Mosby items and derived items copyright © 2002 by Mosby, Inc. COLLECTIVE BARGAINING

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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

• 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

• 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

• 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 alternative4. Justify the selection

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Identify Ethical Issues and Problems

• 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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• What assumptions are required, and what are their implications for future actions?

• What additional ethical problems do alternatives raise?

Identify and Analyze Available Alternatives—cont’d

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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

• 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

• Veracity• Paternalism• Autonomy• Accountability

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