Nursing Education Ethical Issues
Nurses seem to face ethical issues on a semi-regular if not a regular basis. Every nurse has faced an ethical issue at some point in their career. It doesn’t matter which area of nursing one works, ethics and ethical issues seem to rear up at what this author would consider “inopportune times.” Some of the issues are easy to deal with or work through, while others do not seem to have a clear cut and dry, right or wrong answer. When this happens, the nurse is faced with an ethical dilemma.
In order to determine what an ethical dilemma is, the terms ethical and dilemma need to be defined so there is a clear understanding. According to Merriam Webster ethical means “of or relating to ethics; involving or expressing moral approval or disapproval; or conforming to accepted standards of conduct” (Dictionary and Thesaurus -- Merriam-Webster Online, 2011). Also according to the same source a dilemma is defined as “an argument presenting two or more equally conclusive alternatives against an opponent; a usual undesirable or unpleasant choice; or a problem involving a difficult choice” (Dictionary and Thesaurus -- Merriam-Webster Online, 2011).
Now that the terms have been defined the content of this paper can be discussed.
This paper will use Davis and Aroskar’s ethical decision making model to work through an ethical dilemma that is relevant to nursing education. This model has several components involved when attempting to resolve an ethical dilemma. The steps involved in making a decision include the following” reviewing the situation and identifying what is going on; identification of significant facts; identify the stakeholders; identify relevant legal data; identify ethical principles; identify possible choices and their consequences; identify the practical constraints; recommend an ethically supportable action; and finally act or evaluate the action (Davis & Aroskar, 1983).
The ethical issue to be explored in this paper is as follows. A certain school of nursing needs ten students in order to have a cohort to be able to start classes. There are nine students that meet the criteria for admission to the program. The tenth student that applied does not meet the criteria for admission to the nursing program. The faculty knows that there is a nursing shortage and that they need to have a class on track to graduate to help fill the much needed positions. The dilemma involved in this case is to admit the student that does not meet the criteria for admission so that they can start a new class of nursing students on the path to helping the nursing shortage.
The Significant Facts
The significant facts in this particular situation are that there is a nursing shortage. The school of nursing needs ten students to have a graduating class. There are only nine students that meet the criteria for admission. The tenth student that applied does not meet the admission criteria. The faculty have to make a decision whether or not to allow the tenth student to be admitted so that the nine students -- who are ready to go through the program -- to help with the nursing shortage.
The stake holders in this situation include the following: the school of nursing, the faculty, the students, the accrediting body, the student’s parents, the university where the school of nursing is located, and potential future students. Now that the stake holders have been identified, let’s examine why these particular aspects have a vested interest in this situation.
The school of nursing’s interest in this case is to have a cohort of students that can have a class start the nursing program. The vested interest of the faculty is to have a cohort of students to educate, continue working, and make money. The vested interest of the students would be to start and finish the nursing program and to take and pass the NCLEX so they can start working and do what they love and make money. The accrediting body for the school of nursing is interested in making sure this particular program has an acceptable NCLEX pass rate to continue granting accreditation.
The student’s parents would be interested in getting the most “bang for their buck.” They would want the students to be able to start and finish the nursing program. The university where the school off nursing is located would be interested in retaining as many students as possible and having an accredited school of nursing that they can advertise to bring in potential future students. The future students would be interested because if the school of nursing doesn’t have a cohort to start the program or doesn’t have a certain NCLEX pass rate, the school of nursing could loose their accreditation.
Relevant Legal Data
The relevant legal dada in this situation might include cheating the government out of money. This would come into play if the student that wasn’t ready failed out of the nursing program, the university would have collected federal money in the form of financial aid. If the student truly didn’t meet the admission criteria and this information is found out, it could potentially affect future students from receiving financial aid to attend this university.
Ethical Principles, Values, or Rules
Let’s now examine the ethical principles, values, or norms and then look at each one individually to determine which one’s apply to this situation. The principles are as follows: beneficence/non-maleficence, autonomy, veracity, confidentiality, justice, and fidelity. Beneficence and non-maleficence refers to doing good things and to not cause harm to anyone. Autonomy means self-directing freedom or an individual’s right to choose. Veracity means being honest and telling the truth in respect and autonomy. Confidentiality is defined as containing information whose unauthorized disclosure could be prejudicial to an individual’s interest. Justice refers to the fact that the benefits and burdens are equally distributed. Lastly, fidelity means being loyal, trustworthy, and keeping promises that are made.
