5 Typical Ethical Dilemmas in Nursing
What happens when a patient’s family member asks for information you’re not sure you can give them? Or what if you get orders from a physician that you think could harm a patient? Ethical dilemmas in nursing are more common than many people realize — you won’t have to go far to find real-life examples of ethical dilemmas in healthcare. Understanding ethical principles can help you practice with confidence and know what to do when similar issues arise.
The focus on ethical standards in nursing dates back to the 1870s, but the first nursing code of ethics wasn’t written until the 1950s. Today, ethical considerations include principles of bioethics, patient rights, obligations to patients and the profession, and more. These principles may seem abstract until you encounter them in your daily practice. Read on as we explore the ins and outs of nursing ethical dilemmas.
What Is an Ethical Dilemma in Nursing?
An ethical dilemma happens when a nurse is caught between conflicting values or duties, and must make a decision that may not be black and white. Nurses work within complex systems, which can make it challenging to determine the right course of action.
The American Nursing Association outlines three broad types of ethical issues, which include:
- Large-scale issues arising from policy and societal structures. For example, the question of whether healthcare is a right or a privilege is an ethical dilemma at the policy level.
- Health issues that occur within organizational structures. For instance, nurses on a short-staffed unit are caught between giving great care and balancing several patient needs at once.
- Patient-level problems that emerge within clinical practice. These include individualized issues related to informed consent, patient rights, and autonomy.
5 Examples of Ethical Dilemmas in Nursing
Looking for a deeper understanding of moral and ethical dilemmas in nursing? You’ll sometimes face competing ethical priorities, so it’s important to think critically about your options in a given scenario. Here are five of the top ethical concerns in nursing, with real-world examples of dilemmas you might face.
1. Autonomy
Patient autonomy is the idea that every patient has the right to make decisions for themselves, so long as they are cognitively able to do so. At times, this means that nurses have to advocate for what the patient wants, even if it means a change to the plan of care or taking a course of action that other medical staff wouldn’t recommend.
Autonomy example:
Mrs. Garcia is admitted to the hospital with chest pain. After a series of tests, the cardiologist recommends a cardiac catheterization to assess her heart’s blood flow. Mrs. Garcia is apprehensive about the procedure and expresses her concerns to the nurse. She asks if there are any alternative treatments, or if she can delay the procedure until her family arrives to discuss it with her.
The nurse knows that time is of the essence, yet Mrs. Garcia has a right to put off the catheterization procedure if she wants to. Medical staff have asked the nurse to prep Mrs. Garcia for catheterization, but she pauses to explain Mrs. Garcia’s options. Even though the nurse feels rushed, Mrs. Garcia can make informed choices about her care and the nurse communicates her wishes to the healthcare team.
2. Justice
Justice in nursing is the fair and equal distribution of health resources. However, nurses encounter systemic issues that affect a patient’s health access and can create unjust outcomes. For example, financial means often impacts care, as does age, ethnicity, religion, and sexual orientation.
Justice example:
Mr. Rodriguez, a 45-year-old man with diabetes, is admitted to the hospital for the third time this year due to diabetic ketoacidosis (DKA). Despite receiving treatment during his hospital stays, Mr. Rodriguez’s condition continues to deteriorate because he cannot afford his insulin medication and lacks health insurance coverage.
Each time Mr. Rodriguez is discharged, the nursing staff provides education on managing his diabetes and emphasizes the importance of regular insulin injections. However, upon returning home, Mr. Rodriguez struggles to adhere to his treatment plan due to financial constraints. This is a frustrating experience for Mr. Rodriguez and the nurses, who can experience moral injury from scenarios like this one.
3. Accountability
Being accountable as a nurse means that you’re responsible for your own actions and you admit mistakes when you make them. Nursing professionals are accountable to patients, their facility, licensing board, and the public.
Accountability example:
During her shift, Nurse Annika administers medication to a patient but later realizes she gave the wrong dosage. The patient is in no distress and didn’t notice the mistake. Annika feels embarrassed and considers not reporting the error, but she ultimately decides that she needs to report the instance.
Despite feeling embarrassed and concerned about the consequences of her mistake, Annika takes full responsibility for her actions. She notifies her clinical supervisor and documents the error in the patient’s medical record according to the facility’s protocol.
4. Veracity
Practicing veracity means being honest, even when the truth is unpleasant. Sometimes it means delivering news that you wish you didn’t have to. But this honesty makes nurses the most trusted professionals, and it’s essential for ethical nursing practice.
Veracity example:
Nurse Cooper is tasked with delivering difficult news to a patient’s family — despite several rounds of CPR, the patient is not regaining a pulse. The family is very emotional, and Cooper dreads having to tell them this news.
Approaching the family with empathy and compassion, Cooper delivers the news clearly and sensitively, explaining the patient’s status while also expressing his genuine concern for the patient. They are very upset. He ensures that the family understands the situation and encourages them to ask questions and express their feelings.
5. Nonmaleficence
You’ve probably heard the phrase “do no harm” in medicine — this is the philosophy behind nonmaleficence. It states that nurses should do everything in their power to prevent harm and injury from happening to patients.
Nonmaleficence example:
Nurse John is floating to a unit that is outside his specialty, when he notices a patient’s medication dosage appears to be higher than he would expect. He knows that this might be normal for this unit, and he’s already behind on his medications. He asks the patient about it, and they say it’s correct, but he still doesn’t feel right.
John pulls another nurse aside and asks them to take a look. Upon further investigation, he discovers that there was an error in the medication order, and the dosage was indeed incorrect. He holds the medication and notifies the physician and charge nurse of the error.
How to Deal with Ethical Dilemmas in Nursing
Working as a professional nurse means recognizing and dealing with ethical problems when they arise. How you should deal with an ethical issue depends on the scale and gravity of the situation. If you’re dealing with an ethical dilemma in nursing practice, you have a few ethics resources and actions to choose from:
- Go to your charge nurse, clinical supervisor, nursing manager, or facility manager for guidance.
- Consult the ANA’s Code of Nursing Ethics.
- Document each patient interaction to ensure the chart has all pertinent information.
- Advocate for the patient’s needs.
- Seek support from other nursing staff when you need it.
- Consult your facility’s ethics committee.
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