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An ethical dilemma: risk versus responsibility.

1. In the psychiatric community, two highly profitable diagnoses currently are filling psychiatric hospitals: dissociative disorder and multiple personality disorder. Certainly these patients need help, and psychiatric nurses are well-qualified to plan their scope of care. However, when the hospital reported on in this article exploited these diagnoses by encouraging practices that extended lengths of stay and restricted patient's rights, the nurses were forced to speak out as advocates for the patients. 2. The dissociative disorder unit housed 10 patients billed at an intensive care unit rate of $1,200 per day. One patient's average fee per day was $1,560; multiply this by 10 patients, and the hospital received $15,600 per day from this unit alone. 3. Financial calculation is not what nurses are used to thinking about; indeed, it somehow seems unbefitting to link nursing care with any mention of monetary gain. Yet, this is exactly the sort of information that nurses must have in order to understand how hospital politics may influence their situation.