Beneficence/non-malificence is pertinent in this situation because the nine students who are ready and meet the criteria should not be punished simply because there are not enough students to enroll and start a class. Autonomy is pertinent in this situation because the student had a right to choose which nursing school they wanted to attend. It also comes into play for the faculty because each person has to decide if the tenth student should be admitted to the nursing program.
Veracity would also be involved in this issue because if the student that didn’t meet the admission criteria was admitted, the faculty would need to let that student know they ere only admitted on a probationary basis. It would also come into play if the tenth student wasn’t allowed to enroll, the school of nursing would need to tell the other nine students that they would not be able to start the program and should be told why.
Confidentiality would be important in this case because if the tenth student is allowed to enroll, the college of nursing and the faculty would need to keep that information private and only share that with the tenth student. Justice would be an important principal in this case because the faculty needs to not only consider the benefits of what allowing the tenth student to enroll would do for the program, but also consider what the burden or burdens’ might be for allowing the tenth student into the program.
Lastly, fidelity would com into play if the nine who met the criteria were promised to have a class to start; the faculty would need to allow the tenth student to be admitted. Likewise if they did admit the tenth student and told that student they would receive as much help as they needed to “catch up” to the rest of the students, that help should be readily available. The faculty would have to be careful of how the help is offered so as to not appear to be playing favorites to the tenth student.
Conflicts Between Ethical Principles
Beneficence would conflict with fidelity in this situation. Doing no harm to the nine students who are prepared and meet the admission criteria would conflict with the honesty and trustworthiness of the nursing program. IF the program has a reputation of only having a certain caliber of student and it is found out that student number ten wasn’t that same caliber, the whole program might be called into question. Beneficence would also conflict with veracity because the school of nursing would be doing the good for the most by allowing the tenth student in to the program, but the program isn’t exactly being honest or telling the truth to the nine students that meet the admission criteria.
The possible choices that would be made in this situation include the following: not allowing the student that doesn’t meet the admission criteria into the nursing program, admitting the student that doesn’t’ meet the admission criteria into the program, or trying to recruit another student on campus that meets the admission criteria. Let’s now explore each option and the possible consequences of each.
If the school of nursing decides to not admit the tenth student, then the nine students would meet the admission criteria suffer. The school risks possible lack of funding, lack of being accredited again by not having a graduating class for a year. The faculty would possibly be temporarily laid off because of not being able to have a class to teach. If the school of nursing decides to admit the tenth student then they would have enough for a cohort, but one student would need extra help. The tenth student might disrupt class a lot with a lot of questions, might give incompetent care during clinical, and could very well likely fail out of the program thus causing them to be ineligible for further financial aid. The third option might be trying to recruit another student on campus that meets the admission criteria. This might be an issue if the recruited student is needed for another program to have a cohort and enrolling that student into the nursing program might make the other program suffer. This could also be an issue if the recruited student fainted at the sight or smell of other people’s bodily fluids or had a very strong dislike for certain people in the medical field or with certain type of people.
The practical constraints of this situation include stealing financial aid from the government for a student that isn’t prepared for the program. The constraints on the nursing program include having a cohort of students to be able to teach or having to be laid off for a semester or a year (depending on how often the school of nursing under goes the admission process) and not having any income. This would also be a financial constraint on the faculty and the school by loosing out on money and would apply to the student’s because they would either fail out of the program or not be able to enroll due to lack of qualified applicants. Other constraints include academic in which the school of nursing could potentially loose accreditation, thus hurting the reputation and being able to effectively recruit future students.
Recommend An Action
After looking at all the information presented in this paper, it would appear that the ethical decision to be made is to allow the tenth student who doesn’t meet the admission criteria to be admitted into the program. In this circumstance the needs of the many outweigh the needs of the few. The nine students that meet the admission criteria should not be told “I’m sorry we just don’t have enough students to start a new class.” With the nursing shortage, the profession needs as many new nurses as it can possible get. The faculty or program coordinator should set up a meeting with the tenth student to let that student know they are only being admitted under probation and provide that student with a list of places and recourses available on campus where they can seek help when the need arises.
Author: Jason hawkins RN, BSN, MSN
Davis, A. J., & Aroskar, M. A. (1983). Ethical dilemmas and nursing practice (2nd ed.). Norwalk, CT: Appleton-Century-Crofts.
Dictionary and Thesaurus -- Merriam-Webster Online. (2011). http://www.merriam-webster.com/