Document Detail

Ethical conflict in nurse practitioners and physician assistants in managed care.
MedLine Citation:
PMID:  17133146     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). These providers are likely to be confronted with a variety of ethical issues as they balance quality care with their patients' rising cost concerns. However, very little is known about the ethical conflicts and causes of these conflicts experienced by these clinicians in their daily practice. OBJECTIVE: To identify ethical concerns and conflicts NPs and PAs encounter related to managed care in the delivery of primary care to patients and the factors that influence ethical conflict. METHODS: A cross-sectional self-administered mailed questionnaire was sent to 3,900 NPs and PAs randomly selected from primary care and primary care subspecialties in the United States (adjusted response rate, 50.6%). Respondents were surveyed on ethical issues and concerns, ethics preparedness, and ethical conflict. Bivariate and multiple linear regression analyses were used to evaluate predictors of ethical conflict. RESULTS: Insurance constraints were reported to have interfered with the ability to provide quality patient care by 72% of respondents, with 55.3% reporting daily to weekly interferences. Nearly half of respondents (47%) have been asked by a patient to mislead insurers to assist them in receiving care. A perceived obligation to advocate for patients, even if it means exaggerating the severity of a patient's condition, was the single most significant predictor of ethical conflict, explaining 25% of the variance. DISCUSSION: NPs and PAs are experiencing ethical conflict often associated with their perceived professional obligations to advocate for patients. Being well-prepared in ethics and having sufficient professional independence help clinicians balance the ethical complexities and demands of meeting patients' needs within a constrained healthcare system.
Connie M Ulrich; Marion Danis; Sarah J Ratcliffe; Elizabeth Garrett-Mayer; Deloris Koziol; Karen L Soeken; Christine Grady
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Nursing research     Volume:  55     ISSN:  0029-6562     ISO Abbreviation:  Nurs Res     Publication Date:    2006 Nov-Dec
Date Detail:
Created Date:  2006-11-29     Completed Date:  2007-01-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376404     Medline TA:  Nurs Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  391-401     Citation Subset:  AIM; IM; N    
School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4210, USA.
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MeSH Terms
Conflict (Psychology)*
Conflict of Interest
Cross-Sectional Studies
Health Services Accessibility / ethics
Linear Models
Managed Care Programs*
Middle Aged
Multivariate Analysis
Nurse Practitioners / ethics*
Patient Advocacy / ethics
Physician Assistants / ethics*
Professional Autonomy
Professional-Patient Relations / ethics*
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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