Transcript 21 Collective Bargaining

COLLECTIVE BARGAINING
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Collective bargaining is a very complex and often
emotional issue. This chapter attempts to present a
balanced view of collective bargaining in the hope that
students, staff nurses, and nurses in managerial
positions will be able to use the information to make
effective decisions when confronted with collective
bargaining issues. The chapter presents collective
bargaining efforts in modern health care institutions,
including recent history, trends, and issues.
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The process of certifying and decertifying a collective
bargaining agent is detailed. Industrial relations studies
are used to illustrate recent trends in the American
workplace, particularly those with potential impact for
nursing. Current characteristics of collective bargaining
in nursing and some of the workplace issues that may
be brought about by collective efforts are described.
Finally, a special point will be made about the American
Nurses Association (ANA) as the parent organization for
a new form of collective bargaining.
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Code of Ethics
• Implicit values and standards for the profession
• American Nurses Association (ANA)
– ANA Code of Ethics
• International Council of Nurses (ICN)
– ICN Code for Nurses
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Bioethics
• Interdisciplinary field within health care that has
evolved with modern medicine to address
questions created as science and technology
produce new ways of knowing
• Physicians, nurses, social workers, psychiatrists,
clergy, philosophers, and theologians are joining
to address ethical questions in health care
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Dilemmas for Health
Professionals
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Life and death
Quality of life
Right to decide
Informed consent
Alternative treatment issues
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Dilemmas Created by
Technology
• Illnesses once leading to mortality are now
classified as chronic illnesses
• Cost is a consequence of prolonging life with
technology
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Ethical Decision Making
• Answering difficult questions
– What does it mean to be ill or well?
– What is the proper balance between science and
technology and the good of humans?
– Where do we find balance when science allows us to
experiment with the basic origins of life?
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Balancing Science and
Morality
• Nurses must examine life and its origins, as well
as its worth, usefulness, and importance
– What does it mean to be ill or well?
– What is the proper balance between science and
technology and the good of humans?
• Nurses must understand their own values and
seek to understand the values of others
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Health Care Decisions
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Patient
Family
Nurse
Transdisciplinary team
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Values Formation and Moral
Development
• Value: Personal belief about worth that acts as a
guide to behavior
• Value system: Entire framework on which
actions are based
• Values clarification: Process by which people
examine personal values and how the values
function as part of the whole
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Values Formation and Moral
Development—cont’d
• Moral development: Forming a world view and
value system in an evolving, continuous,
dynamic process that moves along a continuum
of development
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Examining Values Systems
• Nurses must examine their own values
• Nurses must commit to a virtuous values system
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World View
• Provides a cohesive model for life
• Encourages personal responsibility for living life
• Prepares one for making ethical choices
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Learning Right and Wrong
• Infants
– No concept of right or wrong
– If basic need for trust is met, will develop foundation
for secure moral thought
• School-age children
– Have learned that good behavior is rewarded and
bad behavior is punished
– Begin to make choices based on an understanding
of good and bad
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Learning Right and Wrong—
cont’d
• Adolescents
– Question moral values and relevance to society
– Become aware of contradictions in adults’ values
systems
• Adults
– Strive to make sense of contradictions
– Develop own morals and values
– Begin to make choices based on internalized set of
principles
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Moral Development Theory
• Kohlberg’s theory
– Most widely accepted
– Cognitive developmental process; sequential in
nature
– Rules imposed by authority
– Conformity to expected social and religious mores
– Autonomous thinker strives for a moral code beyond
the issues of authority and reverence
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Essential Values for the
Professional Nurse
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Altruism
Equality
Esthetics
Freedom
Human dignity
Justice
Truth
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Ethical Theories
• Utilitarianism
– Greatest good for the most people
– Assumes that an action is right if it leads to the
greatest balance of good consequences or to the
fewest possible bad consequences
• Deontology
– Decision is right if it conforms to an overriding moral
duty and wrong if it violates that moral duty
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Purpose of Ethical Principles
• Establish common ground between nurse,
patient, family, other health care professionals,
and society to discuss ethical questions and
make ethical decisions
• Permit people to take a consistent position on
specific or related issues
• Provide an analytical framework by which moral
problems can be evaluated
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Autonomy
• Principle of respect for the person
• Unconditional intrinsic value for all
• People are free to form judgments and actions
as long as they do not infringe on others
• Concepts of freedom and informed consent are
grounded in this principle
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Beneficence
• To promote goodness, kindness, and charity
• To abstain from injuring others and to help
others further their well-being by removing them
from harm
• Common bioethical conflict results from an
imbalance between the demands of beneficence
and those of the health care delivery system
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Nonmaleficence
• Implies a duty:
– Not to inflict harm
– To abstain from injuring others
– To help others further their own well-being by
removing harm
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Veracity
• Principle of truth-telling
• Consumers expect accurate and precise
information
• For trust to develop between providers and
patients, there must be truthful communication
• The challenge is to mesh the need for truthful
communication with the need to protect
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Ethical Decision-Making Model
• Situation assessment procedure:
1. Identify ethical issues and problems
2. Identify and analyze available alternatives
3. Select one alternative
4. Justify the selection
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Identify Ethical Issues and
Problems
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What is the issue?
What are the hidden issues?
What are the complexities of the situation?
Is anything being overlooked?
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Identify and Analyze Available
Alternatives
• What are the reasonable possibilities for
action?
• How do different parties want to resolve the
problem?
• What ethical principles are required for each
alternative?
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Identify and Analyze Available
Alternatives—cont’d
• What assumptions are required, and what
are their implications for future actions?
• What additional ethical problems do
alternatives raise?
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Select One Alternative
• Integration of multiple factors
• Blend ethical theory, principles, and values
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Justify the Selection
• Specify reasons for action
• Clearly present ethical basis for these reasons
• Understand the shortcomings of the
justification
• Anticipate objections to the justification
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Bioethical Dilemmas
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Life
Reproduction
Death
Dilemmas in between
– Injustice and the right to health care
– Organ transplantation and allocation of scarce
resources
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Ethical Challenges
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Veracity
Paternalism
Autonomy
Accountability
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