Lupeville Senior Center
Lupeville Senior Center serves adults over sixty years of age by providing in
home nursing care and residential facilities. The center in Lupeville, Indiana can
accommodate up to one hundred residents. The facility was recently investigated for
failing to meet required standards. The investigators noted the following problems that
needed to be addressed.
Work Environment
Nurses and other personal care staff are sometimes harassed by
administrators who put undue pressure on employees to serve more
and more patients in less and less time. The average number of
patients served by one nurse increased from ten to fifteen between
2004 and 2007.
Nurses complain that doctors treat them like second class citizens and
don’t appreciate the one-on-one attention nurses give to their patients.
Nurses and other staff sometimes cover for each other when one takes
personal time. This is not properly recorded and supervisors are not
informed.
Patient Care
Patients have complained that nurses are curt with them and nurses
downplay patient health problems.
Doctors have complained that nurses leave certain tasks undone such
as recording blood pressure and pulse readings on a daily basis.
Staff members have complained that nurses expect them to do more
than is required by their job description. For example, two staff
members said that the nurses expected them to fill out reports
indicating everything is fine with patient care even though patients
consistently complain.
Administrative Oversight
Doctors have complained that administrators are typically too busy to
speak to them when they ask for an appointment to discuss patient
care.
Some doctors have pointed out that they are expected to visit more and
more patients each time they visit the facility without any increase in
their professional fees.
Abel Bodey is the executive director of Lupeville Senior Care. He has just met
with representatives of the doctors, nurses and staff to decide how to respond to the
problems noted in the investigators’ report. Lupeville has been given six months to
describe how it plans to improve the operations of the facility. If the plan is accepted by
the State, then the facility will be removed from the “watch” list, a designation that will
certainly negatively influence future demand by seniors for the facility.
Abel asked the head of internal auditing, Helen Hoosier, to sit in on the meeting.
Hoosier realized early on that one problem is the facility had no written policies on the
behavioral expectations for those who work at Lupeville. She suggested that a starting
point would be to develop a written code of ethics. As is often the case, the reward for a
good suggestion was for Helen to be assigned the task of developing a draft of the code
of ethics.
Helen returned to her office and called in her assistants. They agreed to help
develop the code and set a meeting in two weeks to develop the first draft. At that
meeting, the following code of ethics was developed.
Code of Ethics
Lupeville Senior Center
Purpose
Lupeville’s Code of Ethics guides us in all that we do. It does not replace the more
specific policies and practices established by management. Each employee is responsible
for reading the Code and complying with its provisions.
Work Environment
We strive to create a supportive work environment. The basis for our working together
and with patients is respect.
Respect differences in position and rank in the workplace.
Respect our patients who have come to us for care and treatment.
Respect deadlines and meet your obligations to management.
Conflicts should be resolved by reporting differences to your supervisor who will
resolve the conflict in a way that respects all parties.
Patient Care
We strive to provide the best possible care consistent with our resources. The basis for
that level of care is empathy.
Empathize with our patients. Oftentimes what’s required to provide good service
is to offer to listen to their “story.”
Be understanding when they act forgetfully or ask naïve questions.
Smile when you see them and say “hello.”
Administrative Oversight
You must complete all required forms on a timely basis and do your own work. If
another worker is a slacker, you should inform your supervisor. The basis for your
obligations to the administrative staff is to be responsible.
Be responsible about coming to work on time, taking breaks in the morning and
afternoon for ten minutes and a one-hour lunch.
Listen to the doctors when they tell you something about patient care and ask
questions if you are not sure what to do.
Uphold the confidentiality of patient information. We rely on your discretion.
This case has the students what should be included in a code of ethics for an organization.
The students should be asked the difference between integrity (values) based and
integrity based codes.
Ethical Issues
Due to a negative investigator’s report on Lupeville Senior Care, management must
address and solve of the problems noted. Many of the problems noted involve how
different level of staff and patients treat each other. The internal auditor has suggested
that a code of ethics be written to address behavioral expectations of staff. Management
sees the suggestion as a way to address most of the problems noted. The drafted code of
ethics is compliance based rather values based. Management seems to be pushing,
threatening or manipulating the code into existence rather than leading by demonstrating
values. The center is hoping that the code will change people rather than change which
people are hired and which stay. The center does not seem to define its mission so
management has been squeezing profit out of center by offering less or quicker care. The
patients may think that their rights are being short changed by no priority on the patients
and little concern on how less or care has caused employee stress. The patients may feel
as if they have a right or implied promise of good service from employees, who must
have enough time to do what must be done.
Questions
1. Evaluate the draft code of ethics from the perspective of
a. Do you think the proposed code meets the standards expressed by the
values discussed in the text? Why or why not?
b. Select one section of the proposed code and rewrite it in a way that
better reflects what you think should be the values of a facility like
Lupeville Senior Care.
The Lupeville code begins with the duty to management. Even empathy is framed as
“consistent with resources” when resources provided are management strategy and the
exact cause for most complaints. It is a code of “do this for this reason.” The code does
Rewrites of the code section could be based on “Who do we care about” and values
rather than who ought to do as management says. For instance:
Purpose:
2. What do you think of the “tone at the top” set by management of Lupeville
Senior Care as evidenced by its operating issues and the draft code of ethics?
The operating complaints in the report are related to efficiency, resources and pressures.
The draft of the code is trying to leverage duty to do what management wants. No section
of the draft code applies to top management, nor does the draft code justify or explain
3. Comment on the following statement:
Meaningful conflict is a cornerstone in healthy, successful organizations.
Adherence to your business ethics depends on it.
Conflict creates stresses. Ethics are easier in a cooperative rather than a contemptuous