How does the nurse manager or leader play a role in the re engineering of health care?Decisions based on ethical and legal principles are common in a person’s life. Choices such as whether to indulge in gossip (breaching confidentiality)

How does the nurse manager or leader play a role in the re engineering of health care?Decisions based on ethical and legal principles are common in a person’s life. Choices such as whether to indulge in gossip (breaching confidentiality)
HEALTH CARE
Reengineering Health Care 5/1
How does the nurse manager or leader play a role in the reengineering of health care?
Reengineering Health Care
Introduction
Decisions based on ethical and legal principles are common in a person’s life. Choices such as whether to indulge in gossip (breaching confidentiality) or driving too fast on the highway are examples of these decisions. Making good ethical and legal decisions in nursing management or leadership practice requires understanding of the underlying principles and incorporating that knowledge into the decision-making process.
Ethical Decision-Making
Ethical decision-making is similar to other decision-making processes in that it requires the manager to gather information, identify the problem, generate alternatives, or select an alternative to implement, and evaluate the results. The difference in ethical decision-making depends on the identification of the ethical principles that guide the selection and expectations of the outcome.
The principles underlying ethical decision-making include concepts that are familiar to practicing nurses. Is it best for the nurse to use specialized knowledge to make decisions for a patient (paternalism) or to support patients in making their own decisions (autonomy)? Are there circumstances in which the need to benefit the majority of staff (utility) outweighs the need to treat everyone fairly (justice)? Is telling a white lie (violating the principle of truth-telling) justified when it is believed that the withholding of the truth will benefit the recipient (beneficence)? These are the competing obligations that create ethical dilemmas. Ethical decision-making requires the identification of competing principles as a part of describing the problem.
Ethical frameworks and professional codes of ethics exist to assist the manager in ethical decision-making. Both frameworks and codes provide guidance in valuing one principle above another, but do not directly provide the solution. There are several ethical frameworks. Two commonly used frameworks are utilitarian-based and rights-based. A utilitarian framework advocates selecting an alternative that will result in the greatest good for the greatest number of people, focusing on the projected outcome. An example of using a utilitarian framework is the isolation of a patient with a communicable disease. Although this isolation infringes on the person’s autonomy, the common good (utility) of not spreading the disease is served. A rights-based framework focuses on the process of decision-making and utilization of identified rights or entitlements. This type of framework is evident in The Bill of Rights for Registered Nurses (The American Nurses Association, n.d.).
Professional codes of ethics have been published by several professional nursing organizations. These codes generally support the principles of autonomy, justice, and beneficence, but they also acknowledge that there are times when competing obligations may require the nurse to select alternatives based on other principles.
Ethical decision-making is also unique in that it often entails choosing among less than desirable alternatives. The outcome of the decision may not be judged as good but as better than other outcomes. When evaluating the outcome of ethical decision-making, reviewing the process used to make the decision is as important as the result (Marquis and Huston, 2009).
Legal Environment in Nursing Management

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