How Nurse Leaders Stay Grounded in Nursing Ethics and Values
Nurse leaders stay grounded in nursing ethics and values by establishing structured systems for addressing moral distress, actively participating in shared decision-making frameworks, maintaining visible leadership presence during ethical conflicts, and creating safe spaces for staff to voice ethical concerns without judgment. 1, 2
Create Open Communication Channels for Moral Distress
Establish formal protocols where nursing staff can openly discuss moral distress without fear of professional repercussion or judgment. 1, 2 This requires active leadership intervention, not passive availability. 1
Implement regular staff meetings specifically designed for ethically challenging cases, with explicit protection from retaliation, as moral distress arises when constraints prevent nurses from doing what they believe is morally right. 1, 2
Provide peer support mechanisms and facilitate self-reflection through peer-to-peer coaching, recognizing that nurses often place patient wellbeing above their own emotional needs. 1 Stimulating self-care and increasing self-awareness about negative emotions during ethical conflicts requires structured support. 1
Join or arrange peer support groups and seek adequate supervision to facilitate ethical decisions and responses. 3
Maintain Visible Leadership During Ethical Conflicts
Advocate for your role as a leader and supervisor to optimize quality of care, increase adherence to ethical standards, and support peers during morally complex situations. 3 Supportive and visible nursing leadership is essential, particularly during crises. 3
Ensure registered nurses have a formally recognized leading role in delegation, oversight, care plan initiation and evaluation, as this leadership position is critical when ethical conflicts arise. 1, 2
Function as a mentor and supervisor for other care personnel during morally complex situations, collaborating diligently with families, physicians, and other healthcare professionals. 1
Actively advocate for patients to shelter them from negative consequences when organizational or resource constraints threaten dignified care. 1, 2
Implement Shared Decision-Making Frameworks
Train staff in shared decision-making processes that include three core elements: information exchange (where patients/surrogates share values and preferences), deliberation (discussing which options align with patient values), and making treatment decisions (reaching agreement on care plans). 1, 2
Use this systematic approach to prevent values-based conflicts from becoming intractable disputes, ensuring decisions incorporate best scientific evidence alongside patient values, goals, and preferences. 1, 2
Tailor the shared decision-making approach based on patient or surrogate preferences, ranging from patient-directed to clinician-directed models, all of which are ethically supportable. 1
Engage in shared decision-making for defining overall goals of care, including decisions about limiting or withdrawing life-prolonging interventions. 1
Ground Decisions in Core Ethical Principles
Apply the four main ethical principles—autonomy, beneficence, non-maleficence, and justice—as the theoretical framework for treating patients with dignity and respect. 4 These principles provide nurses with a foundation for ethical decision-making when confronted with moral questions. 4
Consider virtue ethics as a complementary approach that focuses on the character of the nurse as moral agent, providing more holistic analysis of moral dilemmas and facilitating flexible, creative solutions when combined with principle-based frameworks. 5
Recognize that when principles conflict, virtue ethics can help determine which principle should dominate by considering the interpersonal and emotional elements of human experience. 5
Engage Ethics Resources When Conflicts Become Intractable
When partnerships in decision-making fail to yield mutually acceptable decisions, enlist clinical ethics consultants or others adept at conflict resolution. 1, 2 Implement proactive communication strategies first, including early involvement of expert consultation. 2
Participate on ethics committees to share nursing's unique perspective, using institutional decision-making committees rather than allowing ad hoc decisions when surrogates fundamentally disagree. 1
Advocate for setting up 24-hour ethics consultation hotlines to provide advice and support during ethical dilemmas. 3
Train Staff in Conflict-Specific Communication Skills
Ensure staff receive training specifically designed for ethical decision-making and conflict resolution, including listening closely to patients/surrogates and providing emotional support. 2
Document who was present during ethical discussions (patients, family members, healthcare team members), how patient values were incorporated into deliberation, and any misperceptions that were addressed. 1 This prevents future conflicts and clarifies the ethical reasoning process. 1
Clearly state the decision reached and the rationale, linking it to the patient's expressed values, making the ethical framework explicit and defensible. 1
Discuss prognosis in clear, jargon-free language while eliciting patient values and preferences, and explain principles of surrogate decision-making to prevent misunderstandings. 2
Nurture the Foundation of Ethically Sustainable Caring Cultures
Recognize your responsibility as a nurse leader to realize and pass on ethically sustainable caring cultures, creating prerequisites for staff's growth and development. 6 The basis of good care includes ethics with respectful and dignified care that is evidence-based and economically stable. 6
Nurture and protect the core of caring by creating contextual, professional, and cultural prerequisites to maintain care staff's ethical and professional competence. 6
Foster a care culture where staff are co-creators of ethically sustainable practices that include good traditions for the praxis of care. 6
Advocate for Organizational Support of Ethical Practice
Advocate for or contribute to tailoring information materials and guidelines to address the specific ethical challenges in your care setting. 3
Address your needs and your staff's needs regarding specific information about risks and guidelines on protective measures when ethical conflicts arise. 3
Ensure the institution is committed at all levels, including administrative leadership, to maintaining high quality of life for patients, as trusting relationships that build community and respect patient choice must characterize staff-patient interactions. 3
Common Pitfalls to Avoid
Never allow resource constraints to dictate care decisions without transparent ethical deliberation—strained resources require explicit ethical frameworks, not implicit rationing. 1
Do not assume that traditional hierarchies should determine leadership in ethical decision-making—leadership should be determined by the needs of the team and the specific ethical situation, not by professional scope-of-practice politics. 3
Avoid allowing nurses to exercise rational control over emotions without support—decision-making about moral issues demands acknowledgment of the interpersonal and emotional elements of human experience. 5