Nurses are faced with challenging and difficult decisions on a daily basis. They bear the burden of responsibility to their own profession, other team members, and patients. Nurses also need to ensure that they uphold ethical decisions, even though their ethical and moral values may be challenged frequently. It is not surprising that nurses often find it challenging to make the right decisions. 

The unspoken pledge to duty that nurses make is an important part of nursing. It holds them accountable for the health of their patients and ensures that interventions are suitable. Respecting the intrinsic value, rights, and dignity of all people is also a core nursing principle. Nurses are trained and committed to providing the right care to patients while respecting their decisions and rights. 

In some situations, care requirements may interfere with ethical decision-making. It is important for nurses to be capable and competent in making ethical decisions during their practice.

Understanding nursing ethics

The moral principles that shape how an individual will behave or act in certain situations are known as ethics. In nursing, strong ethics are crucial because providing care to patients often leads to moral dilemmas. Healthcare professionals must be capable of recognizing these dilemmas as they occur and know how to apply professional core values and ethics when making important decisions. 

Professional master’s programs like Rockhurst University’s MSN leadership program provide thorough information and training in ethical decision-making in nursing. The right training makes it easier to understand nursing ethics and how and when to apply them in practice.

Providing equitable care

Health equity means that everyone should have a fair chance at being as healthy as possible. Nurses are responsible for ensuring that each patient receives equitable care. There are four factors that may influence health equity as it applies to nursing:

• Disparities in healthcare among different segments of the population, such as low-income populations, immigrants, and ethnic minorities.
• Nongenetic and nonmedical factors that affect health outcomes. These factors are known as the social determinants of health. 
• Understanding that the behaviors, customs, and beliefs of a segment of society may affect disease manifestations to provide culturally competent care. 
• Nurses are professionally responsible for protecting human rights and standing up against systemic injustice. 

Improved patient care for different demographics 

Health disparities may impair treatment and patient outcomes. Nurses should be aware of this fact and know how to deal with health inequity effectively. They should be mindful of economic and social factors affecting community health. Nurses should also know when to refer patients to other team members, case managers, and social workers for additional services. 

It is important to establish trust to make patients comfortable enough to share information regarding their socioeconomic and cultural status. This can be particularly challenging because nurses and patients may come from different ethnic or racial backgrounds. Knowing how to overcome these barriers and how to provide care that suits the needs of different demographics is important for nursing. 

Principles of ethics in nursing

Throughout their careers, nurses will encounter ethical dilemmas and challenges in different situations. Struggling to identify these dilemmas and the right action to take to address each situation can be very stressful. The American Nurses Association outlines various ethical principles that provide nurses with a firm foundation for making ethical decisions.

• The principle of autonomy refers to respecting and supporting the decision of patients to accept treatments or refuse them. Nurses are patient advocates, and it is their duty to provide patients with all the important information they need, such as complications, benefits, and potential risks. This will help patients make informed decisions. Healthcare teams can create a care plan based on the wishes of the patient. Unless a patient is legally incompetent or incapacitated, family members should not put any pressure on the patient or make decisions on their behalf. Patients may accept or refuse treatment for many reasons, such as previous medical experience, social support, health status, age, and culture. 
• The principle of nonmaleficence refers to selecting treatments that will provide beneficial outcomes with the least harm. This principle ensures nurses make decisions focused on the safety of their patients as well as the community. 
• The principle of beneficence means that all actions must be guided by compassion. Nurses must use beneficence daily when dealing with patients by providing compassionate care. 
• The principle of fidelity states that nurses must deliver care with honesty, caring, altruism, and loyalty. Nurses must establish trust with their patients and honor their relationship. They must also respect the privacy of their patients and refrain from sharing their information with others without their consent. If required, nurses can consult with other professionals such as social workers, healthcare team members, and case managers to ensure the best care for patients. 
• The principle of justice ensures that nurses provide care that is equal and fair, regardless of the financial or social status of patients. Nurses must advocate for their patients to ensure health equity is achieved. 
• The principle of paternalism states that healthcare professionals have the authority to make decisions about concealing or revealing a patient’s diagnosis, prognosis, and treatment options. They need to make the right decision about when and how they reveal this information or conceal it from others based on the unique circumstances surrounding each patient. 

Why ethical decision-making is important in nursing

Situations that may seem mundane and routine could have important implications in healthcare. Nurses have ethical obligations and professional goals that should guide their actions and decisions. Routine actions might not be viewed this way by nurses due to a lack of awareness. It is important for nurses to be aware of maximizing ethical, safe patient care. 

Heightened awareness can help nurses understand how their everyday decisions may affect their patients. For example, it can help them to recognize when patients are at risk so they can intervene and be proactive. The ability and willingness to act is an important part of nursing. Nurses also have to understand that they are obligated to represent the best interests of their patients. Embracing their role can help facilitate resilience and avoid distress for optimal, sustainable, ethical practice. 

Medical ethics refers to issues that healthcare professionals face when treating patients based on logic, facts, and values. The ethical issues doctors face are usually related to economic and legal matters. They may have to make decisions about withholding treatment due to cost, practicing defensively to avoid malpractice claims, and deciding whether to cover up their mistakes. When it comes to nursing, ethical practice focuses on the well-being and rights of patients, the public health of the community, and the safety of the environment. 

Technology has had a big impact on healthcare, and while it has many advantages, there are also a few drawbacks. Nurses have to use new technology in a way that does not threaten the confidentiality and safety of patient data. They must also ensure that the rights of their patients are not threatened by technology. The decision about what is ethical should ultimately be based on what is right for the patient. Ethical decision-making plays an integral role in delivering optimal care to patients.

