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Introduction
Ethical issues addressed in nursing practice are not always associated with tense working conditions and the challenges that are directly related to the care process. Healthcare reforms adopted at the state level affect the activities of nurses directly and play a key role in forming opinions regarding the profession. One of these laws is the Affordable Care Act (ACA), adopted as a bill regulating the US health insurance system and providing freer access to medical services.
Despite its positive perspectives and the importance of this reform, some ethical nuances are inevitably affected. In particular, the workload of nursing staff, the range of responsibilities placed on professionals in healthcare institutions, and some other difficulties arise. In this regard, it is necessary to consider which methods are supported by nurses to overcome emerging conflicts, which practices are traditional in dealing with such issues, and what the consequences are for patients. The evaluation of these aspects of work is valuable in the context of nurses activities in the conditions of the ACA.
Conflicts Between Ethics and the Healthcare Reform
The dynamics of medical services and, in particular, nursing care, had changed since 2015 when the ACA was approved and implemented as a state healthcare reform. As a result, the procedure of insuring citizens has changed, which made it possible to achieve a significant reduction in the number of those people who did not have official documents simplifying treatment and care processes. According to Sommers, Gunja, Finegold, and Musco (2015), changes in insurance and access to medications varied significantly by race/ethnicity, with greater changes among minorities (p. 368). Nevertheless, despite positive outcomes for the population, this reform entailed some nuances that gave rise to conflicts between ethics and the new law.
Junior medical personnel involved in work under new conditions has faced the problem of peoples excessive activity and increased requirements for the services of healthcare institutions. As a result, nurses are forced to work in a tense regime, and the workload becomes high, which affects employees satisfaction with the new conditions adversely. Also, based on the provisions of the reform, the range of medical specialists responsibilities has expanded, and this change inevitably leads to increased fatigue and, as a result, nervous breakdowns. Nurses should not be allowed to express negative emotions when working with patients.
However, the reform implies the same attitude towards all citizens without exception, and conflicts may arise on the basis of misunderstanding and a different cultural background. These challenges may be overcome by teaching nursing personnel to work with all the categories of the population. Nevertheless, ethical conflicts need to be minimized in order not to disrupt the positive perception of medical employees work and not to spoil the reputation of healthcare institutions. Therefore, this topic is relevant and deserves discussion at the state level.
Recommendations for Nurses to Negotiate Conflicts
Although the nursing process is not directly affected by the healthcare reform, the mode of work has changed, and new tasks emerge for nurses who need to work with a large number of patients. In particular, Moreland and Apker (2016) note that interventions, such as communication training, should teach nurses how to avoid isolation and sidestepping and create a culture of respect (p. 821). Different patients origin and their cultural backgrounds become a problem if the nursing staff is not ready to accept responsibility for patients and take into account their differences.
In order to overcome the difficulties of interaction and eliminate conflicts, nurses should spend more time studying the individual characteristics of those who seek help. Sometimes, the lack of understanding between the patients and the caregiver can be an ethical problem. In this case, nurses should not only inform the immediate supervisor of the challenges that arise but also strive to resolve the conflict on their own and eliminate misunderstanding.
Another way to help medical personnel cope with emerging ethical conflicts is to allocate workload and time intelligently. According to Johansen and Cadmus (2016), nursing responsibilities are driven by patient needs that are often complex and dynamic (p. 212). Consequently, it is required to distribute duties so that caregivers could be able to pay attention to all patients without exception. The assistance of senior staff is the valuable source of the delimitation of tasks assigned to nurses.
Also, the leadership role of medical settings is crucial, and a competent policy should be maintained regarding the burden on medical professionals. As Johansen and Cadmus (2016) remark, a conflict management style may solve the problem of work stress and help the junior employees of clinics to provide necessary services without undue fatigue. Therefore, different stakeholders should be involved in the process of resolving conflict situations.
