Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.



Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.


To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.


Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.


Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.


Main Post

A policy is a written detail of the hospital staff’s rules. Policies and procedures allow everyone, no matter their level of education, to follow the same steps to ensure appropriate and safe patient care. Regarding competing needs, if we can work on having a good balance between nursing shortage and patient demands, we can improve the health of the patient and the nursing staff at the same time. According to American Nurses Association (2015), the obligation of nurses to not only patients but also their coworkers is to follow specific steps to do what is correct and try to be an overall good person. As nurses, we give up many things to provide the best care for our patients. We miss our family, lunch, and even bathroom breaks to provide fantastic care for these individuals while they are under our eye.

Twigg et al. (2010) spoke about how even more than ten years ago, there was going to be a shortage of nurses in upwards of 60,000 just in Australia. Turale and Meechamnan (2022) stated that there is now over a 5 million shortage of nurses globally. One policy specific to nursing staffing should include the nurse-to-patient ratio to allow for the appropriate implementation of care safely. Unfortunately, if the number of nurses is at an all-time low, the lousy patient outcomes could be at an all-time high.


The steady workload within the nursing world pushes nurses beyond their means and can lead to patient care errors. According to Walden University (2012), one specific outcome of nursing shortages is that more patients are released earlier than they should and expected to take care of themselves instead of being transferred to a rehab or skilled nursing facility. Ross (2022) stated that the nursing staff is inadequate, and the nurses are asked to do extra jobs. The increasing number of unnecessary patient errors and unable to be good hall buddies to the other staff on the unit is one way this shortage affects both the patients and the nursing staff. Hospital administrators expect the team to follow the policies they have written. Still, it is downright out of reach, and no changes to policies have been implemented to consider the staffing shortages. Policies need to be changed to show how to manage patient care safely during this period of staffing shortages.


American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from to an external site.

Ross, J. (2022). Nursing Shortage Creating Patient Safety Concerns. Journal of PeriAnesthesia Nursing37(4), 565–567. to an external site.

Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity and mortality — the need for a policy change in response to the nursing shortage. Australian Health Review34(3), 312–316. to an external site.

Turale, S., & Meechamnan, C. (2022). Investment in Nursing is Critical for the Health of the World: We Need 6 Million Additional Nurses. Pacific Rim International Journal of Nursing Research26(3), 371–375.

Walden University, LLC. (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author.





How Competing Needs May Impact the Development of Policy 

      The nursing shortage and the associated competing needs have impacted the development of policy. The ANA (American Nurses Association) has developed a code of ethics to guide nurses and supplied interpretive statements to assist with understanding (ANA, 2015). Provision Six states that a nurse or a group of nurses are to assess the ethics of delivery and quality of care (ANA, 2015). This translates to nurses maintaining ethical care, including the safe delivery of care with appropriate staffing and voicing concern if ethical care is not being delivered or improvement is needed. As stated in Provision Two, the patient is the primary concern (ANA, 2015). Nurses have an obligation to advocate, including policymaking, for the patient’s interest which is Provision Seven (ANA, 2015). 

The Nursing Shortage and Competing Needs 

      Nursing is the largest group of health professionals (Haddad et al., 2022). Many factors influence the cost of nursing, including training, recruitment, overtime, and retention. One of the largest competing needs is the cost of recruiting and maintaining a robust nursing staff. Staffing is challenging to predict as staffing is also influenced by acuity and economic downturns (Parsons, 2019). Lower staffing ratios are less expensive but result in overtime, increased errors, and potential nursing dissatisfaction (Haddad et al., 2022). Additionally, the use of agency nurses is more expensive than a traditionally employed nurse. Including nurses’ viewpoints on safe staffing and ethical care will improve nursing satisfaction even in a cost-containment environment (Kelly & Poor, 2018). In summary, a competing need is financial constraints and reducing medical costs 

Policy to Address Competing Needs 

     California, with Bill 394, instituted mandatory staffing ratios and other states have introduced bills with a similar goal (Tevington, 2011). Several other states have laws requiring staffing ratios to be published (Davidson, 2022). The laws surrounding mandatory staffing ratios do not allow for the nurse’s level of experience, insight, education, and acuity, and have yet to be validated by research  (Tevington, 2011). Even without the mandate of staffing ratios, many studies have found an increased RN staffing ratio improves outcomes, quality of care, and staffing turnover rate (Tevington, 2011). The Registered Nurse Safe Staffing Act of 2015 mandates that hospitals provide safe staffing and have committees that include nurses, thereby incorporating nursing insight in the decision of what is considered safe staffing (Congress, 2016). These committees give a platform for nurses to advocate for quality of care and ethical delivery of care illustrating Provision 6 and Provision 7 of the Code of Ethics. 