Ethical dilemmas nurses face

Even though nurses may be trained extensively and have a deep understanding of ethical dilemmas, they cannot predict all the possible dilemmas they may face during their careers. In such situations, it is best to ask for advice from team members. 

Here is a look at a few basic types of ethical dilemmas nurses often face.

• It is important for nurses to obtain the consent of their patients before medical procedures and treatments. Nurses should explain all the benefits and potential risks of a procedure to the patient. They also need to ensure that patients are competent enough to make an informed decision about the procedure. In many situations, such as while under the influence of medication, patients may not have the ability to think clearly about the consequences of their medical situations. The patient’s guardian or family is then required to make the decision on their behalf. 
• Nurses often face dilemmas regarding patient rights. Nurses play the role of the patient’s advocate. This role may be clear in most situations, but when the situation is complicated or the nurse is unprepared, this may prove to be a problem. 
• Nurses have to ensure they protect the confidentiality of their patients. They are required to protect the medical history and other sensitive health information of their patients. When dealing with law enforcement or family members, this may prove to be challenging, but they must preserve the autonomy of their patients.

Respecting the decisions of patients 

Respecting and honoring the decisions patients make is an important part of healthcare. Patients have the right to decide whether or not they want to receive a certain treatment, as long as they are capable of making informed decisions for themselves. Healthcare professionals and doctors may recommend a certain treatment or medication, but they also need to provide the patient enough time to decide for themselves. If the patient does not have decision-making capacity at the time, healthcare professionals must wait for a reasonable time. Nurses are required to protect this right and advocate for their patients. 

Being responsible for the outcomes of decisions 

Nurses try to make the best decisions for their patients based on the situation and the information they have access to at the time. It is important to rely on relevant information to make the right decision. Not all decisions made by nurses lead to positive outcomes. In certain situations, decisions may lead to negative outcomes, and nurses should take responsibility for the outcome. More importantly, they should try to understand why it happened and what steps they can take in the future to avoid the same outcome. 

End-of-life decisions in nursing

Nurses who care for patients who are nearing the end of their life are aware of the many difficult and complicated decisions that families need to make about sensitive issues. While nurses may have their own beliefs, values, and morals, they may not always correspond to the wishes, beliefs, and values of patients. This may lead to an internal conflict. It is the responsibility of nurses to put aside their own beliefs and focus on what is important for the patients and their families. They need to support the patients so they understand the burdens and benefits of the interventions.  

Cultural competency in nursing

While cultural competency has always been a part of nursing ethics, it has received increased attention in recent years. When nurses take the time to hone their cultural competence skills, they learn to pay attention to the verbal and nonverbal cues of their patients. 

Having contact with people from various socioeconomic and cultural backgrounds enables them to understand new belief systems and social norms. This improves the quality of care they provide. Communicating effectively with patients also allows nurses to establish trust, making patients feel more confident in their care. Cultural competency allows nurses to be better equipped to tailor their care based on the changing needs of patients. 

How ethical decision-making affects nursing

Ethical issues and struggling to make the right decisions increase stress. The decisions nurses make should be based on the wishes of the patient while remaining in line with optimal care. This may not always be easy or straightforward. Sometimes patients may refuse treatment, even when it is in their best interest. Knowing how to deal with such situations in an effective manner is important. 

There may be many external factors beyond the control of nurses, such as understaffing, that negatively impact patient safety. The financial situation of the hospital and its staffing status may impact the safety and quality of the services delivered. Nurses have no control over these external issues. They are, however, still responsible for providing treatment and care to their patients in an equitable and ethical manner. This becomes even more important because hospitals are often treating patients with disadvantages and limited access to hospital services and healthcare resources.   

The daily responsibilities of nurses based on ethical considerations 

For nurses to be successful in delivering optimal care to patients, it is important that they clearly understand their responsibilities. They must also know how ready and willing they are to accept these responsibilities. According to Collegian, the responsibilities of nurses cover seven domains that promote quality and safety in healthcare. To establish these domains, researchers asked nurses to describe what they considered to be their responsibilities to provide quality and safe care to patients to ensure they are in line with the expectations of their profession.

The domains are:

• Management of environment
• Evidence-based practice
• Promotion of safety
• Person-centered care
• Technical and medical competence
• Clinical governance and leadership
• Positive interpersonal behaviors

The commitments and core values of nurses 

The code of ethics in nursing is meant to be enduring and self-reflective. These principles guide the actions and decisions nurses make on a daily basis. These core values explain how the role of nurses goes beyond patient interactions. Nurses must juggle many relationships at work, including patients, patients’ families, and healthcare professionals. The core values also make nurses aware of their responsibilities in the environmental, economic, and sociopolitical context. 

At the same time, nurses must also learn to identify boundaries at work and apply them to their relationships with co-workers. They must also learn not to get too involved in the lives of their patients. When dealing with situations that may threaten these boundaries, nurses must ask their supervisors or co-workers for help and guidance. 

Nurses act as advocates for their patients. While this role is always clear in the workplace, nurses must also work to promote health policy and social justice outside. Advocating for their patients also involves speaking up about issues such as the prevention of violence, food safety, and other social issues. 

To do this effectively, nurses can join organizations in their neighborhoods and community groups and get more involved in their community. Nurses are well-respected and trusted community members, and their advocacy efforts and opinions can make a significant difference in the community. 

The bottom line

Nurses are often well aware of their core values and responsibilities to their patients, but they may not be as familiar with specific nursing ethical values. They might minimize the value of other decisions in their daily work that impact their patients as well as society. 

It is important for nurses to think about how ethics apply to nursing so they can integrate ethical decision-making into their profession. However, educators, leaders, and co-workers also have the responsibility to prioritize educating nurses about the importance of ethical decision-making.