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Published by Jeremee John Pingco

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Published by: Jeremee John Pingco on Mar 29, 2010
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UNIT 2Foundation for EffectiveLeadership and Management
Ethical Issues
In some significant respects, moral distressis embedded in the historical and structural fabric of the nursing profession.
 —Hamric (2000, p. 200)
Unit 2 examines ethical,social,legal,and legislative issues affecting leadership andmanagement as well as professional advocacy.This chapter focuses on applied ethi-cal decision making as a critical leadership role for managers.Chapter 5 examinesthe impact of legislation and the law on leadership and management,and Chapter 6focuses on advocacy for patients and for the nursing profession.
is the systematic study of what a person’s conduct and actions ought to be with regard to self,other human beings,and the environment;it is the justificationof what is right or good and the study of what a person’s life and relationshipsought to be,not necessarily what they are.
 Applied ethics
requires application of normative ethical theory to everyday prob-lems.The normative ethical theory for each profession arises from the purpose of the profession.The values and norms of the nursing profession,therefore,providethe foundation and filter from which ethical decisions are made.The nurse manager,however,has a different ethical responsibility than the clinical nurse and does nothave as clearly defined a foundation to use as a base for ethical reasoning.Because management is a discipline and not a profession,it does not have adefined purpose,such as medicine or the law;therefore,it lacks a specific set of norms to guide ethical decision making.Instead,the organization reflects normsand values to the manager,and the personal values of managers are reflectedthrough the organization.The manager’s ethical obligation is tied to the organi-zation’s purpose,and the purpose of the organization is linked to the function itfills in society and the constraints society places on it.Therefore,the responsi-bilities of the nurse manager emerge from a complex set of interactions.Society helps define the purposes of various institutions,and the purposes,in turn,helpensure that the institution fulfills specific functions.However,the specific valuesand norms in any particular institution determine the focus of its resources andshape its organizational life.The values of people within institutions influenceactual management practice.In reviewing this set of complex interactions,itbecomes evident that arriving at appropriate ethical management decisions is adifficult task.Not only is nursing management ethics distinct from clinical nursing ethics,it isalso distinct from other areas of management.Although there are many similar areasof responsibility between nurse managers and non-nurse managers,many leadershiproles and management functions are specific to nursing.These differences requirethe nurse manager to deal with unique obligations and ethical dilemmas that are notencountered in non-nursing management.In addition,because personal,organizational,subordinate,and consumer responsi-bilities differ,there is great potential for nursing managers to experience intrapersonalconflict about the appropriate course of action.
 Moral uncertainty
occurs “when one isunsure what moral principles or values apply in an ethical conflict,or even if there is anethical or moral problem(Raines,2000,p.30).
 Moral distress
occurs when one knowsthe right thing to do,but institutional or other constraints make it difficult to pursuethe desired course of action(p.30).
 Moral anguish,moral distress
moral compromise 
are also terms that have been used to refer to the emotional and psychological aspectsof ethical dilemmas experienced by nurses.
Foundation for Effective Leadership and Management
Ethics is the systematicstudy of what a person’sconduct and actionsought to be with regardto self,other humanbeings,and theenvironment;it is the justification of what isright or good and thestudy of what a person’slife and relationshipsought to be,notnecessarily whatthey are.
Multiple advocacy roles and accountability to the profession further increase the likeli-hood that all nurse managers will be faced with ethical dilemmas in their practice.Ham-ric (2001) calls this “being in the middle.”Nurses are often placed in situations wherethey are expected to be agents for patients,physicians,and the organization simulta-neously,all of which may have conflicting needs,wants,and goals.“It is not unusualthat moral uncertainty is first experienced and escalates to moral distress as patients’rights are not respected or as institutional constraints are applied and nurses feelunable to act on their moral choices and judgments”(Hamric,2000,p.199). To make appropriate ethical decisions,the manager must use a professionalapproach that eliminates trial and error and focuses on proven decision-makingmodels or problem-solving processes.Using a systematic approach allows managersto make better decisions and increases the probability that they will feel good aboutthe decisions they have made.The systematic approaches presented in this chapterinclude ethical frameworks and principles and theoretical problem-solving anddecision-making models.Leadership roles and management functions involved inmanagement ethics are shown in
Display 4.1
Ethical Issues
Leadership Roles
1.Is self-aware regarding own values and basic beliefs about the rights,duties,and goalsof human beings.2.Accepts that some ambiguity and uncertainty must be a part of all ethical decisionmaking.3.Accepts that negative outcomes occur in ethical decision making despite high-qualityproblem solving and decision making.4.Demonstrates risk taking in ethical decision making.5.Role models ethical decision making,which is congruent with the American NursesAssociation Code of Ethics and Interpretive Statements,as well as Professional Standards.6.Clearly communicates expected ethical standards of behavior.
Management Functions
1.Uses a systematic approach to problem solving or decision making when faced withmanagement problems with ethical ramifications.2.Identifies outcomes in ethical decision making that should always be sought or avoided.3.Uses established ethical frameworks to clarify values and beliefs.4.Applies principles of ethical reasoning to define what beliefs or values form the basisfor decision making.5.Is aware of legal precedents that may guide ethical decision making and is accountablefor possible liabilities should they go against the legal precedent.6.Continually reevaluates the quality of own ethical decision making,based on theprocess of decision making or problem solving used.7.Recognizes and rewards ethical conduct of subordinates.8.Takes appropriate action when subordinates use unethical conduct.
Leadership Roles and Management FunctionsAssociated with EthicsDisplay 4.1

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