title: Ethical conflict associated with managed care: views of nurse practitioners.
abstract: BACKGROUND
  Ethical conflict of nurse practitioners (NPs) practicing within a managed care environment has not been systematically examined, yet like physician practitioners, NPs are confronted with daily ethical conflicts.
  
  
  OBJECTIVE
  To determine perceptions toward ethical conflict in practice espoused by NPs affiliated with managed care systems and to identify the relationship between selected individual, organizational, and societal/market contextual factors and ethical conflict in practice.
  
  
  METHODS
  Descriptive, cross-sectional, correlational survey of a stratified random sample of 700 NPs licensed and certified to practice in the state of Maryland, conducted from November 2000 to January 2001.
  
  
  RESULTS
  A majority of respondents reported being moderately to extremely concerned with managed care. Eighty percent of the sample perceived that it was sometimes necessary to bend managed care guidelines with 61% agreeing that the practitioner must weigh the patient's interest against managed care organizations' interests. The NPs in a staff/group model health maintenance organization (a) were less ethically concerned (p <.001); (b) perceived the ethical environment more positively (p <.001); and (c) had lower ethical conflict scores (p <.001) than NPs in other types of practice settings.
  
  
  CONCLUSIONS
  Results from this study indicate that NPs are experiencing ethical conflict associated with practicing within a managed care environment; however, NPs in a staff/group model health maintenance organization report these concerns less. Ethical support through intervening strategies (i.e., ethics education and interdisciplinary ethics support systems) may help mitigate the conflict associated with this system of care.
authors.affiliation: Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. culrich@cc.nih.gov
authors.forename: Connie M
authors.initials: CM
authors.lastname: Ulrich
authors.forename: Karen L
authors.initials: KL
authors.lastname: Soeken
authors.forename: Nancy
authors.initials: N
authors.lastname: Miller
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D004993:Ethics, Nursing / Q000193:education; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008329:Managed Care Programs / Q000941:ethics / Q000458:organization & administration*; D040541:Marketing; D008396:Maryland; D009722:Nurse Practitioners / Q000193:education / Q000941:ethics / Q000523:psychology*; D024802:Nurse's Role; D015404:Nursing Methodology Research; D015279:Organizational Culture; D017009:Professional Autonomy; D012044:Regression Analysis; D011795:Surveys and Questionnaires