American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. to an external site. 

Congress. (2016). Summary: S. 1132-114th Congress (2015-2016). to an external site.   bill/1132#:~:text=Requires%20the%20plan%20to%20require,of%20safe%2C%20quality%20patient%20careLinks to an external site. 

Davidson, Alexa. (2022). Nurse-to-staffing ratio laws and regulation by state. to an external site. 

Haddad LM, Annamaraju P, Toney-Butler TJ. (2022). Nursing Shortage. Stat Pearls 

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from to an external site.  

Parsons, J. E., F.A.C.H.E. (2019). Addressing Workforce Challenges in Healthcare Calls for Proactive Leadership. Frontiers of Health Services Management, 35(4), 11-17.  

Tevington, P. (2011). Professional Issues. Mandatory Nurse-Patient Ratios. MEDSURG Nursing20(5), 265–268. 



How Competing Needs Impact Policy Development

Healthcare is constantly evolving to meet the needs of patients, healthcare facilities, and their communities. Policies and procedures are continuously updated to meet these demands set by business models to be profitable to continue to provide care for the community. Standardized policies are often efficient and cost-effective routine care that can interfere with nurses’ ability to provide ethical, individualized care (Kelly & Porr, 2018). Nurses must recognize their actions’ potential moral repercussions, resolve problems, and address patient needs (ANA, 2015).

Specific Competing Needs that Interfere with Nurse Burnout

            Procedures are updated as needed, which could mean weekly, monthly, or even daily. Depending on nurse staffing, physician staffing and other ancillary departments may be short-staffed, and needs can change. In my outpatient oncology center, when another ancillary department is short staffed it affects the infusion nurses. If one or more operators call out, it is up to the infusion nurse to take off messages and return the patient’s calls. If the lab is short, it is up to the infusion nurses to draw the patients’ labs before their treatment. Suppose the infusion scheduler is out; the infusion nurses send an email to ensure that patients have their next appointment. If the pharmacy technician is out, it is the responsibility of the infusion nurse to fill in and admix the chemotherapy. If a physician is out, the infusion nurses often evaluate and assess the patients, and treatment is administered accordingly. These changes are made daily based on the needs of the office. These changes meet the demands of the office and the patient, adding a lot to the already full role of the infusion nurse. These changes increase the risk of burnout for the infusion nurse. Emotional intelligence is an essential aspect of self-awareness. Awareness of one’s motional intelligence can help enhance relationships and increase self-awareness (Walden, 2009). While a nurse must possess an ethical understanding in caring for their patient, nurses must owe the same duties to themselves as well as others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth (ANA, 2015). While adding more tasks to the already full load of the infusion nurse could create a further ethical dilemma. Nurses must be able to recognize when enough is enough, and they need to speak up for their safety and the patient (Kelly & Porr, 2018).


How Policy Addresses these Competing Needs

Given the complexity of healthcare environments, nurses must recognize ethical issues as they arise. Strong leadership is essential in promoting a healthy environment. Promoting a healthy environment for the nurses helps to promote a healthy environment for the patients. Recognizing that nurses are already performing every task, they are capable of and not adding more jobs to their daily routine will help to reduce ethical risks. Ethical awareness must be evaluated in everyday nursing practice (Milliken, 2018). Most people think of ethical awareness of doing what is morally right and good for the patient. Still, the American Nurses Association also points out that nurses have an ethical commitment to themselves. As professionals who assess, intervene, evaluate, protect, promote, advocate, educate, and conduct research for the health and safety of others and society, nurses must take the same care for their health and safety (ANA, 2015).


Nurses should not take unnecessary risks to jeopardize their health or safety. Burnout and compassion fatigue affect nurses’ ability to care for their patients. Therefore, nurses must be aware of their emotional intelligence and speak up for their ethical well-being to provide better patient care.



