Creating Workplace Environments that Support Moral Courage
Nurses practicing in today's healthcare environment are confronted with increasingly complex moral and ethical dilemmas. Nurses encounter these dilemmas in situations where their ability to do the right thing is frequently hindered by conflicting values and beliefs of other healthcare providers. In these circumstances, upholding their commitment to patients requires significant moral courage. Nurses who possess moral courage and advocate in the best interest of the patient may at times find themselves experiencing adverse outcomes. These issues underscore the need for all nurses in all roles across all settings to commit to working toward creating work environments that support moral courage. In this manuscript the authors describe moral courage in nursing; and explore personal characteristics that promote moral courage, including moral reasoning, the ethic of care, and nursing competence. They also discuss organizational structures that support moral courage, specifically the organization's mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership that promotes moral courage.
Moral distress has been defined as physical and/or emotional suffering that is experienced when internal or external constraints prevent a person from taking the action that one believes is right (Pendry, 2007). Ethical dilemmas in practice arise when one feels drawn both to do and not to do the same thing. They can cause clinicians to experience significant moral distress in dealing with patients, families, other members of the interdisciplinary team, and organizational leaders. Nurses experience moral distress, for example, when financial constraints or inadequate staffing compromise their ability to provide quality patient care. These situations challenge nurses to act with moral courage and result in nurses feeling morally distressed when they cannot do what they believe is appropriate (Cohen & Erickson, 2006). Nurses who consistently practice with moral courage base their decisions to act upon the ethical principle of beneficence (doing good for others) along with internal motivation predicated on virtues, values, and standards that they believe uphold what is right, regardless of personal risk.
Ethical values and practices are the foundation upon which moral actions in professional practice are based. Morally responsible nursing consists of being able to recognize and respond to unethical practices or failure to provide quality patient care. The foundation of quality nursing care includes nurse practice acts, specialty practice guidelines, and professional codes of ethics. Familiarity with these documents is necessary to enable nurses to question practices or actions they do not believe are right. Although a code of ethics and ethical principles can guide actions, in themselves they are not sufficient for providing morally courageous care. Moral ideals are needed to transcend individual obligations and rights. The moral commitment that nurses make to patients and to their coworkers includes upholding virtues such as sympathy, compassion, faithfulness, truth telling, and love. Nurses who act with moral courage do so because their commitment to the patient outweighs concerns they may have regarding risks to themselves.
Deciding whether to act with moral courage may be influenced by the degree of conflict between personal standards and organizational directives; by fear of retaliation, such as job termination; or lack of peer and/or leadership support. In this manuscript the authors begin by describing the concept of moral courage. Next they explore personal characteristics that promote moral courage, including moral reasoning, an ethic of care, and nursing competence. Organizational structures that support moral courage, specifically organizational mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership are addressed.
Abstract and Introduction
Abstract
Nurses practicing in today's healthcare environment are confronted with increasingly complex moral and ethical dilemmas. Nurses encounter these dilemmas in situations where their ability to do the right thing is frequently hindered by conflicting values and beliefs of other healthcare providers. In these circumstances, upholding their commitment to patients requires significant moral courage. Nurses who possess moral courage and advocate in the best interest of the patient may at times find themselves experiencing adverse outcomes. These issues underscore the need for all nurses in all roles across all settings to commit to working toward creating work environments that support moral courage. In this manuscript the authors describe moral courage in nursing; and explore personal characteristics that promote moral courage, including moral reasoning, the ethic of care, and nursing competence. They also discuss organizational structures that support moral courage, specifically the organization's mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership that promotes moral courage.
Introduction
Moral distress has been defined as physical and/or emotional suffering that is experienced when internal or external constraints prevent a person from taking the action that one believes is right (Pendry, 2007). Ethical dilemmas in practice arise when one feels drawn both to do and not to do the same thing. They can cause clinicians to experience significant moral distress in dealing with patients, families, other members of the interdisciplinary team, and organizational leaders. Nurses experience moral distress, for example, when financial constraints or inadequate staffing compromise their ability to provide quality patient care. These situations challenge nurses to act with moral courage and result in nurses feeling morally distressed when they cannot do what they believe is appropriate (Cohen & Erickson, 2006). Nurses who consistently practice with moral courage base their decisions to act upon the ethical principle of beneficence (doing good for others) along with internal motivation predicated on virtues, values, and standards that they believe uphold what is right, regardless of personal risk.
Ethical values and practices are the foundation upon which moral actions in professional practice are based. Morally responsible nursing consists of being able to recognize and respond to unethical practices or failure to provide quality patient care. The foundation of quality nursing care includes nurse practice acts, specialty practice guidelines, and professional codes of ethics. Familiarity with these documents is necessary to enable nurses to question practices or actions they do not believe are right. Although a code of ethics and ethical principles can guide actions, in themselves they are not sufficient for providing morally courageous care. Moral ideals are needed to transcend individual obligations and rights. The moral commitment that nurses make to patients and to their coworkers includes upholding virtues such as sympathy, compassion, faithfulness, truth telling, and love. Nurses who act with moral courage do so because their commitment to the patient outweighs concerns they may have regarding risks to themselves.
Deciding whether to act with moral courage may be influenced by the degree of conflict between personal standards and organizational directives; by fear of retaliation, such as job termination; or lack of peer and/or leadership support. In this manuscript the authors begin by describing the concept of moral courage. Next they explore personal characteristics that promote moral courage, including moral reasoning, an ethic of care, and nursing competence. Organizational structures that support moral courage, specifically organizational mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership are addressed.