| As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. Little is known about the ethical concerns that nurses encounter as they transition from clinical nursing to hospital case management. Given the recent changes in healthcare delivery, healthcare organizations and the personnel they employ, have to sort through the many layers and dimensions of clinical experience. Since the ethical aspect of the operation of the healthcare organization is central to the delivery of healthcare, the overall mission of the organization cannot be overlooked. Most of the previous studies of ethical dilemmas in nursing relate to nurse executives, nurse administrators, nurse managers, and critical care nurses. There is no documented phenomenological study concerning the role of nurse case managers and the ethical conflicts they encounter as hospital case managers. The purpose of this phenomenological study was to identify the ethical concerns encountered by nurse case managers as they transition from clinical nursing to hospital case management and to identify the implications for organizational ethics. Nurse case managers' perceptions of solutions/options in order to resolve such ethical dilemmas were explored. Using an interpretive phenomenological approach, fifteen hospital nurse case managers were asked to describe the process that led them into their new role as nurse case managers. The participants were also asked to describe the ethical dilemmas experienced and the actions the participants took to resolve the dilemmas. Data were collected through in-depth interviews that were audio-taped, transcribed, and interpreted using van Manen's method of thematic analysis of transcripts. The interpretation revealed four themes: (1) balancing act; (2) framing difficult options; (3) speaking for vulnerable individuals; and (4) responsibility without power. The findings from this investigation have implications for organizational ethics in areas of nursing practice, education, policy, and research. Recommendations for further research are discussed. |
