Ethics in healthcare: Why nurses need 'moral courage' to protect patients

Ineffective leaders often fail to promote moral courage or to address the ethical dilemmas nurses routinely face, such as when they witness or experience bullying in the workplace, failure to obtain informed consent or inattention that may endanger patients, according to an article published by

In order to demonstrate moral courage--the ability to overcome fear and stand up to your core values and ethical obligations--nurses must know that their organizations will support them, according to the article. This means leaders of hospitals and health systems must foster a workplace culture that rewards ethical behavior, John S. Murray, Ph.D., R.N., who serves on the American Nurses Association Ethics and Human Rights Advisory board, told the publication. 

He advises nursing teams to talk openly about ethical principles and look at case studies to understand when they should step in, according to the article. Examples include dealing with advance directives, impaired providers or any situation that endangers patient safety.

Further, students and new nurses need to learn how to handle ethical challenges, a second article on points out.

Role play is one way organizations can help new nurses think through ethical dilemmas and how to handle them, said Mary Hooshmand, Ph.D., R.N., an associate dean at the University of Miami School of Nursing and Health Studies. Mentors also can review case studies and best practices within their clinical environments, she said. She advocates organizations include new nurses on hospital ethics committees.

Ultimately nurses' moral and ethical obligation is to their patients, Stephanie Seburn, a former ICU nurse, said in a third article.

"Ethics is all about having a discussion aimed at finding a solution that has the best possible outcome for the patient and is most aligned with the patient's wishes," said Seburn, who helps nurses deal with moral dilemmas. "To me, this means that what the patient wants for him or herself should be of paramount importance when a decision needs to be made."

Last year, a report from the Johns Hopkins Berman Institute of Bioethics examined ethical issues nurses face in clinical practice, nursing education, nursing research and nursing policy. The report said nurses need more ethical support in their practices and called for the creation of tools and guidelines to foster an ethical work environment, FierceHealthcare reported.

Some hospitals have done an exceptional job fostering this culture. Earlier this year Baptist Health South Florida, Cleveland Clinic, North Shore-LIJ Health System and University Hospitals were named to the Ethisphere Institute's 2015 World's Most Ethical Companies list, along with Hospital Corporation of America.

To learn more:
- read the article on moral courage
- here's the article on ethical training
- see the article about moral obligations to patients

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