How to know when you’re facing an ethical dilemma

Consult supervisor, peers, CCMC for assistance

When you’re confronted with an issue that just doesn’t feel right, ask yourself: Am I truly doing the right thing at the right time for the right reason?

If the answer is yes, you’re probably making an ethical decision, says Mindy Owen, RN, CRN, CCM chair of ethics committee and a member of the executive board of the Commission for Case Manager Certification (CCMC) in Rolling Meadows, IL.

In all cases, whether you’re a nurse, a social worker, or a therapist, follow your professional scope of practice and professional code of conduct, Owen advises.

All case managers should take time to review the Code of Professional Conduct issued by the CCMC, suggests Susan Gilpin, JD, chief executive officer of the CCMC. "It’s not designed to be a punitive weapon but a measure that gives case managers guidance when they face something that doesn’t feel right," Gilpin says.

If there is any question about the scope of practice or code of conduct when case managers think they are being asked to overstep their bounds, they should start by raising the issue with their supervisors, Owen advises. Even if they don’t get the answer that makes the situation feel right, if the issue arises in the future, they can say they consulted with their supervisor and were told to follow a certain direction, she adds.

Consult other certified case managers to see how they handled a similar situation.

"In the cases of ethical dilemmas, case managers often get their best help from peers who have faced the same question," Gilpin says.

Once case managers have reviewed their scope of practice within their work environment, if they still have questions, they should bring it to the commission for review, Owens says.

"It goes back to doing the right thing at the right time and for the right reason," she says.

The CCMC hasn’t received a large numbers of complaints against case managers concerning ethical violations. However, the CCM does receive requests for advisory opinions from case managers in the field who aren’t sure what the right direction is, Gilpin says. "In those instances, the case manager has already gone to their supervisor and discussed the issue with their peers but they still don’t feel comfortable," she says.

When case managers have explored all the avenues open to them and still feel they aren’t doing the right thing because of workplace pressure, they have to ask themselves if theirs is a job they can live with or should they move on.

"It’s not an easy issue. You can’t look at it as a black-and-white issue. There are a lot of pressures placed on case managers in the decision-making process. But this is something we as case managers need to consider," Owen says.

What are the consequences of unethical behavior? If someone files a complaint against you, your certification can be revoked and the state licensing board notified. You also could be sued.

"The upside of practicing ethically is that, in the long run, case managers are providing better care to individuals. It’s a great risk management tool to keep them out of legal problems," Gilpin says.