Ethical, Legal and Social issue in Health care– What is the major ethical dilemma the administrator faces?

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Ethical, Legal and Social issue in Health care
Case Study
The question is
– What is the major ethical dilemma the administrator faces?
Outline both the reasons to maintain confidentiality and arguments
for breaching confidentiality, in your own words. Briefly discuss
your final decision and how you came to this conclusion.
in order to answer the above question you should
1) Read Badzek article on Confidentiality. See the case study
Jackie did find the work extremely stressful. She rarely had the
same unit and patient assignment. Each day she worked on a
different unit with different co-workers. She developed few
friendships or collegial relationships. She was often dispensing
medications and treatments she found unfamiliar. When she attempted
to ask questions, she found she approached gruff busy attending
doctors and young uninformed house staff. Jackie’s supervisor,
Karen, was sympathetic to the problems associated with nurses who
work in the flex pool; however, Jackie felt she offered no concrete
ways to decrease the stressors. The pressure at work was becoming
intolerable, but Jackie’s husband was pleased with the increased
income. He urged her to keep working and told her the overtime was
adding an unexpected boost to their savings. Feeling trapped,
Jackie began to divert narcotics. Jackie was able to justify her
actions because she perceived the drugs reduced her anxiety and
stress, which enabled her to better care for her patients.
Jackie’s diversion went unnoticed since she went to many
different units. Initially, she signed out drugs to patients who
had not requested pain medication but had orders for it; later out
of a fear of being caught she began to substitute saline for the
drug in the syringe. Even then the problem did not reveal itself,
for a patient’s lack of relief for one shift might result in an
increase in the dosage, that would then be reduced when not needed,
and Jackie would be off to another unit. Ultimately, she was
discovered when she was assigned to a surgical unit for three weeks
to relieve for someone on vacation. The pattern of suspected drug
diversion was identified by the pharmacist who noted an unusual
increase in narcotic use and found several signature errors on the
medication record of a unit noted to have the lowest number of
medication errors. The pharmacist reported the information to
Michele, the nursing administrator for that unit. Michele’s review
of the pharmacy records, narcotic inventory sheets and patient
records and staff schedule led to the inescapable conclusion that
Jackie had been diverting drugs. Michele informed Karen, and
together they confronted Jackie who confessed to the behavior. As
Jackie had confessed, and asked for help, Karen decided to grant
Jackie a leave of absence to pursue rehabilitation, with the
expectation that she could have her job back if she successfully
completed the program. Karen did not believe it was necessary for
Jackie to report to the State Board of Registered Professional
Nurses since she was actively engaging in rehabilitation
Following these events, Michele called together the nurse
manager of the surgical unit where the diversion was discovered,
the human resources (HR) director, and the chair of the nursing
ethics committee to determine what further action should be taken
and how to best communicate to the unit staff the action taken
against this individual. Michele believed Jackie had a right to
privacy and confidentiality, but thought perhaps an open staff
discussion was needed to highlight for the staff the prevalence of
nurse addictions and to see if anyone knew or suspected, and didn’t
act. Her concern was motivated by the fact that patient’s pain
relief was compromised, and that Jackie’s actions caused harm to
her clients. She was also concerned that in the future, should
Jackie return, how would they handle her situation? When Karen
learned of the meeting she objected to the planning of an all staff
meeting as she felt it would compromise Jackie’s confidentiality.
The initial meeting was thus limited to the two nursing directors,
HR director, and the ethics committee consultant.
At the meeting, the issue was identified as being one of
confidentiality, but with the two nursing administrators having
different focal points as to the scope of confidentiality, and its
impact on others. Michele felt that Jackie’s actions had
compromised her professional status, and because patients had been
affected, and other nurses’ actions had been impacted by Jackie’s
performance, a full discussion needed to take place with the
nurses. Michele wanted to determine what people knew or suspected,
and if so, why they didn’t act. She wanted to reassure the staff
that a problem had been found, and that action had been taken with
the particular nurse. This was important to her to show that
administration was committed to appropriate action in providing a
safe practice environment of competent peers. Without this, she was
concerned that suspicions would continue to circulate throughout
the staff, and that the rumors of drug diversion would create a
climate of distrust. She was also concerned that if and when Jackie
returned to work staff members would need to know that an
individual with a substance abuse history would be one of their
colleagues. Michele was surprised to learn that Karen had not
reported the incident to the State Board of Nursing. Michele
believed that even though the hospital was willing to sponsor her,
Jackie still needed to self report to the State Board of Nurse
Examiners and request that the Board defer action until she
completed rehabilitation. The State Board of Nurse Examiners,
according to state law, has the authority to take disciplinary
action, ranging from a reprimand, probation, suspension, revocation
or refusal to renew a license. In some instances a restriction is
placed on the scope of practice (Aiken & Catalano, 1994).
Karen remained adamantly opposed to conducting a general staff
meeting to discuss this. In her view, confidentiality was to be
protected without exception. She felt that administration was aware
of the incident and the corrective action was being taken. She
believed a thorough review of the patient records had determined no
actionable adverse outcomes. Contrary to Michele, Karen maintained
that if Jackie’s situation became known to the staff, they might
fear that other confidential information might be shared as
determined by administration to be “necessary”. Karen was unwilling
to consider reassigning Jackie. Michele believed that Karen’s
actions were inappropriate. Michele believed she had an obligation
to not only safeguard the patients but also to promote competent
nursing care within the profession and the organization. What
should Michele do?
**Please dont copy and paste from any sources

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