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Running head: ETHICS AND STAFFING IN NURSING

Ethics and Staffing in Nursing

Student: Nicholas Mackay
Student ID: N01042976
Date Submitted: September 30, 2015
NURS-217
Professor: Tamiza Kassam
Humber College ITAL

Running head: ETHICS AND STAFFING IN NURSING

Ethics and Staffing in Nursing

When one is a patient, one will be cared for by a nurse. It is the nurse at the front line of
the healthcare system. The nurse is the eyes, ears, heart and hands of healthcare in Ontario.
Without nurses the system is crippled and yet Ontario has a lack of nurses and funding for them.
Ontario has the second lowest ratio of nurses to population among provinces in Canada. The
scale of the problem is such that Ontario needs to hire 17,600 RNs (let alone other staff) in order
to simply reach the national average (Boyle, 2014). There are troubling consequences to this. The
government is not attempting to change this situation. The governments budgetary decisions are
in fact ethical judgements. They are the allocation of resources in order to do good for our
society. These judgements are complex compromises. Those making these ethical judgements are
fallible. Ontarios judgements about the worth of nurses and the necessity for more nurses are
terribly mistaken. The funding and hiring choices of Ontario have a cascade of effects on the
ethical choices of the government, nurses, and patients.
It is said that this is a time for austerity in the West and it is the same in Ontario. It seems
to follow that it is wise and correct to whittle away at our societys expenses in all sectors. We
are told that even healthcares funding for nurses must be cut or frozen. Yet The Lancet reports
that fewer and less educated nurses lead to poorer patient outcomes and more patient deaths
(Aiken et al, 2014). Ontario is reducing the already relatively low number of nurses (CTV News,
2014). It is also replacing RNs with less educated and less expensive RPNs and PSWs in an
effort to reduce government expenditures. Ontarios government and hospital management teams
are also expecting each nurse to care for more patients. This increase in patients leads to a

Running head: ETHICS AND STAFFING IN NURSING

decrease in quality of care and time per patient. Nurses that are rushed will naturally make more
errors of medication, documentation and judgement. The unintentional effect of this effort is to
cause more sickness, suffering and death than is unavoidable. An ethical society must not choose
to lightly sacrifice a life or ones well-being to save a dollar. The CNO recognizes that at times
nurses must seek an outcome that is the least bad, though what is the least that can be done is
debatable (CNO, 2009). There are, it must be conceded, limits to the number of nurses our
society can sustain but surely Ontario can lead the provinces in the rate of nurses per one
thousand citizens rather than shamefully trail behind.
The governments choices have unforeseen effects on the moral judgements and moral
behaviors of nurses. The author suspects that those who choose to be nurses begin with a strong
moral center that drives them to help and care for others. Nurses undergo education in ethics and
compassion. They are taught to be professional and lawful. The CNO, the governing body of
nurses in Ontario, defines and enforces ethical standards for nurses. Despite these factors nurses
are not immune to ethical shortfalls. The governments policy of understaffing the system results
in more patients per nurse. These excessive demands must surely compromise the standards of
care. A nurse must choose what actions can be cut to cause the smallest reduction in the quality
of care. The policy forces nurses to have less time and thus to give less care. Further, moral
thought is often difficult and time-consuming; one must have the time for it to perform in each
individual situation. The CNO expects that nurses demonstrate a regard for client wellbeing by listening to, understanding and respecting clients values, opinions, needs and ethnocultural beliefs(CNO, 2009). This expectation is only reasonable if one has the time to gain
these insights. Lastly, a shortage of time and resources encourages nurses to approach their task
as a type of factory work; an assembly line of care. It sacrifices the necessary time for bonding

Running head: ETHICS AND STAFFING IN NURSING

between patients and the nurse. Inevitably it helps to dehumanise the patients. The less time there
is per client the more that the clients become merely tasks or diagnoses. Nurses must have the
time to comprehend each as a whole person. As we have seen countless times in history and
industry, dehumanizing anyone is the death of ethical behavior. Without intending to, this policy
cultivates a departure from moral thought and action in nurses.
Finally, it must be considered how this policy affects the clients behavior and experience.
In the CNOs practice standards paper Ethics, it emphasizes repeatedly that nurses must provide
client centred care (CNO, 2009). An excessively busy nurse will be forced to pursue task centred
care. One most easily understands what is personal, immediate, and simple and one tends to draw
ones conclusions from this imperfect perspective. From the clients viewpoint it must seem that
the nurses are intentionally callous and unfriendly while in reality they are busy and stretched too
thin. This perception discourages patients from asking for help or information when its needed.
It seems likely that it causes stress and feelings of isolation that oppose the systems goals of
both physical and psychological wellness. This understaffing reduces the quality of the patients
care and this causes a loss of faith in the system. An unpleasant and substandard experience
discourages the people of Ontario from getting the medical help that they will need. This policy
encourages patients to put themselves at risk in order to avoid another unpleasant and
dissatisfactory encounter with the healthcare system. Perhaps as importantly, this policy leads to
such a constraint on time that very little bonding between the client and the nurse can occur. The
client may perceive a distant and uncaring nurse as an appropriate target for unethical behavior.
Clients are already agitated as a result of their respective medical conditions and this coupled
with alienation with healthcare staff can lead to nurses being mistreated and even assaulted.
These incidents are on the rise in Ontario (Vendeville, 2015).

Running head: ETHICS AND STAFFING IN NURSING

Ontarios policy towards nurses was meant to control healthcares expenditure but it is a
policy that will have and has had a number of unintended consequences for society, nurses and
individual clients. Our provinces healthcare system is not perfect and never will be but we must
still aspire towards perfection. Nurses are critical to our collective health and well-being and
there are simply not enough of them for our large and growing population. When the correct
number of nurses is considered, the question becomes should we save our money or our lives?
Ontario is said to be the heart of Canada, it must be that in every sense.

References
Aiken, L., Sloane, D., Bruyneel, L. (2014). Nurse staffing and education and hospital mortality
in nine European countries: A retrospective observational study. The Lancet, 383(9931), 18241830.

Running head: ETHICS AND STAFFING IN NURSING

Boyle, T. (2014, February 25). Fewer nurses means more hospital deaths, study finds | Toronto
Star. Retrieved October 1, 2015.
Ethics. (2009, June). CNO. Retrieved October 1, 2015.
Hundreds of Ontario nurses being laid off. (2015, April 9). Retrieved October 1, 2015, from
http://www.ctvnews.ca/politics/hundreds-of-ontario-nurses-being-laid-off-1.2319898
Mulligan, C. (2015, March 15). Nurse cuts jeopardize lives. Sudbury Star. Retrieved October 1,
2015.
Vedeville, G. (2015, August 3). Ontario group to tackle growing violence in hospitals | Toronto
Star. Retrieved October 1, 2015.