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This article presents a case study highlighting the conflict between an individual’s right to privacy and the rights of patients and staff to know when a professional standard has been breached. The process by which the administrator determines a course of action is reviewed in the context of workplace realities through an ethical analysis. The growth of information systems and the increased involvement of third parties in decision-making have created new issues regarding confidentiality and the release of sensitive information for health care personnel who are in a position of public trust.
The issues facing nursing administrators are complex, and of particular concern are the conflicting demands of providing quality care with limited resources. The authors identify strategies to deal with the workplace issues that give rise to the potential for abuse as well as the strategies to support an impaired colleague who attempts to reenter the workforce (Badzek, Mitchell, Marra, & Bower, 1998).
When asking the general public what health care ethics and health care privacy mean, most will relate that they are about protecting patients. Health care ethics and health care privacy do exist to protect patients and to ensure that care is delivered with moral and ethical standards. Health care ethics not only apply to patients, but to organizations as well. The rapidly changing world of health care is witnessing a growing need for institutional ethics that includes ethical employer-employee relations.
The article cited in this paper highlights two managers that encounter an employee diverting narcotics on the job, how each manager deals with this incident, and the ethical dilemma of whether this employee is entitled to confidentiality or if fellow staff should be informed of the narcotic abuse. Identifying and analyzing the ethical question is how the best possible solution may be determined. By examining the issue and its impact on the population affected, discussing the proposed solution, and highlighting the ethical and legal implications of the issue will explain managerial responsibilities in this case. Issue and Impact
The article reflects the ethical dilemma of whether or not an employee who has been identified as using diverted narcotics on the job is entitled to confidentiality or if the staff involved with the employee are entitled to know about the drug abuse. Jackie is a nurse that has returned to work after taking many years off to raise a family. She takes a job at a hospital working in the flexible staffing pool. As time passes, Jackie finds that work is extremely stressful because she rarely works in the same unit. She is asked to pass meds and perform work she is unfamiliar with and despite asking for help, has not received adequate support.
The increasing stress leads Jackie to divert narcotics. Jackie’s diversion of narcotics goes unnoticed for quite awhile because she works in so many different units. She is eventually discovered when she spends three weeks in the same unit covering for someone’s vacation. Michele and Karen are both nursing administrators involved in Jackie’s case. Jackie reports directly to Karen, who is head of the flexible nursing pool. Michele is the nursing administrator of the unit Jackie was discovered diverting narcotics from.
Karen makes the decision to grant Jackie a leave of absence to pursue rehabilitation. The stipulation of completion of the rehabilitation program will allow Jackie to return to her job. Karen does not report Jackie to the State Board of Registered Professional Nurses because she is actively engaging in rehabilitation activities. Following these events, Michele meets with the human resources director, the nurse manager of the unit Jackie was working on when the drugs were diverted, and the chair of the nursing ethics committee to determine if further action should be taken.
Michele believes that Jackie has a right to privacy and confidentiality, but thinks that an open staff discussion is needed to highlight for the staff the prevalence of nurse addiction. She also wants to identify if anyone knew or suspected Jackie’s diversion of narcotics and didn’t act. Karen’s concern is motivated by not knowing how to handle Jackie’s issue should she return to work and by the fact that Jackie compromised patient’s pain relief by diverting their narcotics. Karen objected to planning an open staff meeting because she felt it would compromise Jackie’s confidentiality. Supporting the Proposed Solution The issues to address involve separating the greater good of the patient population and the rights of the other staff from the individual right of Jackie’s confidentiality. Karen believes that confidentiality should be protected without exception and that the corrective action initiated by the administration was adequate. Karen also argues that if Jackie’s situation becomes common knowledge to staff, they might fear that other confidential information will be shared by administration.
Michele believes that Jackie’s actions warranted a discussion with the nursing staff to determine if anyone knew or suspected and why they did not act. Despite Jackie’s willing participation in rehabilitation, she still needs to self-report to the State Board of Nursing. Mandatory reporting for most state boards includes actual or suspected drug diversion (Arizona State Board of Nursing, 2012). The State Board of Nurse Examiners assesses each report and can take disciplinary action, ranging from a reprimand, probation, suspension, revocation, or refusal to renew a license (Badzek et al., 1998). Michele needs to collect information about her organizational policy and procedures in relation to impaired employees. The state Nurse Practice Act provides standards of practice that reflect current state laws and regulations. In the absence of relevant law, ethics help determine what is morally acceptable (Weinstein, 1995). Information regarding the ethical and proper management of nurses with substance abuse problems is also available through the American Associations of Colleges of Nursing (AACN).
The arguments for protecting private information are closely linked to human dignity and respect (Garrett, Baillie, & Garrett, 2009). It is incredibly important for Michele to utilize all of these resources to sort through her legal and ethical obligations to patients, Jackie, other staff, and her profession. Managerial Responsibility Michele ultimately honors Jackie’s privacy and confidentiality, but in order to fulfill her ethical obligation to the nursing profession, she also finds solutions to place measures to provide competent, ethical nursing conduct. Solutions include: 1) clarifying policies and issues of employee confidentiality 2) Identifying and developing education for administration in identification of ethical issues and decision making 3) Reviewing and improving policy in regards to impaired employees 4) Educating all staff about the signs and symptoms of drug abuse, reporting requirements, and the available resources. Conclusion When discussing privacy and confidentiality in healthcare we often assume that this is in regards to patients only. What the healthcare community is finding is that it is equally important to have clear policy and code regarding privacy in employer-employee relations.
Ethical dilemmas are complex and require collection of all pertinent information to find ethical solutions. This paper highlighted an ethical dilemma that involved a choice between honoring an employee’s privacy and disclosing important information involving substance abuse to the other staff. Examining the facts and collecting information from professional organizations and regulatory agencies assisted in reaching an ethical decision. Not only was the employee’s privacy honored, the organization improved processes to recognize and deal with substance abuse more effectively.