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The situation discussed can happen often in the acute care setting. Often times, patients’ families and medical staff disagree on the plan of care and this can cause poor outcomes for patients. In this situation, I would first obtain permission from the patient to discuss their condition with their daughter. After obtaining consent, I would sit down with the daughter to let her discuss her concerns, I would listen and remain empathetic. Then I would meet with the primary nurse and the physician and try to reach a compromise. The ability to pay should never influence the course of treatment. I would work with the medical staff to attempt to reach a compromise and if the physician is unwilling to perform more tests, I would speak to another physician to get their input. The shift in the relationships between insurers, doctors, nurses, and patients is maybe the biggest worry regarding the development of managed care in this nation. It is unknown how much of a negative influence there may be on clinical judgment when physician and nurse wages are linked to rewards, fines, and other schemes meant to decrease service and resource use and boost revenue. Consequently, there has never been a stronger need for self-awareness on the principles that underpin each professional nurse’s practice (Huston, 2022). I would want to assure that the physician is not basing his/her plan of care because of the ability to pay.
As a nurse, my values to act are always more aligned with the patient than the company. However, emergency departments are meant to rule out life-threatening emergencies, they are not meant to perform deep-dive investigations to get an ultimate diagnosis. If the physician ultimately declines to perform more testing, I would ensure that the patient had adequate follow up scheduled and was assured that the daughter could facilitate the followup. There is a moral dilemma when patients or their families are given unwanted information, which has prompted a great deal of research on moral sensitivity in this setting. Research has indicated that nurses’ capacity to communicate with patients and their families is impacted by their moral sensitivity. A strong moral sensitivity makes it possible for nurses to actively seek out verbal or nonverbal ways to solve problems and to be more sensitive to the physical and psychological states of patients (Guo et al., 2024).
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