicians' perspectives on equity of access to dialysis and kidney transplantation for rural people: a semi structured interview study. BMJ open , 12 (2), e052315. https://doi.org/10.1136/bmjopen-2021-052315 Stewart C, Brennan F. Legal issues concerning withholding and withdrawal of dialysis. Nephrology (Carlton). 2013 Apr 16. doi: 10.1111/nep.12086. Epub ahead of print. PMID: 23586615. Westrick, S. J. (2013). Essentials of nursing law and ethics (2nd ed.). Jones & Bartlett Learning. 6

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Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., Maddah, S. B., Cheraghi, M., Mirzabeigi, G., Larijani, B., & Dastgerdi, M. V. (2013). The code of ethics for nurses. Iranian journal of public health , 42 (Supple1), 1–8. 7

Unit 2 Assignment MCO and ACO GSutton-Pasco

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