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Ethics
 A system of moral conduct and principles that guide a
person’s actions in regard to right and wrong and in regard
to oneself and society at large
 The systematic study of what a person’s conduct and actions
should be with regard to self, other human beings, and the
environment
 The justification of what is right or good and the study of
what a person’s life and relationships should be, not necessarily
what they are

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 Nurses as Agents

• Nurses are often placed in situations where they are expected

to be agents for patients, physicians, and the organization
simultaneously, all of which may have conflicting needs, wants,
and goals.
 How does this impact a nurse’s ability to function from an
ethical standpoint?

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 Competencies for Making Ethical
Decisions as a Nurse-Manager

• Having knowledge of ethical principles and frameworks

• Using a professional approach that eliminates trial and error and

focuses on proven decision-making models

• Using available organizational processes to assist in making such

decisions

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 Types of Ethical Issues
 Moral indifference: an individual questions why morality in
practice is even necessary

 Moral uncertainty or conflict: an individual is unsure which

moral principles or values apply and may even include
uncertainty as to what the moral problem is

 Moral distress: occurs when the individual knows the right

thing to do but organizational constraints make it difficult
to take the right course of action

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 Types of Ethical Issues—(cont.)
 Moral outrage: occurs when an individual witnesses the
immoral act of another but feels powerless to stop it

 Ethical dilemmas: described as being forced to choose

between two or more undesirable alternatives

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 Question

A nurse witnesses another nurse providing care without proper hand

hygiene and reports this to the charge nurse. The charge nurse is
friends with the other nurse and refuses to take action.
This is an example of:
A. Moral indifference
B. Moral conflict
C. Moral distress
D. Ethical dilemma

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 Answer
C. Moral distress
Rationale: Moral distress occurs when the individual knows
the right thing to do but organizational constraints make it
difficult to take the right course of action. With moral

uncertainty or conflict, an individual is unsure which moral

principles or values apply. An ethical dilemma occurs when an
individual is being forced to choose between two or more
undesirable alternatives.

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Management Ethical Responsibilities

 Understand the ethical problem-solving process

 Be familiar with ethical frameworks and principles

 Know ethical professional code

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Ethical Frameworks to Assist in
Solving Ethical Dilemmas

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 Question
Tell whether the following statement is true or
false:
A nurse-manager who makes decisions based on
what will benefit the majority of the nurses in his
or her charge is using the intuitionism ethical
framework for decision making.
A. True

B. False

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 Answer
B. False
Rationale: Using an ethical framework of
utilitarianism encourages decision making based
on what provides the greatest good for the greatest
number of people. The intuitionist framework
allows the decision maker to review each ethical
problem or issue on a case-by-case basis,
comparing the
relative weights of goals, duties, and rights.

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 Ethical Principles
 Autonomy: promotes self-determination and freedom
of choice
 Beneficence: actions are taken in an effort to promote
good
 Nonmaleficence: actions are taken in an effort to avoid
harm
 Paternalism: one individual assumes the right to make
decisions for another
 Utility: the good of the many outweighs the wants or
needs of the individual
 Justice: seek fairness, treat “equals” equally, and treat
“unequals” according to their differences

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 Ethical Principles—(cont.)

 Veracity: obligation to tell the

truth
 Fidelity: need to keep promises
 Confidentiality:keep privileged
information private

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 Question
Which is not an element of ethical
decision making?
A.Beneficence
B.Paternalism
C.Utility
D.Pragmatism

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 Answer
D. Pragmatism
Rationale: The principles of
ethical decision making include
autonomy, beneficence,
paternalism, utility, justice,
truth telling (veracity), fidelity,
and confidentiality.

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 Professional Code of Ethics

 Itis a set of principles, established by a

profession, to guide the individual
practitioner.
 The first Code of Ethics for Nurses was
adopted by the ANA in 1950 and has
been revised five times since then.
 Thiscode outlines the important
general values, duties, and
responsibilities that flow from the
specific role of being a nurse.

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Standards of Practice for Nurse
Administrators

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Standards of Practice for Nurse
Administrators—(cont.)

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 Reminder

 If a structured approach to problem solving is

used, data gathering is adequate, and multiple
alternatives are analyzed, even with a poor
outcome, the manager should accept that the
best possible decision was made at that time
with the information and resources available.

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 Types of Problem-Solving Processes

Traditional problem-solving
process
Nursing process
MORAL decision-making model

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The MORAL Decision–Making Model
(Crisham, 1985)
M—Massage the dilemma.
O—Outline options.
R—Review criteria and
resolve.
A—Affirm position and act.
L—Look back. Evaluate the
decision making.

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Strategies to Promote Ethical
Behavior as the Norm

1. Separate legal and ethical

issues.
2. Collaborate through ethics
committees.
3. Use institutional review boards
appropriately.
4. Foster an ethical work
environment.

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 Integrating Leadership Roles and
Management Functions in Ethics
 Leadership roles in ethics focus on the human
element involved in ethical decision making
 Leaders are self-aware regarding their values
and basic beliefs about the rights, duties, and
goals of human beings.
 As self-aware and ethical people, they role
model confidence in their decision making to
subordinates.
 Leaders also are realists and recognize that
some ambiguity and uncertainty must be a
part of all ethical decision making.

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 Integrating Leadership Roles and
Management Functions in Ethics—(cont.)

 In ethical issues, the manager is often the

decision maker.
 Because ethical decisions are so complex and
the cost of a poor decision may be high,
management functions focus on increasing the
chances that the best possible decision will be
made at the least possible cost.
 The manager must become an expert at using
systematic approaches to problem solving or
decision making.

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