Favoritism Is Unethical In Nursing, Article Review Example

Healthcare professionals operating within clinical settings, education, administration, and research, and administration are still vulnerable to unethical behavior. On a regular basis, individuals in these sectors deal with ethical challenges. Some of the causes of these challenges can be attributed to reductions in the number of clinicians available to deliver quality patient care, inadequate staffing routines, consolidation of healthcare organizations, limited budgets and impractical budget containment tactics, and ineffective leadership have all further enhanced presence of ethical challenges facing the healthcare industry (Murray 2010). Likewise the American Nurse Association’s code of ethics has specific guidelines that dictate how nurses should interact with colleagues and one another. The following to take a deeper look into the nature of of favoritism and ethics in nursing.

Favoritism in a clinical Academic Setting

Organizational cultures end up harboring unethical behavior in response to acts of favoritism. The authors note another side effect is that students and staff end up compromising their personal and professional standards in attempts to avoid losing favor (Murray, 2010). Napa Valley College recently faced a scandal regarding its nursing program when a group of nursing students who attended Napa Valley College accused the institution of unethical behavior and rampant harassment. The group also claimed that complaints to college administrators were ignored. Specifically 11 nursing students, put their name on a letter to college officials, the letter claimed that the Napa Valley College Nursing department was plagued with a lack of oversight in regards to the bias practices of the school’s professors. The letter further noted, “the Napa Valley College boasts a campus free from discrimination,” the students said, yet “in our short time as students, we have witnessed professors’ use their authority to pass or fail students based on their preference” (Dills, 2013). A core issue that seemed to be the main reason why the conflict was brought to the attention of the media, verses being resolved through campus administration, was due to the fact the university implemented no remediation in response to performance reviews of their instructors. No professors were fired.

Combating Favoritism in a Clinical Academic Setting

One subtle way proposed to combat favoritism and its use in the academic setting is through the use of project based learning groups in clinical academia. Project based learning groups create a learning community environments that make it more difficult for nursing instructors to play favorites, and less likely for students to feel isolated and deprived of equal opportunity to acquire knowledge in the field. The learning community is a group used in professional settings among nurses and their colleagues or in academic setting among groups of students that create a supportive educational environment. Elzubeir (2012) states that, “in three 90-minute small group PBL tutorials per week. They work in groups of eight to ten students with a student chairperson and a scribe. They are supervised by a PBL tutor who facilitates the process. These PBL tutorials are supported by resource sessions including lectures, theme sessions, practical classes, web-based learning packages and clinical sessions in the main teaching hospital” (Elzubeir, 2012). This is the method through which learning communities are established in clinical settings where students can take advantage of evidence based learning through group projects and receive group grades. While there is still the potential for inter-group and outer-group prejudice an example of how a learning community is setup; most importantly, the students are interacting,  putting them in the perfect position to learn from one another.

Dogherty and Graham (2010) detail the process of program planning and the impact it can have on  as procedure to establish evidence based practice in nursing and a way for administrators to have a more hands on approach in respect to the oversight of their instructors.  They argue that the best nursing program is one that can provide the most realistic atmosphere and utilize the most current resources in the industry They state that “further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence-based practice in nursing (Dogherty & Graham, 2010).”  They further point out that much research is needed early on to establish a clear understanding of the objectives and resources required to establish a relevant and competitive program that can match others within in the industry. They note that one may find the need to change certain instructional requirements in response to industry changes to make sure evaluations are effective and correspond with nursing approaches in the field (Dogherty & Graham, 2010).

