Nurse Leaders Report Ethical Dilemmas Related to Patient Care, Work Environment
As part of a nursing leadership course, students at the University of North Carolina Wilmington interview nurse leaders from acute care and outpatient settings. One of the interview questions is, “What ethical dilemmas have you faced?” The students submitted in-depth, thoughtful responses from their interviews.
“As we began to review the answers, we realized we were getting high-value feedback that had the potential to impact how we educate nurse leaders,” says Melissa Scott, PhD, RN, an assistant professor at the School of Nursing.
The nurse leaders discussed ethical dilemmas involving patient care issues, including end-of-life care, care planning, and responses to child and elder abuse. They also described ethical difficulties in cases of disciplinary issues, such as drug diversion or staff not following hospital policies. One nurse leader talked about an employee who was consistently late for work.
“She was a single mother who had very little help, and the school would not accept her child earlier enough for her to make it to work on time,” Scott recalls. Despite feeling empathy for this employee, the nurse leader had to follow hospital policy, which required disciplinary action.
Another nurse leader described disciplining an employee who went against hospital policy. However, in this case, following the policy likely would have resulted in patient harm. “Both of these situations created ethical dilemmas,” Scott says. “The employees were doing the best they could, yet the leader had the obligation to follow organizational policy.”
The faculty decided to use these insights to develop content to add to nurse leader curricula and professional development courses. “Patient care issues and work environment issues require critical reasoning. Nurse leaders need help with both of these issues,” Scott notes.
Ethicists could offer this help by taking a more active role in developing educational content for nurse leaders. “I think it would also be helpful for the ethicist to deliver the education as well,” Scott says.
Formally, the ethicist could deliver content in a classroom in collaboration with the organization’s professional development team. “Informally, in-services, email blasts, and joining in-unit huddles are a possibility,” Scott adds. The ethicist can make sure nurses know the easiest way to contact ethicists. Some nurses do not realize what ethics can offer them or think it is too time-consuming to involve the ethics team. “Ensuring the leaders of an efficient process for asking for a consult might encourage leaders and staff to reach out for assistance,” Scott says.
Patient care issues and work environment issues require critical reasoning. Nurse leaders need help with both of these issues. Ethicists could help by taking a more active role in developing educational content for nurse leaders.
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