Abstract:
Beneficence and Nonmaleficence are the main “pillars” of the health care system. These two ethical principles seem to be the foundation and set a basic framework for the practice of health care. Hippocrates recognized the significance of these two principles and he pledged to practice healthcare following them (Morrison 48). The function of these two principles go beyond treatment of patients, in fact, it is relevant when dealing with the healthcare staff. As a health care administrator it is vital to create a working environment that runs by the two ethical principles as well as the ethical principle of justice. Justice comes into play because it is a healthcare administrator’s responsibility and obligation to make sure that each individual staff members is being treated fairly and equally. Thus, ethical issues that are raised in the workplace, specifically, in a health care facility, more often are associated with the principles of nonmaleficence, beneficence, and justice.
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A health care administrator is expected to follow all ethical guidelines in the practice of health care. The principle of nonmaleficence is to prevent harm from occurring or the “duty to avoid harming others” (Morrison 48). This is associated with the treatment of patients which should be done with care and not carelessly. Additionally, the patient’s autonomy should not be violated under any circumstance in order to prevent potential harm from taking place. In the “U.S. Hostile Workplace Survey” that was taken in the year 2000 showed that about one out of six workers in a workplace experience some type of bullying that occurred within the last six months (ahanews.com). This shows that some health care administrators are not fully looking after their healthcare facilities and this is allowing bullying to take place. In this case, the healthcare administrator is not doing his/her job in preventing harm, and is therefore not following the ethical principle of nonmaleficence. Furthermore, nonmaleficence goes beyond merely preventing physical harm that might take place during a treatment procedure such as surgery, but it also refers to preventing any harm from occurring to the staff and healthcare facility. The benefits and harms are most often weighed against each other in health care to guide what needs to be done.
It is a responsibility of the health care administrator to construct an environment that is not harmful for the employees or staff members. In addition to preventing harm to patients, you must prevent any harm from occurring to the staff as well. The issues of discrimination, bullying and harassment, including sexual harassment in the working environment must be fully and openly addressed. These topics should be taken in as being intolerable and potential harm should be prevented to the employees in risk of these. Moreover, any type of bullying that may occur in the work force should be prevented. Bullying in the workforce is extremely prevalent and this most commonly leads to depression and lowered morale of the individual staff member being bullied. There should be a positive environment in the work area for open discussion and no fear of judgment in the case of telling the HCA about the bullying. There should be an ease to talk to the HCA, and he/she should create an open relationship with the staff so there is strict guidelines needed to be followed, but an openness to speak about issues of bullying, discrimination, or harassment. There should be a procedure to report someone who is harassed and they should not feel fear of reprisal for mentioning the issue. The supervisor should not be so strict or too lenient because the staff could be scared or too comfortable with him/her. In order to be fair and equal and prevent any harm by being too strict or too lenient, the principles of justice and nonmaleficence need to be followed.
Bullying can include “intimidating and disruptive behaviors” which can cause significant issues for a staff member who is experiencing lowered morale. The staff member being bullied could have trouble caring for the patient as effectively, thus can cause “poor patient satisfaction”. Patient care in a healthcare facility is reliant on “teamwork, communication, and a collaborative work environment.” It is important to provide a safe environment and to do so a health care professional who is experiencing bullying or seeing it occur should report it or address the issue. Addressing the issue is very crucial to the success of performance and patient care. The joint effort is needed in health care organizations and a mere act of bullying can affect the entire healthcare facility by lowering the morale and lowering the teamwork and interaction. This is obviously causing harm and the principle of nonmaleficence is not coming into play when bullying has occurred. Therefore, the health care administrator should adopt a code of conduct in order to follow guidelines and ensure that the staff members are clear what is bullying. Additionally, it is essential “to create and implement a process for managing disruptive and inappropriate behaviors” in the workplace (newworkplace.wordpress.com). This will ensure that every staff member is being treated fairly and the principle of justice is being followed.
More commonly it has been seen that bosses are one of the main sources of bullying. Physicians oftentimes feel that they might know better or more than nurses and treat them unfairly which is going against the principle of nonmaleficence because they are directly causing harm instead of preventing harm. It was seen in one situation that a physician refused to allow his staff member to go to the bathroom which was insulting as well as inappropriate bullying. The “National Accrediting Agency” now requires of some hospitals to adopt a code of conduct which addresses issues of bullying. “Intimidating behavior” or bullying can cause staff members to become submissive because of the bullying has cause psychological harm to the individual and this oftentimes leads to medical errors and errors in patient care (workplacebullying.org).
