Ethical Dilemmas Faced by Nurse Practitioners and Physician Assistants within Managed Care Settings

Abstract

Background: In Pakistan, nurse practitioners (NPs) and physician assistants (PAs) are playing an increasingly vital role in healthcare delivery, facing escalating ethical challenges. Balancing quality care with patients' concerns over costs poses significant ethical dilemmas for these providers. However, there is a lack of comprehensive understanding regarding the specific ethical conflicts encountered by NPs and PAs in their daily practice within managed care settings in Pakistan. This study seeks to pinpoint the ethical concerns and conflicts experienced by Pakistani NPs and PAs delivering primary care in managed care settings. It aims to explore the factors contributing to these ethical dilemmas.
Methodology: A cross-sectional self-administered questionnaire was mailed to 50 randomly selected NPs and PAs practicing in primary care and related subspecialties in Karachi, Pakistan. The survey, with an adjusted response rate of 50.6%, delved into ethical issues, ethics preparedness, and experiences of ethical conflict. Statistical analyses, including bivariate and multiple linear regression, were employed to identify predictors of ethical conflict
Results: The study revealed that 75% of respondents faced challenges in providing quality care due to insurance limitations, with 50.5% encountering such obstacles on a daily to weekly basis. Additionally, 45% of participants recounted instances where patients requested them to deceive insurers for access to care. The most significant predictor of ethical conflict was the perceived duty to advocate for patients, even if it meant exaggerating a patient's condition, explaining 25% of the variance.
Conclusion: Pakistani NPs and PAs frequently grapple with ethical conflicts, primarily stemming from their professional obligation to advocate for patients. Adequate training in ethics and possessing sufficient professional autonomy are crucial factors that empower these clinicians to navigate the complex ethical terrain and meet patients' needs within the confines of the Pakistani healthcare system.