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Ethical/Legal Issues and the Nurse Manager

Monday June 12, 2000
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Ethical dilemmas and moral conflicts are an everyday reality in nursing practice. Bioethical dilemmas in healthcare are raised by issues such as termination of life-sustaining treatment, care of the dying, euthanasia and physician-assisted suicide, organ transplantation, genetic testing and engineering, resource allocation, electronic data management, and confidentiality. These bioethical dilemmas have different practice ramifications for different healthcare professionals.
Nevertheless, nurse managers must recognize that nurses, like themselves, are typically ill-equipped to deal with ethical and legal issues in practice. Nurses say that they lack sufficient knowledge in bioethics to participate in ethical decision-making, both as advocates for the patient and family and in their own right as a healthcare provider. Many nurses report they receive little or no formal education in bioethics at school or at work and therefore feel inadequate and unqualified to participate in bioethics discussions and decision-making. This lack of preparation is particularly troubling because there are ethical, legal, and regulatory mandates that impose a duty on healthcare professionals to participate in bioethical decision-making.
Such realities pose tremendous challenges to nursing's integrity as a profession. Without clinical ethics competence, nurses will not be viewed as participants in clinical ethics discussions and will not be valued by patients, families, and other healthcare professionals when discussing ethical questions. Thus, nurses can and should become more knowledgeable about the interaction of ethical, legal, social, economic, and political issues that affect institutional and public policy decisions. Nurses can seek to address and influence these decisions individually and collectively. Expertise is a form of power. A sense of powerlessness and moral distress in nursing often leads to inaction rather than the leadership necessary to meet patient and societal needs for nursing and healthcare.
What Should the Nurse Manager Do?
What might the nurse manager do to become more empowered and gain competence in ethics and law? How can the nurse manager avoid or reduce moral distress? Here are a few suggestions:
Ethics committees: Generally, ethics committees offer education, consultation, case review, and policy development for the organization. Nurses contribute to institutional ethics committees through discussions and deliberations either as committee members or by appearing before the committee as patient advocates. Because nurses bring a strong clinical voice and patient-focused approach to an ethics committee, they are essential members of the committee. Nurses may also consider establishing their own ethics committee. A nursing ethics committee should not be a substitute for an institutional ethics committee. Nurses should make an initial attempt to use and resolve a problem through the organization's normal channels. However, nursing ethics committees provide a forum for nurses to share their concerns and seek solutions when they experience ethical problems that are not being addressed by the institutional ethics committees.
Ethics roundtables: Another forum that nursing students and nurses might use for ethics education is a roundtable. Nursing ethics roundtables give nurses valuable support, further professional development, and provide a forum for nurses to become more comfortable in presenting clinical ethics situations and addressing an interdisciplinary team.
Ethics conferences: An ethics conference provides an opportunity for nurses to address current ethical and legal issues in practice and a rich forum for support and networking.
Ethics week: Ethics Week, separate from and unlike Nurses Week, would concentrate on relevant ethical issues in nursing practice.
Ethics courses and ethics programs: Nurses should receive preparation in ethics during their professional education. Lack of knowledge can result in nurses feeling unqualified and unable to participate in ethical decision-making. Courses and programs provide a rich opportunity for nurses to gain additional information about ethical issues and their impact on practice. Schools of nursing and departments of staff development should provide and/or support ongoing ethics education.
Ethics research: Ongoing nurse-focused ethics research is needed. Research empowers the nurse to institute changes in clinical practice.
Nurses are in a key position to prevent the escalation of bioethical dilemmas that result in wrenching situations for patients, families, providers, and the courts. We have an ethical and legal obligation to be competent practitioners. Moral thinking and ethical awareness are aspects of competent nursing practice. Therefore, if we are to be excellent nurses and participants in ethical decision-making in the 21st century, it is imperative that the nurse manager and nurses gain competence in ethics and law.