In the evolving environment of public healthcare, Human Resources (HR) professionals are facing significant challenges to maintain the financial sustainability while also ensuring the delivery of high-quality patient care. This chapter explores the ethical dilemmas that arise when budget constraints threaten to compromise the quality of care that healthcare organisations provide. It investigates how HR practices have taken an important role in addressing these challenges, emphasising recruitment, workforce planning, and employee training as key areas where ethical considerations are important. By examining different innovative workforce strategies, this chapter underscores best practices for ensuring that cost management does not compromise patient well-being. This chapter also investigates how leadership styles and organisational culture in the public healthcare sector influence ethical behaviour and decision-making within HR. By examining case studies of organisations that have successfully navigated these dilemmas, this chapter offers insights into the importance of ethical decision-making in HR practices within the public healthcare sector. Apart from that, this chapter aims to evaluate the outcome by suggesting metrics for the effectiveness of HR practices in maintaining quality care amid budget constraints. Ultimately, it advocates for a commitment to incorporating ethical considerations into financial decision-making processes to cultivate a healthcare environment that values both fiscal responsibility and excellence in patient care.