# Situation: A registered nurse has worked for 3 years on the medical ward of a private hospital that cares for many clients with diabetes, thyroid disorders, and liver disease. The nurse is planning a career in diabetes and endocrine nursing. A home care agency offers the nurse ₱500 for every discharged client with diabetes who signs up with the agency on the nurse's advice. Which response BEST follows the Code of Ethics for Registered Nurses?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630565  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A registered nurse has worked for 3 years on the medical ward of a private hospital that cares for many clients with diabetes, thyroid disorders, and liver disease. The nurse is planning a career in diabetes and endocrine nursing.

A home care agency offers the nurse ₱500 for every discharged client with diabetes who signs up with the agency on the nurse's advice. Which response BEST follows the Code of Ethics for Registered Nurses?

## 보기

1. Accept, provided each client is told about the payment beforehand
2. Decline, and stop mentioning this agency to any client at all
3. Decline, and guide clients to agencies by need and their choice **✔ 정답**
4. Accept, and give all payments to the ward's staff welfare fund

**정답: 3**

## 해설

The Code of Ethics for Registered Nurses bars nurses from accepting fees or commissions for referrals, because payment creates a conflict of interest in advising clients. The nurse declines, and continues to guide clients toward suitable agencies, including this one, according to their needs and choices.

## 심화 해설

Referral commissions are not allowed
A home care agency offers the nurse ₱500 for every discharged client with diabetes who signs up with the agency on the nurse's advice. The Code of Ethics for Registered Nurses bars nurses from accepting fees or commissions for referrals, because payment creates a conflict of interest in advising clients. Once the nurse is paid per referral, the advice can be shaped by the nurse's gain rather than the client's needs, and clients can no longer trust that a recommendation is impartial. The nurse therefore declines the payment.

Keep guiding clients by their needs
Declining the commission does not mean the agency is bad or must be avoided. The correct response also includes continuing to guide clients toward suitable agencies according to their needs and choices, which may include this agency. The nurse can give balanced information about the services available, help clients compare options such as cost, location, and services, and respect the client's right to decide. This protects client autonomy and the nurse's role as an advocate.

| Response | Follows the Code? | Reason |
| --- | --- | --- |
| Decline; guide by need and choice | Yes | No conflict of interest; client-centered |
| Accept with disclosure | No | Disclosure does not make a commission acceptable |
| Decline and never mention this agency | No | Punishes clients if the agency suits them |
| Accept and give to staff welfare fund | No | Still a commission for referrals |

Why the other responses are wrong
Disclosing the payment to each client does not remove the conflict of interest; the Code prohibits taking the commission, not merely hiding it. Refusing to mention the agency at all is an overcorrection: if this agency is the best fit for a client, excluding it harms the client. Passing the money to the ward's welfare fund still means accepting payment in exchange for referrals, and the referral decisions would still be influenced by the payment.

Related ethical principles
The situation touches on fidelity to clients, justice in fair advice, and the nurse's integrity. Nurses also should not use their position to promote commercial products or services for personal gain. If the offer appears to be a pattern, the nurse may inform the nurse manager so that the hospital can address it under its own policies.

Exam takeaway
Key point Do not accept fees or commissions for referrals, but keep advising clients fairly, based on their needs and choices.

## 임상 시나리오

Referral Commissions and the Code of EthicsAvoiding conflict of interest
The Code of Ethics for Registered Nurses bars accepting fees or commissions for referrals, because payment creates a conflict of interest.

The nurse declines the ₱500 per-client offer and continues to guide clients to agencies by need and choice, which may include this agency.

Disclosure or donating the money to a fund does not make the commission acceptable.

CautionDo not overcorrect by refusing ever to mention the agency. Advice should follow what is best for each client.

## 핵심 개념

- **Conflict of interest** — A situation in which personal gain could influence a professional's judgment or advice.
- **Referral commission** — A payment given in exchange for directing clients to a particular provider or service.
- **Client autonomy** — The client's right to make informed decisions about their own care.
- **Code of Ethics for Registered Nurses** — The set of ethical standards adopted for Filipino registered nurses in practice.

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