Ethical Problems Encountered by Nurse Practitioners in the Primary Care Setting

Abstract

The purpose of this non-experimental, descriptive, comparative design study was to identify ethical problems encountered by nurse practitioners in primary care settings and to describe how they dealt with these problems. The framework was based on the review of literature and the research tool. It was designed by the researcher to provide a systematic method of identifying and resolving ethical problems. A 61-item questionnaire was mailed to all nurse practitioners employed in a primary care setting in a midwestern state. The analysis is based on only those nurse practitioners in a primary care setting who returned a completed survey (N=53). Findings from this study indicated that nurse practitioners do indeed experience ethical problems in their primary care practice and utilize resources and beliefs when implementing decision-making guides. Some predominant ethical problems were: 1) complying with the patients' wishes, 2) respect for patient autonomy, informed consent. competence, and disclosure of information, 3) requests from workplace that are felt to be unethical, 4) lack of confidentiality, and 5) refusal to treat because of lack of reimbursement. There was a significant difference found in two situations experienced between rural and urban nurse practitioners. Lack of adherence to agency policy, rules and regulations by individual nurses was rated significantly higher by urban nurse practitioners than rural. Participating in research conducted by others was also rated as more significant by urban nurse practitioners than rural. There was also a significant difference on eight of the questions between rural and urban nurse practitioners on the extent to which situations were perceived as ethical problems. Greater ethical problems for urban nurse practitioners were: 1) lack of adherence of agency policy, 2) abuse of clients' rights, 3) confidentiality of client information, 4) accuracy of documentation, 5) failure to take responsibility for nursing judgements and actions, 6) coercion of nursing staff, and 7) rejection of a patient care assignment. Rural nurse practitioners rated telling the truth to client or family and reporting abuse of elderly client as more significant ethical problems.