Best practices for ethical nursing leadership

The American Nurses Association (ANA) Code of Ethics offers guidance for implementing a more ethical approach to nursing care. But how can nurse leaders in all practice areas act as help to create safe forums for ethical discussion, reasoning, and influence? From nursing administration to new graduate floor nurses, each nurse has a responsibility to help lead the profession toward a more positive ethical practice environment.

Understanding the 4 ethical principles for nurses

Regardless of the circumstances, any ethical decision involves an examination of four basic ethical principles that must be understood and implemented in practice. Encouraging nurses to review each principle as it applies to unique workplace situations is the first step in fostering a more ethical practice environment.

1. Autonomy: Autonomy refers to the patient’s ability to make choices for themselves regarding their own healthcare. As long as a patient receives full disclosure of all treatment options, he or she is entitled to choose the best therapy for their personal healthcare needs. If a patient does not have the mental capacity to make such decisions, the healthcare team refers to the patient’s healthcare power of attorney.
2. Benevolence: Each nurse must be committed to do good for their patients. It is the nurse’s responsibility to seek out the best outcomes possible for each person in their care.
3. Nonmaleficence: Nurses must do no harm to those in their care. While treatment itself can have negative impacts or cause adverse events, these effects are not brought about with the intent to cause further harm.
4. Distributive justice: This principle refers to how the greater good influences decision making. In some cases, distributive justice may be based solely on equal delivery of available resources.

The role of nursing leadership in ethical practice

Nurse leaders are at the forefront of efforts to increase ethical thinking and discourse within the workplace. After identifying the need for resources to address ethical issues, it is possible to implement a successful ethics program to promote better decision making and collaboration for the good of each patient. Failure to do so may result in increased rates of moral distress, which occurs when nurses carry out actions that do not meet their ethical standards. As moral distress on a unit increases, so too does staff turnover and a loss of job satisfaction.

As a first step toward more ethical practice, many nurse leaders elect an ethics champion to facilitate the ethical decision-making process. In many cases, ethics champions receive additional training to broaden their understanding of medical ethics and the ethical challenges nurses may face as part of their daily work. Ethics champions may be nurses familiar with specific patient populations and the unique needs each type of patient presents.

But nursing is an evidence-based practice, and evidence-based results can help pave the way toward a more ethical workplace. Beyond designating an ethics champion, nursing leadership should be prepared to help other nurses evaluate ethical dilemmas by taking specific steps that promote ethical dialogue, including:

• Identifying common ethical problems occurring with regular frequency on the unit.
• Encouraging staff to seek out and utilize appropriate ethical resources within the facility, including the ethics champion, the organization’s ethics committee, or the nurse leader herself.
• Supporting a positive ethical environment by creating ethical policies, practices, or guidelines.
• Providing further training and education to all staff members about ethics and ethical issues that may arise on the unit.
• Promoting open discussions among the entire healthcare team about specific ethical issues as they relate to patient care.

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