Running head: BRIDGE TO PRACTICE ETHICS PAPER 1

Bridge to Practice Ethics Paper

Shannon K. Umhafer

James Madison University

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Bridge to Practice Ethics Paper

Introduction

Length of stay within the hospital setting has contributed to various issues concerning

financial costs for the hospital and overpopulation of patients. According to Carey (2000), there

have been significant efforts made by hospitals and insurers to reduce length of stay for patients

in the hospital in order to provide considerable benefits in cost savings. Overpopulation of

patients leads to denying admission of individuals seeking entry into the hospital. Specifically,

emergency departments within hospitals have had such dramatic increases in number of patients

which caused hospitals to close (Lee et al., 2015). Length of stay can be extended by diverse

factors including patient’s deceit of condition, hospital-acquired illnesses, etc. Regardless of the

reason behind patients’ lengthened stay, there is a clear impact financially for the hospital and

ethically regarding admission of new patients in need of health care.

Background

Personally, I experienced an ethical dilemma regarding a patient’s length of stay in the

hospital during one of my clinical rotations. I was given one patient to care for the entire clinical

day. This patient was admitted to the hospital with the diagnosis of a urinary tract infection that

caused the patient confusion due to his elderly age. The patient had fallen in combination with

the symptoms of the infection and had been on the floor for several hours. When I entered the

room at the start of the day, the patient was completely oriented to person, place, time and

situation. I spent the day aiding the patient with feeding, toileting, bathing, etc. During all of

these tasks, I had a variety of conversations with the patient. The patient spoke to me about his

family and children, his career, his house, and what he enjoyed doing for fun. His wife had come

to visit and sit with the patient as well. When the doctor came in during the later portion of the
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day, the patient immediately stated that he did not know his date of birth, where he was, why he

was there, or who his wife was. This was contradictory from exactly what he was telling me all

day to just the minute before the doctor had entered the room. I remained in the room while the

doctor did his assessment of the patient and I did not speak. After the assessment, I left the room

and walked straight to my clinical instructor to explain the situation. An alternative way that I

could have responded in this situation would be to have waited for the doctor to exit the room

and speak with him about the condition the patient was in with me before he entered the room.

This position did cause me some moral distress for I was quite confused at why the

patient was deceitful about his condition to the doctor. When I spoke about this with my clinical

instructor, we evaluated some reasons as to why the patient would want to be deceitful about his

condition not improving. We decided that the patient could either seek to stay in the hospital

longer because he enjoyed the care and attention, or simply did not want to go to a nursing home

as detailed by discharge plans. After our discussion, I morally struggled because I had not taken

the opportunity to speak with the doctor due to my intimidation of being a nursing student who is

not yet a registered nurse. By the time I came to the conclusion that I should have told the doctor

about the patient, he had already left the floor.

Methods/Findings

In order to analyze this ethical dilemma, I am going to utilize the JMU Eight Key

Questions (The Madison Collaborative, 2013). The JMU Eight Key Questions include fairness,

outcomes, responsibilities, character, liberty, empathy, authority and rights. Individually and

collectively, these questions provide thought-provoking considerations that can be used during

ethical decision-making. Each individual question includes an elaborated description of what

should be reflected on when making a moral decision as well as examples of each.

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Fairness in this ethical dilemma plays an evident role. If the patient’s length of stay in the

hospital was extended due to deceit, there is not only an issue of fairness toward other patients

seeking to be admitted who could potentially have that bed; but also to the hospital and insurers

for further costs. Short-term outcomes could lead to a patient being denied admission into the

hospital because there is one less bed available for a patient who is not truthfully in need of

further health care. Long-term outcomes could result in this specific patient in the situation

struggling financially if insurance does not support an extended stay in the hospital. As a student

seeking to become a health care professional, I feel that it is my obligation to be honest in this

situation and fulfill my responsibilities as if I were a registered nurse. If I were a registered

nurse, I would approach the doctor and explain the patient situation rather than remain silent due

to my feelings of inferiority. Additionally, I believe this situation correlates with character in

JMU’s Eight Key Questions. I seek to hold high virtue and character in my profession, which

includes honesty. During the time that this situation occurred, I feel that I respected the patient’s

freedom and autonomy to express his words and thoughts to the doctor. Conversely, it is also my

freedom to communicate my perspective of the patient’s actions throughout the day that

significantly differed from the patient’s actions in the presence of the doctor. I felt empathy

toward the patients who are ill and could have a bed in the hospital. If this patient was one of my

family members, I would have tried to understand the reason behind the deceitfulness yet explain

the repercussions of his actions as well. After the doctor had left, I could have re-entered the

room and spoke with the patient about plans after discharge to see if the patient felt fear toward

arrangements that followed hospitalization. I view the doctor, hospital, and insurers as authorities

within this ethical dilemma who expect truthfulness and integrity. Lastly, I believe it is crucial to

respect the right of individuals who are ill to receive health care. In this moral dilemma, there
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could be prevention of sick individuals getting the help they need.

The American Nurses Association is one authority that reflects on nursing ethics by

creating provisions in the ANA Code of Ethics. Provision Six states, “The nurse participates in

establishing, maintaining, and improving health care environments and conditions of

employment conducive to the provision of quality health care and consistent with the values of

the profession through individual and collective action” (Olson & Stokes, 2016). This particular

provision includes influences of the environment on moral virtues, values, ethical obligations and

responsibility for the health care environment. It serves as a guide in making an ethical decision

regarding the situation I have dealt with. This statement instills that as a nurse, it is a duty to

improve the health care environment and in this case, the unnecessary lengthened stay of a

patient that could interfere with the health care of other patients as well as hospital costs.

Additionally, Provision Six acknowledges values in this profession which include honesty and

integrity. The ANA Code of Ethics offers aid in moral decision-making through these provisions.

Conclusion

After analyzing this moral dilemma with the use of JMU’s Eight Key Questions, ANA’s

Code of Ethics, and outside scholarly articles, I have concluded that I could have acted

differently in order to decrease distress and resolve the issue. It would still have been appropriate

to speak with my clinical instructor after the situation, but then also to approach the doctor and

explain to him what I had experienced with that patient throughout the day. This would have

upheld my integrity as a striving health care professional and would protect the health care

environment. Not only I, but others can learn how beneficial resources are in aiding in difficult

moral decisions. In the future, I recommend being valiant and despite feelings of inferiority,

acting out of personal moral truthfulness and upholding my duty as a person and professional.
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References

Carey, K. (2000). Hospital cost containment and length of stay: An econometric analysis.

Southern Economic Journal, 67(2), 363-380.

https://www.jstor.org/stable/1061475?seq=1#page_scan_tab_contents.

Lee, D.C., Carr, B.G., Smith, T.E., Tran, V.C., Polsky, D., & Branas, C.C. (2015). The impact of

hospital closures and hospital and population characteristics on increasing emergency

department volume: A geographic analysis. Population Health Management, 18(6), 459-

466. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319431/.

The Madison Collaborative. (2013). The Eight Key Questions Handbook. Retrieved from

https://www.jmu.edu/mc/Docs/131101%208KQ%20Handout%20Revision.pdf.

Olson, L. L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses with Interpretive

Statements: Resource for Nursing Regulation. Journal of Nursing Regulation, 7(2), 9-20.

doi:10.1016/s2155-8256(16)31073-0.