Ethics: Employer-sponsored wellness programs for nurses: The ethics of carrots and sticks

Research has demonstrated that job stress and shiftwork, both of which nurses often experience, are risk factors for obesity. Zhao and Turner (2008) carried out a systematic review of studies focused on shift workers' lifestyle. Findings from the 17 studies reviewed by the authors suggested that shift workers, as compared to non-shiftworkers, were more likely to be overweight, have adverse lifestyle behaviors, and eat less healthfully. In another study, a sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys (Malik. Blake. & Batt. 2011), Results of the study showed that a majority of nurses were overweight and that their self-reported health, diet, and physical activity ratings were low. As researchers continue to find relationships between obesity and chronic illnesses and also the negative impact of unhealthy eating habits and lack of exercise on health, employers are considering new ways to help ensure a healthy work environment.In 2011, the Surgeon General recommended a focus on Creating Healthy Worksites to make it easier for employees to participate in exercise programs and make nutritious food choices (Corporate Fitness Works. 2011 ). There are increasing numbers of employer-sponsored wellness programs that are designed to contain rising healthcare costs by encouraging healthy behaviors (Lessack. 20131. Behaviors that are targeted most frequently by wellness programs are exercise, smoking, and weight loss (Muitaba &Cavico, 2013). The Patient Protection and Affordable Care Act (ACA) has allowed companies to provide financial incentives to employees for healthy behaviors (Berman. 2013: Madison. VoIpp. & Haloern. 2011). ACA regulations distinguish between participatory and health-contingent wellness programs. Participatory wellness programs do not require employees to satisfy any particular standard, such as joining a gym or participating in a smoking-cessation program, in order to receive a reward. Health-contingent wellness programs require employees to perform specific activities related to a health factor or to achieve a specific health outcome in order to receive a reward (Lessack. 2013J.In theory, the primary ethical justification for employer-sponsored wellness programs is beneficence - the moral obligation to act for the benefit of others (Rothstein & Harrell, 2009). These programs appear to be a win-win situation: employees have opportunities to be healthier and save on healthcare costs, and employers can benefit from a more productive and healthier workforce (Voigt & Schmidt. 2013)In spite of these advantages, however, implementation of these programs has raised some ethical concerns. The model of beneficence that is integrated by employee-sponsored wellness programs tends to be paternalistic, with health plans designed for economic leverage to encourage employees to adopt the type of healthy lifestyle activities selected by the specific health plan (Rothstein & Harrell. 2009). Privacy for employees is another concern, as coaches and others carrying out the programs collect sensitive health information about employee participants. There are risks of this information being stolen, as well as concerns with employee autonomy (Berman. 2013). In addition, there are concerns about potential discrimination of unhealthy employees that may occur if the incentive programs result in discouraging unhealthy job applicants, encouraging unhealthy employees to resign, or discouraging them from taking advantage of health benefit packages offered by the institution (Madison. VoIpp. & Halpern. 2011). As increasing numbers and types of employer-sponsored healthy lifestyle programs increase, the question arises: At what point are incentives to participate or penalties for nonparticipation so great as to render participation in the program involuntary (Lessack. 2013)? Both the carrot (rewards) and stick (penalties) approaches to employee-sponsored healthy lifestyle program may raise some ethical concerns. …