Development of Nursing Methods to Overcome Conflicts
In order to evaluate how nursing conflict resolution methods have developed historically, it is important to mention that there are two main types of professional disagreements constructive and destructive. According to Chan, Sit, and Lau (2014), a constructive conflict can inspire innovations and creative strategies to address challenging issues, improve teamwork, patient care delivery and outcomes (p. 934). However, destructive disagreements, on the contrary, serve as a catalyst for conflicts and complicate the process of providing medical care. Therefore, throughout the entire period of the development of nursing science, appropriate methodologies have been developed to eliminate potential challenges of interaction management stakeholders healthcare institutions management, staff, and patients.
The application of valuable practices to eliminate conflict situations in the workplace is largely based on the use of educational methods aimed at encouraging staff loyalty to entrusted responsibilities. Moreland and Apker (2016) argue that training technology is a useful resource for replenishing the experience of nurses in relation to the approaches to solving problems associated with poor interaction among caregivers and patients.
Regardless of the profile of a particular medical setting, topical practices are required to maintain comprehensive care, and following both professional and ethical standards is a key to the successful outcomes of treatment. Despite potential disagreements among participants in the care process, the application of the conflict management policy, which has been developed recently, can play a crucial role in forming the professional competence of medical personnel. Adherence to the basic principles of the nursing profession has always been considered the successful indicator of assistance programs implemented. Thus, an ability to overcome differences is one of the testimonies of quality assistance provided by junior medical personnel.
Consequences for Uninsured Patients
The provisions of the ACA allow for easier access to health insurance among the population. However, despite the trend of increasing the number of citizens with relevant documents, a significant percentage of people remain uninsured. According to Desmond, Laux, Levin, Huang, and Williams (2016), the causes of this phenomenon may vary, making it necessary to revise the conditions of the healthcare reform. The consequences for uninsured patients can be negative, and a number of difficulties appear.
Despite civil rights and the possibility of receiving medical care, citizens with no insurance cannot count on the comprehensive assistance of specialists. Any requests for the help associated with such serious interventions as surgery, functional diagnostics, and other procedures become impossible. Insurance companies are not responsible for those people who do not have the official guarantee of the reimbursement of financial assistance.
As a result, patients are often forced to solve their health problems independently, which is unacceptable in many cases. Therefore, a number of important tasks are to be performed in order to achieve compliance with the conditions of the ACA and to ensure that everyone without exception has access to health insurance and. For this purpose, the interests of different stakeholders should be taken into account to maintain a high level of service and both patients and employees satisfaction with the new conditions of interaction.
Conclusion
The evaluation of practices and techniques for overcoming ethical nursing conflicts in conditions after the adoption of the ACA makes it possible to identify key issues and the ways of resolving them. Recommendations for nurses may include improving patient interaction through more efficient workload distribution and taking part in educational training aimed at enhancing professional competence. The development of nursing practice has always been associated with a number of challenges caused by the complexity of the profession. The policy of conflict management is one of the valuable resources that are essential for resolving disagreements. Health consequences for uninsured patients may be significant, and the interests of all stakeholders in the care process are to be taken into account.
References
Chan, J. C., Sit, E. N., & Lau, W. M. (2014). Conflict management styles, emotional intelligence and implicit theories of personality of nursing students: A cross-sectional study. Nurse Education Today, 34(6), 934-939. Web.
Desmond, B. S., Laux, M. A., Levin, C. C., Huang, J., & Williams, B. C. (2016). Reasons why individuals remain uninsured under the Affordable Care Act: Experiences of patients at a student-run free clinic in Michigan, a Medicaid expansion state. Journal of Community Health, 41(2), 417-423. Web.
Johansen, M. L., & Cadmus, E. (2016). Conflict management style, supportive work environments and the experience of work stress in emergency nurses. Journal of Nursing Management, 24(2), 211-218. Web.
Moreland, J. J., & Apker, J. (2016). Conflict and stress in hospital nursing: Improving communicative responses to enduring professional challenges. Health Communication, 31(7), 815-823. Web.
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. Jama, 314(4), 366-374. Web.
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