Every business has competition and competing needs which is the same for healthcare. Competing needs in healthcare can include appropriate allocation of resources such as medical equipment, medications, and even staff. Currently, the United States is facing a pandemic in a system that was already battling epidemics. One of those epidemics is the opioid crisis. The emergency department (ED) is at the frontline of both, therefore placing an increased stress on staff and patients, and creating limited availability of resources. To ensure efficient care and optimal patient outcomes, policies must be in place to ensure ethical decision making occurs when delivering care to all patients. In the case of the opioid epidemic, misuse and abuse of narcotics occurs daily at Maryview ED creating rapid allocation of resources during the event of an overdose. It is not rare to see one overdose a day, thus making it difficult to focus on policies and ethical considerations. Policies need to be put in place to decrease this occurrence and improve the availability of resources such as nurses and physicians caring for patients in the already overwhelmed, understaffed ED.
Competing Needs
The opiate abuse epidemic continues to increase across the United States. Clinicians are faced with battling this epidemic within the emergency room setting and often many resources are needed to do so. Patients who are truly in need of prescription narcotics for pain management are in competition with those who truly do not. The epidemic has made clinicians very cautious of prescribing such drugs from the ED due to the overuse and misuse of opiates, making it difficult for those who need the medication to obtain it. Clinicians are faced with competing needs in battling the COVID pandemic so much to where the opiate epidemic is overlooked. Opiate addicted patients are expected to isolate themselves or social distance, as is the public, due to COVID, which is a recipe for disaster for an addict. Treatment modalities have shifted to telehealth options rather than the traditional face to face office meeting with counselors and therapists. This change in healthcare deliverance for opiate addicted individuals can have a negative impact on their recovery, thus placing an increased workload on ED’s. Access to care has become a competing need for these patients in an already overburdened system. Finding effective treatment options for these individuals in a system that was already underserviced prior to the COVID pandemic can take several days. This creates increased stress for both the patients and the clinicians and takes up an ED bed that other patients could use. Since the pandemic, ED patient volumes have increased, leaving hospital beds full and treatment for opiate addicted individuals inadequate. Workplace stress is at an all-time high which increases when workflow changes occur when treating patients who overdose or are drug seeking for opiates or narcotics.
Policy Impact on Competing Needs
Policies need to be implemented when managing healthcare situations with competing needs as with the opioid epidemic. Policy would require that prescribers must check the prescription monitoring program (PMP) to write narcotic prescriptions safely for patients who need it. The provider will also be required to prescribe naloxone in case of accidental overdose. Doing so can decrease the amount of drug overdoses that come into the ED and hold the providers accountable. Nurses are also held accountable in that they will be required to provide the education needed for patients to safely use their prescription and naloxone if needed. It is important to have policies as mentioned in place specifically when treating emergent situations that occur frequently. It also helps staff know what is expected of them per the policy. Having policies in place also prevents both patients and clinicians from practicing outside of their scope of practice. Currently there is an overwhelming demand for healthcare resources due to the pandemic, but what happens when an epidemic is also in the mix? Ardagh, 2006 states “ethical issues arising during planning for, and responding to, a pandemic include: a possible need to restrict personal freedoms (quarantining and border control); the extent of the ‘duty of care’ of healthcare workers who are putting themselves at risk of infection in the course of their duties; and the distribution of overwhelmed healthcare resources (which are likely to be depleted due to illness among the healthcare workforce)”. This is true and creates an even larger amount of stress on clinicians when handling the opioid epidemic. This article suggests ranking patients in a net benefit method in which those patients who benefit the most from a resource receives it first and if no net benefit is identified then it is allocated on a first come first serve basis (Ardagh, 2006). With the epidemic in the middle of a pandemic, patients are very likely to come into the ED overdosed, therefore receiving immediate allocation of the already limited resources, due to it being a life or death situation. These patients become a number one priority with the highest acuity level. Therefore, it is the ethical duty of the ED staff to identify and intervene with these patients to prevent further abuse or misuse of opiates, and to help advocate to get the help they need.
Currently, ED nurses at Maryview Medical Center are faced with ethical dilemmas. Daily there are staffing issues which require the charge nurse to take on 3 patient loads, meaning she is caring for 12 to 15 patients at one time along with running the department. This is unsafe, especially in an ED with high acuity patients in the middle of a pandemic. This situation puts the nurse and the patient at risk for an error to occur. This is an ethical dilemma in that nurses are taught the principles of benevolence, however care is not safe or as effective with such large patient loads in an ED. Policies should be developed that limit the amount of patients it takes for leaders to decide that capacity has been met, thus creating an environment in which ethical awareness and safe care can be provided. Milliken, 2018 states that “the important role of ethical awareness in patient care suggests that individual nurses, as well as nurse leaders and healthcare organizations, hold the responsibility to develop this important skill”. To develop these interpersonal skills, leaders must develop safe care policies for the ED and develop educational resources to help clinicians with self-awareness such as interprofessional education and in-services.
References
Ardagh, M. (2006). Criteria for prioritising access to healthcare resources in new zealand during an influenza pandemic or at other times of overwhelming demand. The New Zealand Medical Journal (Online), 119(1243), U2256. Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fcriteria-prioritising-access-healthcare-resources%2Fdocview%2F1034230052%2Fse-2%3Faccountid%3D14872
Milliken, A., (January 31, 2018) “Ethical Awareness: What It Is and Why It Matters” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
Discussion: Organizational Policies and Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.
To Prepare:
- Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
- Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.
By Day 3 of Week 3
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.
By Day 6 of Week 3
Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.