Ethical issues for nurses in performance of utilization review

Objectives. Using an orientation of Beauchamp and Childress' principle-based common morality theory and selected business ethics literature as its theoretical foundation, this research investigated the demographic characteristics of nurses employed in utilization review, the ethical orientation of these nurses, the perceived ethical climate (at the organizational level) in which they work, the types of ethical dilemmas they face, and the strategies they employ for resolving these ethical dilemmas. Further, this research examined the derived ethical positions of the nurses and their self-reported orientation toward dilemma resolution. Finally, the research investigated the association between methods of resolving dilemmas and the ethical climates of the nurses' employment settings.;Participants. The sample was a nonprobability convenience sample of 97 registered nurses working at least 20 hours per week as utilization reviewers. Respondents were recruited from three different organizations that conduct utilization reviews in a large Midwestern city.;Methods. A cross-sectional survey research design was used to collect demographic data and to answer open-ended research questions. In addition, all respondents completed the 43-item Integrity Audit.;Results. The nurses who responded to this survey were demographically similar to nurses in clinical nursing settings. Ethical dilemmas reported were similar across utilization review settings and to those reported by nurses employed in clinical nursing settings. Closed-response self-reported ethical orientations were similar to ethical orientations derived from open-ended responses to resolution strategies for specific ethical dilemmas. Differences were found in how respondents' perceptions of their organization's ethical climate ranked on five factors of the Integrity Audit. Means for the Integrity Audit's organizational ethical climate factors "Solving Ethical Problems Directly and Reflectively" and "Valuing Stakeholder Perspectives" showed a statistically significant difference across the three organizations. The research did not show a statistically significant association between ethical dilemma resolution strategy and organizational climate.;Conclusions. This research is the first published nursing research to examine the characteristics of and ethical dilemmas experienced by utilization review nurses. The research demonstrated that the demographic characteristics of nurses employed in utilization review settings were similar across organizations and were not different from those of nurses who are employed in other settings. While this research demonstrated that utilization review nurses tried to respond responsibly to ethical dilemmas in managed care, they lacked organizational and professional support systems that would facilitate consistent ethical decision making across nurses, across situations, and across organizations. Greater political and educational attention is suggested for this growing group of nurses.