American Nurses Association. (2015). Code of ethics for nurses with interpretive

            Statements. Silver Spring, MD: Author, Retrieved from to an external site.

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment:

            Considerations to enhance RN practice. OJJN. Online Journal of Issues in

Nursing, 23(1), Manuscript 6. Doi:10.3912/ONJJ.Vol23No01Man06.

Retrieved from to an external site.



Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN:Online

Journal of Issues in Nursing. 23(1). Manuscript 1.

Doi:10.3912/OJIN.Vol23.No01.Man01. Retrieved from http://ojnn.nursingworldLinks to an external site..



Walden University, LLC. (Producer). (2009). Working with Individuals. [Video file].

Baltimore, MD: Author.




Competing needs 

As nurses we are met with ethical dilemmas daily. Ethics and laws cannot be confused, even though they both go hand in hand we must not get confused because ethics and laws are not the same. In the healthcare field, ethical dilemmas occur quite often, which aids in nurses being able to adapt and handle such events. All healthcare professionals that encounter an ethical dilemma are put in the mindset of doing what is best for the patient (Laureate Education, 2012).  

Currently, a national healthcare issue that is becoming a worldwide healthcare issue, is the nursing shortage in the work field. The shortages in nursing at many facilities have multiple effects on the quality of care rendered. Overwhelming patient assignments lead to dissatisfied and burned-out staff which then affects patient satisfaction and safety (Ingram & Powell, 2018). Safety is the number one goal of patient care. Over the years many policies surrounding safety have been revamped to ensure a safer working environment for nurses and patients during the shortage of nurses (Yang etal., 2015). 

Development of policies 

Leaders such as managers and directors of a unit must find the common balance to retain nurses. They should work to understand a common balance as well as demands being placed on staff with dangerous and unbearable patient acuities. Finding a balance between those key items can significantly aid in decreasing staff burnout and retention in medical facilities. Higher demands of needs for the care of patients vary for each unit. A patient in the Intensive Care unit will need a higher level of care than a patient on the mother baby/Postpartum unit. For each level of acuity for a patient the needs relayed back to the charge nurse and managers to appropriately assign safe nurse patient ratios on the unit. How the acuity is measured is by using an acuity tool that aids in formulating proper nurse to patient ratios. The purpose of acuity tools is to aid in increasing nurse satisfaction with their patient assignment (Ingram & Powell, 2018). 

Policies Addressing Nursing shortage 

The American Nurses Association (ANA) is an organization that safeguards nurses from unsafe nursing conditions. They have policies and standards in place to protect staff in what may be an unsafe working environment. Federal regulations have been put in place to support nursing staff for safer working environments. The goal of the policies is to ensure the patient’s safety and safe workloads in the healthcare facilities. In the state that I live in there are staffing laws, but with the use of the patient acuity tool it helps my facility create a safe and shared assignment amongst all the nurse son the unit. 


American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. to an external site. 

Ingram, A., BSN, RN-BC, & Powell, J., BSN, RN. (2018, April 18). Patient acuity tool on a medical-surgical unit. 

Laureate Education (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author. 

Yang, P., Hung, C., & Chen, Y. (2015). The impact of three nursing staffing models on nursing outcomes. Journal of Advanced Nursing (John Wiley & Sons, inc.), 71(8), 1847–1856. 

https://doi-Links to an external 





Complaints about rising healthcare expenditures are common in today’s healthcare. Due to the nature of the healthcare industry, competing needs often exist. It is especially true when it comes to the technology doctor-patient relationships, where the patient wants more attention and time from their doctor, but there are only a certain number of hours in a day. According to Kelly & Porr (2018), healthcare expense has possibly increased at a noticeably rapid rate in recent years. It has mostly been attributed to the requirement to switch from an analog to a digital style of healthcare delivery. This change has been described as expensive yet necessary for the modern healthcare society to achieve the desired results, as stated by American Nurses Association (2015). Since most of the policies being developed are in accordance with digital migration and the embrace of technology, the formulation of healthcare policies has become fairly difficult as a result of these rising costs. Each policy is perceived to have a negative impact on healthcare.