A health care administrator has the responsibility of being observant of what is going on in the working environment around him/her and to recognize any social isolation issues, belittling, and overload of work on one particular employee. Segregation and isolation oftentimes occurs due to bullying, however, sometimes it refers to cultural differences. It was seen that the staff members at a particular hospital were critical of the other Latino or Spanish-speaking employees and this caused a rift. There was obvious “prejudice” and “stereotyping” because the staff did not communicate with the Latino staff members as much, which caused language discrimination (gradworks.umi.com). This discrimination caused isolation of one particular group and it could and should have been spotted easily by the HCA whose responsibility it is to recognize instances of discrimination and isolation. This situation is also associated with racial discrimination which means that a group is isolated due to their ethnicity. It is thus the HCA’s responsibility to prevent harm and act on the principle of nonmaleficence; he/she should also ensure that the ethical principle of justice is being practiced by the staff members and everyone is treated fairly and equally. By fixing the problem and causing the staff members to accept each other the health care administrator would be bringing about good which is acting on the ethical principle of beneficence.
Racial discrimination is very common when it comes to the workplace. Many have felt that they were refused a promotion because their ethnicity or race. Nurses, specifically Caucasian nurses, felt isolated and discriminated by nurses of different ethnicities. The other nurses who spoke a non-English language seem to exclude Caucasian nurses which cause segregation and is something that should be prevented in the work place (diversityof.net). The impact of this isolation can cause low team effort and cause patient care to be poor. National surveys have shown that many physicians that are of a “racial/ethnic minority” often feel isolated and racially discriminated in the working environment. Racial discrimination among physicians in the workplace causes “lower rates of promotion and career satisfaction when compared with nonminority physician peers with similar productivity” (nmanet.org). Ultimately, this has caused a poor working environment and discrimination causes harm to the staff members as well as the health care organization.
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In addition to preventing harm, a health care provider must also do good for the patients, which is the principle of beneficence. Beneficence refers to the obligation a HCA has to his/her patients in providing fair treatment that will benefit them, protecting patients’ autonomous rights and providing aid for anyone in need. It is also an obligation of a health care administrator to bring about good in the workplace and make sure it is a safe working environment for his staff. There should be an appreciation which comes with this principle and should be displayed to the staff members in order to encourage them to always do better and continue to have a high morale. An HCA should balance the benefits and potential harms by deciding the costs against benefits and deciding what would provide the greatest good. The principle of beneficence should always be reinforced in order for the staff members to apply this ethical principle daily. Staff should be treated with beneficence in order for them to treat patients using this same principle. It is the responsibility of the administrator to be encouraging and compassionate towards the staff and to prevent negative attitudes which can lower the morale and cause potential harm. Also, an administrator should always offer assistance whereas being too authoritative would make the staff uneasy. Undoubtedly, the administrator should work on the weaknesses of the staff members and build upon their strengths in order for each individual to use their strengths for the good of the health care organization.
Furthermore, downsizing in the workplace which include laying-off employees can affect the employees that are laid off as well as the staff members who are left feeling guilty and cannot work as efficiently due to this guilt. An HCA should not be keeping silent in a time when laying off is occurring because it can lead to rumors spreading around the workplace and a situation can become worse than it really is. Also, it can cause employees to be stressed and upset, which inevitably causes harm. After the lay-off has occurred, there should be open forums and discussion in order to be aware of everyone’s feelings towards the issue. The work place should be safe and healthy as well as have a positive atmosphere in order for there to be no fear of judgment which will prevent harm from happening such as harassment, bullying, or discrimination.
The ethical issues raised in the workplace can range from bullying, discrimination, to harassment. These issues in the workplace cause harm to the staff members due to lowered morale and poor working efficiency. Discrimination can isolate and segregate groups of people or one person due to ethnicity, which would be racial discrimination or by other factors involved. This inevitably causes harm and not everyone is being treated fairly, thus the principle of nonmaleficence and justice are not being applied. Beneficence should be used when creating an environment that is safe and positive for the staff members to feel comfortable enough to report bullying, discrimination or harassment. Nonmaleficence, justice and beneficence are interconnected and work together in many situations for good ethical decision making. The relationship between the employee and administrator and the staff members themselves should be positive if using these three principles.
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