“Every day in the United States, nurses watch patients forgo beneficial treatment they cannot afford despite nursing’s moral standard to treat patients without regard to financial condition.”

How often have you been left, pretty much on your own, to figure out a way that your uninsured and/or homeless patients have access to something (anything!) that will maintain their health when you aren’t with them? Are there meds they can’t pay for? Do they need prenatal care that they can’t afford? Can they possibly function without home care of some kind?

Moral distress as a call to seek systemic change.

In “Ethical Issues: The Moral Distress of Nurses When Patients Forgo Treatment Because of Cost” in this month’s AJN (free to access until October 7), Douglas Olsen and Linda Keilman discuss the moral distress of nurses when we are unable to meet the needs of patients who don’t have the money to pay for care in our for-profit health care system.

The authors argue that individual nurses who find they can’t improve patients’ access to health care are in fact being confronted with wider systemic problems.

“Moral inclination as well as the ANA Code of Ethics obligate nurses to provide care regardless of the patient’s ability to pay; yet because many work in hospitals, nursing homes, and other facilities that withhold care without payment, nurses are vulnerable to moral distress at the individual and collective professional level.”

In this article, the authors argue that our personal moral distress, as well as our intimate knowledge of the precise ways in which the U.S. health care system fails our patients, can fuel efforts to change the system.