The small team in an outpatient specialty clinic has run into workload issues. When one of their nurses retired, the decision was made to adjust the model of care, and not to replace the position. The remaining nurses divided up the caseload and shifted some parts of their roles to the administrative assistant, and have been managing reasonably well for several months. However, a recent improvement in diagnostic techniques has resulted in an increase in new patient referrals. This means that the team is no longer able to see patients within the recommended time frame and a wait list has developed. This is not something the team has ever had to deal with, and due to the wait, they are finding that the acuity of the patients is higher than the clinic usually sees by the time patients receive their first appointment.
The team requests approval to post the retired nurse’s position or for overtime to allow an extended clinic once a week but this is denied. The team is becoming demoralized, and wonders how they will keep up with the demand. To relieve the backlog and ensure prompt care, some staff say they would be willing to do a few hours of unpaid work. Others are adamantly opposed, concerned about contravening the collective agreement and setting a precedent. This disagreement is causing significant discord amongst the team.
Questions for consideration:
- What is the ethical dilemma for this team?
- What are the ethical considerations? How should the team resolve them?
- How could the team deal with the internal conflict?
- How should the team manage the moral distress they are experiencing?
Case of the Month: health ethics case studies 