Favoritism in the Nursing Profession

In one of the first studies done on favoritism in personnel to patient interaction in clinical settings Francoise R. Morimoto (1955) actually argued in favor of the use of favoritism as opposed to creating an environment where care is impersonal. Morimoto states that the orientation of psychiatric nursing to patient care has always been based in the belief that nurses should provide fair and equal treatment to all patients, and distribute attention unilaterally across clinical settings. The author argued that this perceived ideal practice is actually impractical, noting that, it is essential to provide optimum care that individual differences be take into account, and in order to do so, the nurses feelings towards patients and the patient’s feelings towards the nurse play a pivotal role in that process  (Morimoto, 1955).  Even though the nurse has responsibility to care for all staff, she is going to naturally find certain patients more appealing than others as patients wills also grow to have their preferences. Morimoto’s main argument is that acknowledging this aspect of favoritism and utilizing at as a fundamental aspect of treatment, while unethical on the surface, it may produce optimal results.

There are also instances of favoritism within the nursing profession between groups of nurses. This can lead to disruptions in the ethos of cooperation which is ethically supposed to be the standard corporate culture within clinical settings. Oaker & Brown (1986) studied inter-group relationship between nurses in various fields. The authors utilized social identity theory to assess whether data retrieved from 40 qualified nurses, working across 3 different hospitals, would indicate acts of favoritism within groups and sub-groups operating in a clinical setting. The authors predicted that strength of identification with the nursing subgroup would be positively correlated with inter-group differentiation. They also found that contact between the different nurse groups is associated with less differentiation (Oaker & Brown, 1986). The main finding of their study was a clear case of “ingroup bias was found in intergroup attitudes, despite a strong ethos of cooperation within the nursing profession” (Oaker & Brown, 1986). This finding reaffirms Murray’s (2010) argument that when favoritism is prevalent within an organization its impact supersedes corporate culture.

Favoritism and The Code of Ethics

On the topic of how nurses should interact with colleagues and others, it is noted in the American Nurses Association Code of Ethics, that nurses must maintain “compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise, and to resolving conflict. Nurses function in the many roles, including direct care provider, administrator, educator, researcher and consultant” (American Nurses Association, 2001). The code of ethics further states that this standard takes priority over any prejudices, harassment or potentially threatening behavior and that may occur and the document specifically emphasizes the use of this standard when nurses are cooperating with other individual nurses or interacting with medical groups.

Here it becomes clear that the code of ethics, as it relates to relationships between colleagues and other people,  mandates nurses do not exercise any form of favoritism. It is implied through the language that this includes favoritism that could potentially optimize care. Favoritism in all forms according to the American Nurse Association is unethical.

Conclusion

The findings of both Morimoto and the work of Oaker and Brown are very telling, as they reveal the advantages and disadvantages of favoritism implemented within the clinical setting and bring to question whether or not the practice is truly unethical. On one hand, Morimoto’s belief that favoritism leads to optimum performance in certain situation, specifically when its in respect to a patient preferring the care of one particular nurse over another. If it’s possible the patient would respond better the care, then an exception should be made to exercise favoritism in this instance. On the other hand, as Murray noted, favoritism exercised routinely as an unsaid company policy can corrupt corporate culture and lead to cronyism within the health industry which could negatively impact quality of care. This is especially true in regards to favoritism that is harbored and overlooked within academic clinical settings where students are being trained to be professional nurses.

References

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursesbooks. org.

Dills, I. (2013). Nursing program draws students complaints. Napa valley register.

Dogherty, E. J., Harrison, M. B., & Graham, I. D. (2010). Facilitation as a Role and Process in Achieving Evidence?Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence?Based Nursing, 7(2), 76-89.

Elzubeir, M. A. (2012). Teaching of the renal system in an integrated, problem-based curriculum. Saudi Journal of Kidney Diseases and Transplantation,23(1), 93.

Morimoto, F. R. (1955). Favoritism in personnel-patient interaction. Nursing research, 3(3), 109-111.

Murray, J. S. (2010). Moral courage in healthcare: acting ethically even in the presence of risk. Online Journal of Issues in Nursing, 15(3).

Oaker, G., & Brown, R. (1986). Intergroup relations in a hospital setting: A further test of social identity theory. Human Relations, 39(8), 767-778.