A clinical ethics residency for nurses met with strong demand at two academic medical centers. Nurses who applied to the program wanted:

• to improve their communication skills;

• to help colleagues with tough ethical problems;

• to learn approaches for management of chronically critically ill and culturally diverse patients.

Demand is strong for a clinical ethics residency for nurses (CERN), which is offered selectively to nurses affiliated with two Boston academic medical centers. A team of ethics experts created the program, several of whom had hosted a one-day nursing ethics conference for several years.

“It was increasingly well-subscribed, and the evaluation feedback was ‘More, please!’” says Martha Jurchak, PhD, RN, executive director of the ethics service at Brigham and Women’s Hospital in Boston. The group had more applicants than it could accommodate.

CERN’s goal was to develop point-of-care and advanced practice nurses to serve as ethics resources. “Each year for three years, we accepted a cohort of nurses to take part in a multimodel education curriculum,” says Pamela J. Grace, RN, PhD, FAAN, associate professor of nursing and ethics at Boston College’s William F. Connell School of Nursing in Chestnut Hill, MA.

Inadequate Ethics Education

About 20 nurses attend a monthly eight-hour program for 10 months. This includes didactic instruction, role-play, and mentored practice. Faculty work with participants to use the skills developed in unit rounds, ethics consultations, educational offerings, and to serve on ethics and patient care committees. Some participants developed unit-based programs, policies, or guidelines, as well.

To learn more about the nurses’ reasons for applying, researchers analyzed 67 successful application essays. These described why nurses wanted to be in the program, and how they would apply the knowledge gained.

The overarching theme identified was “developing abilities to navigate through the gray zones in complex environments.”

“Although nurses may have had some ethics education in practice, it is inadequate to maintain moral agency in contemporary healthcare environments,” says Grace.

Three subthemes were identified:

• encountering patients who are chronically critically ill, culturally diverse, and presenting with complex circumstances;

• desiring enhanced ethics knowledge and skills to improve quality of care, understand different perspectives, and act as a resource for others;

• supporting and facilitating patient-centered ethical decision-making.

“Of the findings that were surprising, the major one was how important learning more about communication skills, and then getting to practice them, were to the participants,” says Jurchak. For example, lessons learned in the communication module about finding common ground could be readily practiced in the clinical role-play about a mother of a dying patient requesting treatment beyond what the physicians are recommending. “There was very positive feedback about the interwoven modes of learning,” says Jurchak.

Nurses wanted to help their colleagues with tough ethical problems. “It was not just about them, but how to help everyone deal with the clinical ethical problems that were coming up,” says Jurchak.

The researchers are currently analyzing more than 60 post-CERN essays. “Emerging from these analyses is support for the idea that ongoing ethics education is necessary for nurses, and that such multimodal efforts can be personally and professionally transformative,” says Grace.


1. Jurchak M, Grace PJ, Lee SM, et al. Developing abilities to navigate through the grey zones in complex environments: Nurses’ reasons for applying to a clinical ethics residency for nurses. J Nurs Scholarsh 2017; 49(4):445-455.


• Pamela J. Grace, RN, PhD, FAAN, Associate Professor of Nursing and Ethics, William F. Connell School of Nursing, Boston College, Chestnut Hill, MA. Phone: (617) 552-1246. Email: pamela.grace.2@bc.edu.

• Martha Jurchak, PhD, RN, Executive Director, Ethics Service, Brigham and Women’s Hospital, Boston. Phone: (617) 983-7842. Email: mjurchak@partners.org.