However, this has led to an ethical dilemma at work. Technology has helped address some of the most difficult medical issues, and it has also allowed for the commercialization of drugs that were previously unavailable. Through screening, which is carried out using advanced technological tools to observe the inside of the human body, some diseases, such as cancer, are rapidly diagnosed (Barba et al., 2021). In theory, this is a great step toward better healthcare and eradicating some of the deadliest diseases in the world. However, as technology has developed, fewer people can obtain healthcare, at least not without an insurance plan. Policymakers must explore ways to enhance financing for research and therapy to ensure that people suffering from different diseases can get the care they need.

The impacts of these competing needs include how technology makes better access to medical data and information possible. Our improved capacity for data storage and access has been one of the major advantages of the digital revolution. Now, healthcare professionals may access patient data from any location. Now, healthcare practitioners can quickly communicate medical data through the intranet and the internet, enhancing patient care. To view the results of their tests, patients may visit their EHR on the patient portal without having to call the doctor’s office. (“Intelligence Retinal Imaging Systems,” n.d.). However, this has been faced with a setback in data loss and breaches since care teams can coordinate decision-making using the same current information.

Furthermore, the time that the office personnel spends on the phone exchanging information and moving paperwork can be reduced. The problem with technological requirements is portability. However, an increasing number of technology firms are starting to recognize this problem and provide EHR connectors that enable adopting new technologies easier. However, policymakers will be up to considering how to increase access to care so those who need care can get the assistance they require. Policymakers must also weigh these and other competing objectives to create effective plans to tackle illnesses.

Technology also improves access to care. Healthcare access is one of the biggest barriers to providing high-quality care. Because they cannot receive the required care owing to physical, location, and cost limitations, patients frequently face treatment delays (AlQudah et al., 2021). “Advantaged populations are particularly impacted, and clinicians can give them solutions that will enable them to benefit from healthcare technology” (, 2020). As a result, policymakers need to focus on setting rules limiting how telehealth can decrease the number of trips patients take to the emergency room while lowering expenditures for providers and patients. Rather than communicating and assessing patients and instructing them online, there is a need for portable diagnostic equipment which can help treat patients in their local areas.

Remote patient monitoring can lower healthcare costs by averting future effects, much like earlier issue discovery. Using remote monitoring and telehealth, it is also possible to address the problem of a lack of physicians in rural areas, which has plagued many countries, including ours. However, according to Galen Data (2022), “there may be issues because technology has evolved over the year, thus serving as the conduit between clinicians and patients.” A happy, delighted doctor administers medication to his patient. Working with dashboards on connected medical equipment and computers removes the human touch of therapy, which results in a lack of compassion for patient care. Policymakers should develop laws that shield patients since using technology as an interface for treatment may confuse and frustrate individuals, especially elderly and disadvantaged patients. It could also result in client disobedience or confusion about treatment strategies.

The necessity for technology and the ensuing rise in expenses have caused a serious issue for the medical community. Technology is a necessary component of today’s environment, but what good is a highly technologically advanced institution if its costs are so high that it excludes a sizable portion of the population it is intended to serve? For instance, cancer can be easily detected and tracked today, but it is quite expensive, and only the wealthy can afford it. Since most members of the lower middle class and the poor cannot afford these services and are likely to pass away from their illness, this is unethical (Milliken, 2018). Therefore, it is crucial for today’s healthcare leaders to develop regulations that guarantee that prices are significantly restricted as technology improves.




AlQudah, A. A., Salloum, S. A., & Shaalan, K. (2021). The role of technology acceptance in healthcare to mitigate COVID-19 outbreak. Emerging Technologies During the Era of COVID-19 Pandemic, 223-244.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from

Barba, D., León-Sosa, A., Lugo, P., Suquillo, D., Torres, F., Surre, F., … & Caicedo, A. (2021). Breast cancer, screening, and diagnostic tools: All you need to know. Critical Reviews in Oncology/Hematology157, 103174.

Galen Data. (n.d.). The disadvantages of technology in Healthcare – Galen Data. (2020, February 20). The impact of digital technology on healthcare. HealthManagement.

Intelligent Retinal Imaging Systems. (n.d.). Top 3 benefits of technology in healthcare – iris. IRIS.

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1). Retrieved from ORGANIZATIONAL POLICIES AND PRACTICES TO SUPPORT HEALTHCARE ISSUES