Ethical issues occur when tough decisions need to be made. In particular, nurses are susceptible to facing various ethical issues and difficult situations in their day-to-day work.
Here are examples of ethical dilemmas in nursing, as discussed by experts.
Table of Contents
- A patient who has a drug addiction is admitted for extensive trauma but the provider will not order adequate pain medication
- Inadequate staffing with too many patients per nurse to provide necessary care for each one
- Limited health care resources for too many critically ill patients.
- Patients who have low literacy levels and do not know what documents they are signing in the hospital
- Patients who have terminal illnesses expressed to end life and wishes to discontinue treatments, but do not have Advanced Directives
- Sense of duty and compassion versus hospital safety protocols
- Suspicion of abuse or maltreatment
Laura Reyher, MSN, RN
Instructor of Nursing, West Texas A&M University
A patient who has a drug addiction is admitted for extensive trauma but the provider will not order adequate pain medication
Ethical dilemma: Should the nurse go up the chain of command to meet the patient’s needs and risk professional retribution for insubordination, or ignore the situation because the patient is an addict?
What should the nurse do? ALWAYS advocate for the patient’s needs, especially if it costs an uncomfortable conversation with a supervisor or administrator. They will always know where you stand – upholding the rights of every patient for compassionate care.
Inadequate staffing with too many patients per nurse to provide necessary care for each one
Ethical Dilemma: Should nurses refuse to come on-duty creating further staffing shortages, or risk patient harm due to missed care that could cause lawsuits?
What should the nurse do? Be a part of the solution instead of the problem. This is an administrative/system-level problem, and patients come first.
As nurses, we should work together to bring this detrimental issue to a mediation table to diplomatically develop solutions. If patients are harmed because of poor staffing, judges and juries are far more likely to rule on the side of nurses who are acting in the best interests of their patients and doing what any reasonable nurse would do in a similar situation.
Limited health care resources for too many critically ill patients.
Ethical dilemma: Which patients, in life-threatening situations, should get higher levels of care that could increase their survival rates, and which patients should get lower levels of care that could decrease their survival rates?
What should the nurse do? This is a triage challenge for nurses that requires experience in critical thinking and clinical judgment.
Knowledge of staff expertise, available support staff, and appropriate equipment, along with understanding the seriousness of the patient’s condition and other overlapping illnesses will guide the nurse in analyzing which patients could have the best chance for survival by receiving the highest level of care.
Patients who have low literacy levels and do not know what documents they are signing in the hospital
Ethical dilemma: Should the nurse cause a delay in a busy surgical schedule to ask the surgeon to provide additional information for the patient, or should the nurse go ahead and prepare the patient for surgery in order to keep the busy surgical team on schedule?
What should the nurse do? ALWAYS err on the side of vulnerable patients. Health care language is complicated, but every patient has a right to know what is happening.
Information should be given in a way that patients can understand, ask questions, and allow or refuse treatments, procedures, medications, surgeries, or any other type of care. It may complicate a busy schedule, but it’s their right to know.
Patients who have terminal illnesses expressed to end life and wishes to discontinue treatments, but do not have Advanced Directives
Ethical dilemma: Should the nurse ignore the patient, and listen to well-meaning family members who plead to have all possible care given, including chemotherapy, tube feedings, a ventilator, and CPR (cardiopulmonary resuscitation)?
What should the nurse do? Nurses should encourage every patient to have an Advanced Directive to let the health care team know what their wishes are if their heart or lungs should stop, or they develop an irreversible condition.
Families may be influenced by deep feelings, emotions, or other issues, but the patient’s wishes are of paramount importance. If the patient is unable to speak for themselves and no Advanced Directives are in place, state laws allow for a delineation of authority for a patient that will include parents or guardians for a child, spouse/adult children/siblings/other family members to make these important decisions.
If the patient has no family, the hospital Ethics committee that includes persons from the community can assist with reaching a conclusion in the patient’s best interest.
Organizational Psychologist | Registered Nurse | Founder, Nurse2Nurse Network
Sense of duty and compassion versus hospital safety protocols
A nurse mentor in Nurse2Nurse Network told me about a nurse working in a COVID unit who has lingering feelings of guilt and self-doubt about a decision she was forced to make between her sense of duty and compassion for a dying patient and the demands of hospital safety protocols.
She was at the bedside of a patient whose death was imminent but taking longer than anticipated to transpire. The nurse had made a promise to the patient and the family that the patient would not be alone at the time of death. However, because of the prolonged nature of that passing, she had been at the bedside far longer than allowed under the guidelines the hospital had adopted to protect nurses from extended exposure to the virus.
Her co-workers, then her supervisor, were gesturing to her stridently through the glass to come out of the room. The nurse tried to ignore them at first, but the gesturing from the supervisor clearly became a command.
Ultimately, the nurse left the room before the patient had died. She feels that she betrayed her patient’s trust at the patient’s most vulnerable moment. It has been hard to let go of the guilt and remorse even though she knows she was in an impossible situation.
Dr. Peter Koch
Clinical Ethicist | Professor of Philosophy, Villanova University
As a clinical ethicist, I have found that nurses often face unique ethical dilemmas because of their role as bedside caregivers and patient advocates.
This role is unique because nurses experience the day-to-day care of the patient, and so often come to know their patients and families in ways that doctors and specialists might not.
Suspicion of abuse or maltreatment
Of the many kinds of dilemmas that nurses might face, one that is particularly daunting and troublesome arises in pediatric nursing. It is unfortunately common to care for a child whom a nurse suspects to be a victim of abuse or maltreatment – perhaps as evidenced in the reasons that the child is admitted in the first place.
While various state-by-state legal structures are in place, these situations still pose a number of ethical dilemmas for nurses, especially since there is often a degree of uncertainty about whether abuse has occurred.
Such situations call for the nurses to professionally engage with the child’s parents, who make decisions on the child’s behalf while balancing a heightened concern for the wellbeing of the child.
All of this, in turn, must be balanced with the uncertainty and risk of being wrong if the nurse decides to report the suspicion. Such situations are sources of great moral distress for nurses, and understandably so.