Nursing Ethics and Healthcare Reform Conflict

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It is evident that throughout the years, nurses had a crucial role in assisting doctors and caring for patients. The ethical principles that guide the profession imply that one must provide care for all as equal individuals. According to Tunzi (2013), around 56 million people in the U.S. did not have health insurance in 2013, while only 30 million were eligible to receive it through different governmental programs.

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The result is twenty-six million people without health coverage in the country; thus, an issue of providing care to all patients remains in place. Historically, nurses often had to deal with the problem connected to treating patients who cannot afford to pay for services. This paper aims to examine the historical and ethical aspects of providing care to the uninsured from a perspective of nursing.

Individuals encounter ethical dilemmas every day, both in their personal and professional lives. It can be argued that for medical personnel, such issues are especially challenging as they concern the life and health of other people. The American Nurses Association states that “the protection, promotion, and optimization of health and abilities… and advocacy in the care of individuals, families, communities, and populations” should be the core values for a medical professional (Epstein & Turner, 2015, p. 4). Thus, nurses should care for patients regardless of circumstances to fulfill their duty.

Ethical principles of nursing should be a guide that suggests proper ways to carry out the work. Cliff, Rozier, and Fendrick (2017) state that the approach should be to provide health care to people who need it when they need it. The suggestion aligns with the core moral values of nursing, which have existed for decades. By transmitting this approach to the legislation, nurses will no longer have to face the issue of providing care to people without insurance.

Nurses at times had to work under challenging conditions that are not ideal for providing care. For instance, Wakefield (2013) reflected on her experience of being a nurse at a small rural hospital in 1970. According to the author, she understood that in such establishments that are underfunded, “necessity is the mother of innovation” (para. 2). Thus, the example provides an understanding that throughout history, nurses had to find ways to assist patients, regardless of the financial incentives. Today they provide individuals with valuable information regarding laws and rights that people have as part of their social responsibility. Thus, nurses over the years had to perform their duties regardless of the conditions they were in, including cases where patients were unable to pay for services.

In the present day, legislative initiatives provide access to health care services for the majority of the U.S. population. The Affordable Care Act (ACA) has transformed the industry of healthcare and the way the services are delivered to patients. Wakefield (2013) states that the implementation of the law marks an essential change within healthcare as millions of U.S. citizens will be able to afford insurance. Ideally, such initiatives would illuminate the issue of the uninsured.

However, not every citizen in the U.S. will be able to receive insurance under the ACA or Medicaid. Tunzi (2013) argues that the legislative initiative would bring around the old ethical dilemma of uninsured patients. Thus, many institutions will deny providing care to those who have not obtained insurance in accordance with the new laws. The primary groups that will be left out are illegal immigrants, as those are people who often work without proper documentation. Tunzi (2013) states that a solution in the form of obligatory social services for each medical professional would counteract the problem. It can be argued that most physicians and nurses would not accept such an offer as their daily work involves treating many patients. Providing such services during work hours would pose questions of payment for work.

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Patients that do not have insurance can participate in local programs funded by the state. However, in case those individuals have a problem, they will be unable to go to a doctor’s office to resolve it as most of such initiatives provide screenings only. Although nurses can give advice and participate in local programs, legally, they are unable to care for patients that do not have insurance. The economic question is at the center of this problem, as hospitals have to pay their employees and finance their operations.

Thus, on the one hand, a nurse providing care to the uninsured would be harming the establishment and compromising its ability to function. On the other hand, such actions are dictated by the ethics and compassion that each nurse has to have. Therefore, changes are required in the legal aspect of the problem to ensure that medical professionals can adhere to the standards.

Overall, nurses over the years provided care for patients in difficult conditions and without regard for financial incentives. They were guided by the ethical principles and moral values of society. Recently, the rhetoric has changed as nationwide insurance programs were implemented. The initiative should help many people in the U.S. to receive quality care, however, over twenty million people will not be able to obtain it. Therefore, nurses will have to face the issue of caring for the uninsured.


Epstein, B., & Turner, M., (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2), 4. Web.

Cliff, B. Q., Rozier, M., & Fendrick, A. M. (2017). Ethics of equitable versus equal in health care. PNPH. Web.

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Tunzi, M. (2013). Health reform and the uninsured: The new requirements of the old ethics. The Hastings Centre Report, 43(2), 1. doi:10.1002/hast.160

Wakefield, M. (2013). Nurses and the Affordable Care Act: A call to lead. RNL. Web.

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NursingBird. (2021) 'Nursing Ethics and Healthcare Reform Conflict'. 8 June.


NursingBird. 2021. "Nursing Ethics and Healthcare Reform Conflict." June 8, 2021.

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NursingBird. "Nursing Ethics and Healthcare Reform Conflict." June 8, 2021.