Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part II.
OBJECTIVE
The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics.


METHODS
In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities.


METHODS
An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved.


RESULTS
Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified.


CONCLUSIONS
1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.
O'Donnell
Lolita T
LT
School of Nursing, College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA. lodonnel@gmu.edu
D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D019090:Case Management / Q000941:ethics* / Q000458:organization & administration; D002755:Choice Behavior / Q000941:ethics; D003220:Conflict, Psychological; D004991:Ethics, Institutional; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000941:ethics* / Q000458:organization & administration / Q000523:psychology; D010344:Patient Advocacy / Q000941:ethics; D010351:Patient Discharge; D010558:Personnel Loyalty; D011209:Power, Psychological; D011340:Problem Solving / Q000941:ethics; D017009:Professional Autonomy; D011361:Professional Competence; D036301:Qualitative Research; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014600:Utilization Review / Q000941:ethics; D035862:Vulnerable Populations