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 explanation of the rules for hospital staff. Policies and procedures help everyone, no matter their level of education, to know what steps to take to give the right and safe care to patients. When there are competing needs, finding a good balance between the shortage of nurses and the demands of patients can make both patients and nurses healthier. According to the American Nurses Association (2015), nurses have a duty not only to patients but also to their colleagues, to follow specific steps to do what is right and to be good people overall. As nurses, we sacrifice many things, like time with our families, meal breaks, and even bathroom breaks, to provide excellent care for our patients while they are in our care.


Twigg et al. (2010) talked about how more than ten years ago, there was going to be a shortage of nurses, with over 60,000 predicted just in Australia. Turale and Meechamnan (2022) stated that there is now a shortage of over 5 million nurses worldwide. One policy related to nursing staffing should include setting a specific nurse-to-patient ratio to ensure safe care delivery. Unfortunately, if the number of nurses is at an all-time low, patient outcomes could be at an all-time high.

The consistent workload in the nursing field pushes nurses to their limits and can lead to errors in patient care. According to Walden University (2012), one result of nursing shortages is that more patients are discharged earlier than they should be, and expected to care for themselves instead of being transferred to a rehabilitation or skilled nursing facility. Ross (2022) mentioned that the nursing staff is insufficient, and nurses are asked to take on extra responsibilities. The increasing number of preventable patient errors and the inability to support colleagues on the unit is one way this shortage affects both patients and nursing staff. Hospital administrators expect the team to follow the policies they have set, but it is nearly impossible when staffing shortages are not addressed in policy changes. Policies should be updated to outline how to safely manage patient care during times 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 shortage of nurses and the conflicting needs it brings have influenced how policies are developed. The American Nurses Association (ANA) has established a code of ethics to direct nurses, along with explanations to enhance their comprehension (ANA, 2015). One aspect, Provision Six, indicates that nurses or groups of nurses should assess the ethics of the care they provide (ANA, 2015). This implies that nurses must ensure they deliver ethical care, including safe care with adequate staffing, and raise concerns if they observe unethical care or areas needing enhancement. Provision Two underscores the primacy of the patient’s well-being (ANA, 2015). Nurses have a duty to advocate for the patient’s interests, even in policymaking, as articulated in Provision Seven (ANA, 2015).

The Nursing Shortage and Competing Needs

Nursing comprises the largest segment of healthcare workers (Haddad et al., 2022). Various factors influence nursing costs, such as training, recruitment, overtime, and staff retention. Among the significant challenges is the expense of acquiring and retaining a sufficient nursing workforce. Predicting staffing needs is complicated by factors like patient acuity and economic fluctuations (Parsons, 2019). While reducing staff numbers may save money, it can result in increased overtime, errors, and nurse dissatisfaction (Haddad et al., 2022). Additionally, employing temporary nurses through agencies is costlier than hiring permanent staff. Taking into account nurses’ perspectives on safe staffing and ethical care can enhance nursing satisfaction even amid cost-saving efforts (Kelly & Poor, 2018). In essence, one competing demand is the pressure to cut costs while maintaining quality care.

Policies to Address Competing Needs

In California, Bill 394 mandated specific nurse-to-patient ratios, with other states considering similar measures (Tevington, 2011). Some states also require hospitals to disclose their staffing ratios to the public (Davidson, 2022). However, these laws concerning staffing levels do not consider factors like a nurse’s experience, knowledge, education, or patient acuity, and lack validation through research (Tevington, 2011). Nevertheless, numerous studies indicate that higher ratios of registered nurses (RNs) lead to improved outcomes, quality of care, and reduced nurse turnover rates (Tevington, 2011). The Registered Nurse Safe Staffing Act of 2015 mandates hospitals to ensure adequate staffing and involve nurses in determining appropriate staffing levels. This empowers nurses to advocate for quality care and ethical treatment, aligning with Provisions 6 and 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 always changing to meet the needs of patients, medical centers, and communities. Rules and procedures are updated regularly to match the demands set by business models, ensuring profitability to sustain care for the community. While standardized policies often streamline routine care efficiently and cost-effectively, they can sometimes hinder nurses from providing personalized and ethical care. Nurses must be aware of the potential moral consequences of their actions, solve problems, and tend to patient needs.

Specific challenges arise that can contribute to nurse burnout. Procedures are adjusted as necessary, sometimes even on a daily basis, depending on factors like nurse and physician staffing. Shortages in other departments can impact the workload of infusion nurses significantly. For instance, if there’s a shortage in operators, infusion nurses may need to handle patient calls. Similarly, if the lab or pharmacy technician is short-staffed, infusion nurses may need to step in to perform tasks like drawing labs or preparing chemotherapy. These changes occur daily to meet the demands of the office and patients, adding to the already heavy workload of infusion nurses and increasing the risk of burnout. Emotional intelligence, which involves being aware of and managing one’s emotions, is crucial for maintaining relationships and self-awareness.

While nurses have a duty to provide ethical care to patients, they also owe it to themselves to ensure their own well-being. This includes promoting health and safety, maintaining integrity, competence, and continuing personal and professional growth. Overloading infusion nurses with additional tasks can create ethical dilemmas and compromise patient safety. Nurses need to recognize their limits and advocate for their own well-being and that of their patients.

