Morals and Ethics in Nursing

The conceptual framework that I feel best helps to explain ethics, morals and laws is that found in the Aristotelian framework, which stipulates that ethics describe the theoretical beliefs and standards that are held individually or in a society, morality describes the behavior or activity of an individual or society, and laws refer to what is prohibited or what one has the right to do in society according to the government (Kristjansson, 2014; Chowdhury, 2016). Building on this framework in the modern era is the utilitarian framework which holds that a community should pursue the common good—i.e., the greatest good for the greatest amount of people. In the nursing environment, this type of conceptual framework can help nurses to better understand their roles in the health care organization and how to ensure that the greatest level of quality care is being achieved.

The utilitarian ethical framework can be used by leaders to help identify the common good that a community should pursue before individual self-interest (Mill, 1859). This is also known as a practical approach to ethics. The ethical standards and principles that are used to guide and teach people to be moral are rooted in this concept of one doing good so that the whole of one’s community benefits rather than any single one individual of the good of the rest of the community. It is a concept that allows people to recognize that there are others who are our neighbors and that they have a right to have a happy existence. It also helps to reduce the kind of competition and self-advancement that people can pursue in the workplace because they want to get ahead or because they harbor petty dislikes for others.

In my workplace, it became apparent that nursing shifts were not being sufficiently covered as the nurse manager in charge of scheduling shifts was not doing an effective job of ensuring that all shifts were covered. As a result, several nights a week, nurses were pulling double duty and working extra hours in order to cover a missing shift that should have been filled by another nurse. This was leading to overwork and to burnout and it was making the entire department feel joyless. A number of nurses were complaining and it was obvious that there was low job satisfaction as a result. Some nurses were thinking about quitting. The issue was even threatening the well-being of patients because medical errors and mistakes tend to be made more when nurses are overworked (IOM, 2000).

I saw that if I wanted to be considered a leader I should speak up about this problem and go to a hire manager in the administration to point out the problem that was occurring in our department. I showed how by routinely failing to have shifts covered in the schedule, the nurse manager responsible was actually destabilizing the workplace, which could in effect lead to harm for a patient and high turnover rate for the health care organization, both of which would lead to more costs in the long run for the facility. Even though I feared potential blowback from the nurse manage making the schedules, I knew that I had to take a stand and speak out to the administration because the nurse manager in our department was not listening to us and was not correcting the situation even after we brought it to her attention over the course of several weeks. She continued to under-staff the shifts and it was clearly taking its toll on the nurses.

In this role I was using transformative leadership because I had spoken with lower level nurses and heard their complaints, issues and needs, and now I was working to make a change in the department to help transform it into a better functioning workplace where nurses could feel respected, healthy, not overworked, and refreshed when they came on shift. Transformational leadership is helping for overseeing the change management process and uses a vision of the leader to help guide the process to completion. I presented a vision of where we were to the administration and of where we should and could be—and the response was favorable.

As the IOM (2000) has pointed out, nursing errors are committed most often when nurses are overworked and are not getting enough off-duty rest. To avoid this issue, it is important that all shifts are covered by their respective nurses and that no nurses are pulling double-duty repeatedly. Patients are likely to receive greater quality care when nurses are alert, awake, attentive and reflective as opposed to when they are tired, burdened, exhausted or resentful.
Making sure that all shifts were covered and that the department was properly and adequately staffed was a positive step in ensuring better quality care for patients. It was also a positive step in ensuring that nurses themselves were ready and able to perform their duty.

The ethical, moral and legal implications of not properly staffing the workplace were that the values and vision of the health care organization were not being followed: nurses were being overworked and this was going to inevitably have a negative impact on patients through nursing error. The goal of the facility is to deliver quality care to patients and overworked nurses are not going to be able to deliver that, so the nurse manager was failing to perform her duty according to the ethical duties and responsibilities as dictated by the organization. Morally speaking, failing to cover the shifts was a problem because her behavior was causing others to suffer. She was not looking at or considering the common good; instead she was looking at how she could get the schedule out with as few headaches to herself as possible. She did not care if we were going to be overworked.

The nurse as a moral agent is motivated by the moral behavior associated with being an ethical person and being part of a law-abiding, ethical community. The desire to perform one’s duty as it is expected of one is a strong motivating force for myself and can enable a nurse to be an effective moral agent—especially in this case where there was a clear need for a change.