According to Code of Ethics for Nurses, the nurse in all professional relationships, practices with compassion and respect for the inherent dignity, worth of uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (“Code of Ethics for Nurses,” 2001, p. 11). People have a right to quality medical care, even if they do not have insurance. My scenario for this paper is: You observe a homeless person without any insurance being provided substandard care by the medical team.
I have never experienced a situation of this kind. I could see this happening in the emergency room or a doctor’s office. I work in the intensive care unit; insurance is irrelevant to me. When case management is on my case to get them out of the unit and transferred to telemetry, it has come across my mind, is it an insurance issue? To read the scenario at first gland, I can see that it is unethical and illegal. I will inform you why this scenario is unethical and illegal in this paper.
As stated in my first sentence, the nurse must practice without restrictions by consideration of social or economic status. Healthcare needs are universal, and the nurse’s primary commitment is to the safety and well-being of the patient. As a patient advocate the nurse must take appropriate action regarding any instances of unethical, illegal, or impaired practice by any member of the healthcare team. Nurses also have the responsibility to assist those who identify potentially questionable practice (“Code of Ethics for Nurses,” 2001, p. 19).
As stated in Code of Ethics for Nurses “All nurses, regardless of role, have a responsibility to create, maintain, and contribute to environments of practice that support nurses in fulfilling their ethical obligations (“Code of Ethics for Nurses,” 2001, p. 26). ” Enacted in 1986, Emergency Medical Treatment and Active Labor Act (EMTALA) apply to hospitals receiving Medicare dollars.
Lawmaker felt it was need to protect patients who don’t have health insurance from being either turned away from the emergency department or sent to another hospital via ambulance even if the transferring hospital had the resources need to treat the patient, sometime called “patient dumping”. A patient was left unattended in the emergency room for three hours in a Chicago hospital.
This patient arrived by ambulance, was never examined or checked in. A family member approached the staff, but it was too late, the patient was unresponsive and pronounced dead in an exam room. The hospital was charged $50,000 in penalties. The nursing staff had a duty to screen, prioritize, and monitor this patient, but failed to do so.
Patient triage is not a medical screening exam, according to Centers for Medicare and Medicaid Services (CMS). When an emergency medical condition is identified, the hospital has the obligation to treat the patient within the “capability and capacity” of the hospital’s resources, regardless of the patient’s ability to pay (Austin, 2011, p. 36). In 2010 a California hospital was cited because a patient came in with chest pain, sat in the waiting room for three hours, proceeded to leave, collapsed in the parking lot of the facility, and could not be resuscitated.
EMTALA guidelines are in effect within 250 yards of an emergency room. In 2009 a Florida hospital diverted an active labor patient to another hospital, by having her friend drive her instead of securing an ambulance. There were no complications during delivery, but the Florida hospital failed to perform a medical screening exam and secure transport. The hospital paid $40,000 in civil penalties.
An on call physician failed to respond to a request to come into the emergency room, patient was transferred to another hospital, underwent emergency surgery, the physician paid $35,000 in civil penalties.
Not only is it unethical to give substandard care, it is also illegal. I am unsure if my patient scenario is an emergency room patient, it is usually where it starts. There are many interventional programs for the uninsured and the homeless, in hopes of keeping humans healthy and safe. In 2002, Albany New York, a go ahead is given to open a homeless medical aid station. Called the Schenectady Volunteer Physician Project, they were awarded $100,000 to get started. Taking three years and jumping through many legislative loops, a department of thirty five volunteers will provide medical care at no charge to homeless people.
The idea was to get medical care to homeless people before they end up in the emergency room. The doctor’s state remembering days before government and private insurance, when cash was paid. If the patient could not afford it, the cost was reduced or free. They considered their charity care a responsibility of being a doctor, use to the idea of Physicians treating everyone (Hughes, 2002, p. B1). With many programs in place there are still many people without insurance, and the emergency room is sometimes used as the only access to treatment.
A study conducted by The Journal of American Medical Association (JAMA) found that uninsured patients are at a greater risk of receiving substandard medical care. It was statistically shown that adverse reactions due to negligence were six times higher than just having adverse reactions. This was in relation to uninsured and being minority. Another study conducted compared quality of care for uninsured patients with diabetes in private physician of? ces and community/migrant health centers found that patients had a higher quality of care.
This sample could have been limited to the sample size of 85 versus 31,000 in the JAMA study. It may also be in relation to living in the rural environment, where this center may be an only option. If I was to ever be in a situation where my care team was giving substandard care I would definitely address it. I would address it with that person first. Maybe that person has many things on their mind and is overwhelmed, it is up to me as a team player and a patient advocate; to step in and assist with the problem first. If it is something critical, I would get my manager involved immediately.
If it is something small, it can be addressed with that person at the moment, and maybe an email sent to my manager. Maybe that person needs to be reeducated. I chose this scenario because I have been without insurance and I’ve also been in a situation where I received substandard care. When I received substandard care, I had insurance, and it was from the physician. I had a physician diagnose me without looking, listening, labs, etc. He sat in a chair across the room and told me what was wrong with me; unfortunately the nurse was not at the bedside.
This was in the emergency room. I was not a nurse at the time, and ignorant to the fact that the care was substandard. When I did not have insurance, I did not need to seek medical treatment, so I cannot relate. I go into the rooms with the physicians every chance I get, to assure that the patient understands, and all questions are answered, the patients and mine.
In closing, Because nurses have the belief of holistic care and not diagnosing diseases and prescribing, they are the ones who can step in and advocate. I would hope that if a nurse is around, that patient receives high quality care to the best of their ability. References American Nurses Association. (2001).
In Code of ethics for nurses. Silver Spring, MD. : Nursesbooks. org. Austin, S. (2011). What does EMTALA mean for you? [Entire issue]. Nursing Management, 42(9). Burstin, H. (2002). Socioeconomic status and risk for substandard medical care [Entire issue]. JAMA: the journal of the American Medical Association, 268(17). doi: 10. 1001/jama. 1992. 03490170055025 Hughes, C. (2002, October 18). Health care for uninsured poor. Times-Union, p. B1. Retrieved from http://pl8cg5fc8w.
search. serialssolutions. com/? ctx_ver=Z39. 88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon. serialssolutions. com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft. genre=news&rft. atitle=Health+care+for+uninsured+poor&rft. jtitle=Times-union+%28Albany%2C+N.
Y. %29&rft. au=CLAIRE+HUGHES+Staff+writer&rft. date=2002-10-18&rft. spage=B. 1&rft. externalDBID=UAAS&rft. externalDocID=214713461 Porterfield, D. (2002). Quality of care for uninsured patients with diabetes in a rural area [Entire issue]. Diabetes Care, 25(2). doi: 10. 2337/diacare. 25. 2. 319