Case 14
You have been practicing physical therapy about fifteen years and you are ready for a change. Your children are growing up and you need to earn more money for their college educations. After some investigation in the area, you determine that your best offer is from a home health agency. Not only will you receive a higher salary, but it also offers some flexibility in your schedule. You report to a nurse manager who gives you a brief orientation and then assigns you a list of patients to see. In preparation for this change from acute care, you took some extra continuing education courses and feel ready for the challenges of home health. You perform thorough initial evaluations and comply with all documentation requirements. You enjoy the freedom to make the decisions about your patients and your patients seem to respond well to you.
Yesterday the nurse
manager told you that you are not seeing your patients for enough visits for the
agency to make money. You are told that you must see each of your patients for
at least ten visits, and preferably more, before discharging them. You explain
to the manager that not all of the patients need that many visits and it would
be wrong to see them more than necessary. You also say something about how
seeing patients more than necessary would raise the cost of health care. The
manager tells you that if you cannot abide by the "policies" of the
agency that they do not need your services any longer.
What will you decide to do?
Will you see all patients at least ten times or not?
Why or why not?
What is the ethical basis for your decision?
What would you tell the manager?