Addressing these competing needs requires strong leadership and a focus on creating a healthy work environment for nurses. Ethical awareness should be ingrained in everyday nursing practice, with a recognition that nurses have a commitment to their own well-being as well as that of their patients. Nurses should prioritize their health and safety to avoid burnout and provide optimal care to patients.

In conclusion, nurses should prioritize their well-being to ensure they can effectively care for their patients. Burnout and compassion fatigue can impair nurses’ ability to provide quality care, so it’s essential for nurses to be emotionally aware and advocate for their ethical needs.



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.


Different Needs to Consider

As nurses, we face moral challenges every day. It’s important to understand that ethics and laws, while related, are not the same thing. In healthcare, ethical dilemmas are common, and they help nurses learn to adapt and handle difficult situations. Healthcare professionals always strive to do what’s best for the patient when faced with an ethical dilemma.

One major issue in healthcare today is the shortage of nurses. This problem isn’t just local—it’s becoming a global concern. Nursing shortages in many places affect the quality of care provided. When nurses are overwhelmed with too many patients, they become dissatisfied and burnt out, which can ultimately impact patient satisfaction and safety. Patient safety is the top priority in healthcare, so many policies have been updated over the years to ensure a safer working environment for both nurses and patients during these shortages.

Developing Policies

Leaders in healthcare, like managers and unit directors, must find a balance to retain nurses. They need to understand the demands placed on staff, especially in units with high patient acuity. Balancing these factors can help decrease staff burnout and improve retention rates. The level of care needed for patients varies from unit to unit. For example, patients in the Intensive Care Unit require more intensive care than those in the mother-baby unit. It’s essential for charge nurses and managers to use acuity tools to assign safe nurse-to-patient ratios based on the patients’ needs. Acuity tools help ensure that nurses are satisfied with their patient assignments.

Policies to Address Nursing Shortages

The American Nurses Association (ANA) works to protect nurses from unsafe working conditions. They have established policies and standards to safeguard staff in potentially unsafe environments. Federal regulations also support nursing staff by promoting safer working conditions. In many states, including where I live, there are staffing laws in place. Additionally, using patient acuity tools helps my facility ensure that patient assignments are safe and distributed evenly among all nurses on 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 



Many people are unhappy about the increasing costs of healthcare these days. In the healthcare field, there are often different needs competing for attention. This is especially true in the relationship between doctors and patients. Patients often want more time and attention from their doctors, but there are only so many hours in a day. According to Kelly & Porr (2018), healthcare costs have been going up quite quickly in recent years. This increase is mostly because healthcare is moving from old-fashioned ways to using more digital technology. The American Nurses Association (2015) says this change is expensive but necessary to get good results in modern healthcare. Because most new policies are about using digital technology, making healthcare rules is harder because of the rising costs. People think each new rule will make healthcare worse.

However, there’s a problem with this. Technology has helped with some really tough medical issues, and it’s made new drugs available. Advanced tools can find diseases like cancer quickly by looking inside the body. This seems like a great step forward for healthcare and fighting deadly diseases. But as technology gets better, fewer people can afford healthcare, especially without insurance. Leaders need to find ways to pay for research and treatments so everyone with a disease can get help.

Technology has some good sides too. It makes it easier for doctors to get information about patients. We can store and access data better because of computers. Doctors can look at patient records from anywhere. They can also share information quickly through the internet. Patients can check their test results online without calling the doctor’s office. But sometimes, there are problems like losing data or someone getting access to private information.

Also, technology can save time for office workers who would otherwise be on the phone or dealing with paperwork. But one issue with technology is that it’s not always easy to move it around. Some tech companies are trying to fix this by making tools that work together better. Leaders also need to think about how to make sure everyone who needs healthcare can get it. They have to balance different goals to make good plans for treating illnesses.

Technology also helps more people get healthcare. Not everyone can get good healthcare because of where they live or how much money they have. Some patients have to wait a long time for treatment because of these problems. “People with advantages are affected the most, and doctors can use technology to help them get better care” (, 2020). So leaders need to make rules about things like telehealth to make healthcare cheaper and easier for everyone. We also need portable tools to diagnose and treat patients where they live.

Monitoring patients from far away can save money by stopping problems before they happen, just like finding issues early on. Using remote monitoring and telehealth can also help with the problem of not enough doctors in rural areas. But technology can also cause problems, like making it harder for doctors and patients to talk. Doctors might rely too much on technology and forget about treating patients with care. Leaders should make rules to protect patients because using technology for treatment might be confusing or upsetting for some people, especially older or disadvantaged patients. It could also lead to patients not following instructions or not understanding their treatment.

The need for technology and the higher costs that come with it are causing big problems for the medical field. Technology is important for healthcare today, but what’s the point if it’s so expensive that many people can’t afford it? For example, cancer can be detected and treated easily now, but it’s very expensive, so only rich people can afford it. This is unfair because many middle and lower-class people can’t get these services and might die from their illness. So healthcare leaders need to make rules to make sure prices stay low as technology gets better.



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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