Case Management-Nurse Advocate

Ethics, moral, and legal standards guide the conduct of a nurse throughout his or her profession. Ethics determine the principles that govern a nurse behavior while executing respective duties and responsibilities. The ability to determine right or wrong states his or her moral position. Some rules and regulations governing the conduct of nursing which each nurse ought to follow. A prudent nurse adheres to the nursing ethical, moral, and legal standards as well as a code of conduct (McKee et al., 2014). During execution of duties and responsibilities, a nurse encounters several issues that encompass ethics, moral, or legal standards.

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The behavior of a nursing officer in solving such scenarios depicts the level of his level of leadership competence or experience. This paper evaluates a moral issue I encountered in my workplace, analyzes the moral, ethical, and legal implications applied while attempting to solve the situation, describes my role as an advocate for the issue, and evaluates my leadership styles.

Moral Issue Encountered in Work Environment
A patient was pushed to be discharged from short-term acute care as a result of none reimbursement. However, the patient was not stable. As a nurse manager, I advocated for the patient in an endeavor to fight his stay in the acute care setting. Nevertheless, the management was upset due to this action.

Moral, Ethical, and Legal Implications Utilized in this Situation
Moral Implications
It is wrong to force discharge of a patient from acute care subsequent to none reimbursement. The primary role of acute care is to offer vital clinical and nursing support to the respective patient. Termination of such services when the patient has not recovered can result in a number of outcomes that are not limited to developing additional complications and death, among others (McKee et al., 2014). The management reserves the right for payment for services rendered. However, delay or failure to reimburse the services offered should not warrant immediate termination. There are some debt collection and recovery options that can be exercised once such a patient becomes stable.

Ethical Implications
According to Wheeler (2013), it is the responsibility of a nurse to provide the required care to a patient at hand despite the monetary background. Failure to perform the required duties subsequent to other factors such as money beyond the core nursing care functions is unethical.

Legal Implications
Guido (2010) states that termination of the nursing acute care services of a patient who have not fully recovered amounts to malpractice. Consequently, the management can be sued for this course. After a court battle, the management will not only lose the case but also more money than the amount the patient would have spent in acute care until full recovery.

My Role as a Moral Advocate
I applied the following strategies to help resolve the issue; playing a voluntary role, acting as an intermediary between the patient and the executive management, and striking a balance between the two. I took a voluntary role to fight for the stay of the affected patient in acute care unit until he became stable. There was a lot of resistance from the management who were opposed to this course of action. It is not my responsibility to intervene or handle cases regarding none disbursement or any other monetary issues. Nevertheless, I had to go beyond my role and responsibilities to and convene a meeting with the management to enlighten them about the moral, ethical, and legal principles underlying the situation. I acted as an intermediary between the patient and the administration. Even though I am under obligation to protect the interests of the organization moral, ethical, and legal implications supersede such obligation. Striking a balance between the patient and management was a risky affair. However, following my competence, I managed to convince the management to allow the patient continue receiving nursing care in the acute care unit until stability is achieved. The organizational mission is to provide quality services at a cost to the patient. Persuading the executive management team which is dedicated to implementing such a mission was a daunting task. The organizational values were my stronghold. One significant organizational value states that patient comes first. Therefore, I used this value to insist that the welfare of the patient is more important than monetary processes. At the end of it all, they subscribed to my arguments and applauded my course of action.

Leadership Styles Identified through Self-Assessment
Transformational Leadership
This style acted as facilitation to resolve this dilemma. I applied it to initiate change in the manner in which executive management conducts its operation regarding reimbursements. During the meetings, I convened I motivated key decision makers to abort their original determination. The task appeared challenging, but I was in a position to achieve the desired results. According to Engelke, Swanson & Guttu (2014) motivating others to change their original decision and resolving a challenging task are key aspects of transformational leadership style.

Team Leadership
This method facilitated to resolve the subject standoff (Fitzpatrick et al., 2012). I applied this style through working with minds and hearts of the involved parties by forming a strong bond of trust and cooperation between the two. In this case, I had the interest of both the management and patient at heart. I took a lead role to facilitate ethical, moral, and legal principles implementation.
Democratic Leadership
This methodology facilitated achieving the success of the subject stalemate. This style involves subordinates making sustainable decisions (Kelly, 2011). In the eyes of executive management, I am a subordinate and at the same time a nursing care manager. The executive management upheld the decisions I made to uphold moral, ethical, and legal principles and forgo the operational interests of the hospital (Thomas, 2015).
Ethics, moral and legal standards determine the principles that govern a nurse behavior while executing respective duties and responsibilities. A prudent nurse adheres to the nursing ethical, honest, and legal standards as well as a code of conduct. Ethical, moral and legal dilemmas are prevalent in the course of a nursing profession. Leadership is a critical factor towards resolving such dilemma. The moral issue at hand was a case whereby a patient was pushed to be discharged from short-term acute care as a result of none reimbursement. However, the patient was not stable. I took a voluntary role to fight for the stay of the affected patient in acute care unit until he became stable. Consequently, I applied three leadership styles while resolving this issue. The styles include transformational, democratic, and team leadership. After successfully resolving this dilemma I achieved a sense of fulfilment that I am serving nurse a not because it is my preferred career but as a calling.


1. Clavelle, J. T., Drenkard, K., Tullai-McGuinness, S., and Fitzpatrick, J. J. (2012). Transformational leadership practices of chief nursing officers in Magnet® organizations. Journal of Nursing Administration, 42(4), 195-201.
2. Day, D. V., Fleenor, J. W., Atwater, L. E., Sturm, R. E., and McKee, R. A. (2014). Advances in leader and leadership development: A review of 25 years of research and theory. The Leadership Quarterly, 25(1), 63-82.
3. Engelke, M. K., Swanson, M., and Guttu, M. (2014). Process and outcomes of school nurse case management for students with asthma. The Journal of School Nursing, 30(3), 196-205.
4. Kelly, P. (2011). Nursing Leadership and Management. Boston: Cengage Learning.
5. Russell, K. A. (2012). Nurse practice acts guide and govern nursing practice. Journal of Nursing Regulation, 3(3), 36-42.
6. Thomas, T. (2015). Management and leadership for nurse administrators. Jones and Bartlett Publishers.
7. Wheeler, H. (2013). Law, Ethics and Professional Issues for Nursing: A Reflective and Portfolio- Building Approach. London: Routledge.

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