Nurses deal with a vast number of patients daily, and these patients expect their nurses to know and understand their health and what needs to be done. It is also expected that nurses stand up for their patients and their own ethical beliefs when an incident occurs or if a patent’s well-being is in jeopardy. When a nurse does voice concern around a patient’s care or another issue within the facility, especially if professional risk is involved, it’s seen as a sign of one displaying moral courage.
When working in the nursing field, there are numerous obstacles that one may face, ranging from organizational finances and staffing to care delivery and research studies. Nurses who advance to leadership positions may find themselves asking questions that they never thought they would concerning the care of a patient. In emotionally charged emergency situations, nurse leaders often need to make serious decisions that account for both ethical care and compassion.
When a nurse's moral compass and ethics are challenged, it's paramount to understand how to maintain courage and continue on the right path.
Understanding When a Nurse's Courage is Tested
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Numerous times throughout a nurse’s career their moral courage and ethics will be tested, which may lead to internal distress. According to the Online Journal of Issues in Nursing, “Initial moral distress is the distress nurses experience when they are faced with interpersonal value conflicts. It is experienced as feelings of frustration, anxiety, anger and an inability to act as one sees fit due to organizational constraints.”
If the catalyst for one’s stress is not handled in a timely fashion and is left to grow, it will only manifest into a larger issue, causing greater internal conflict. For example, if a nurse feels that a staff is not providing a patient with the proper level of care, but is hesitant to speak up about the issue, the feelings can be turned inward and evolve into self-hate or job dissatisfaction. However, it is a nurse’s responsibility to take action and bring matters of low performance to light. While one may be hesitant, speaking up for a patient’s care is actually supported by many state nurse practice acts. And it’s important for an individual to remember they are part of a team, and odds are, if one person recognizes a problem, there are others who are also aware but may be apprehensive to voice their opinions, too.
Acknowledging Nursing Risk Factors
In some cases, there may be risk factors for nurses when standing up for their ethical beliefs. If nurses and doctors don't agree on the course of action for a patient's health, nurses may find themselves staying quiet. This is because of possible risk factors, such as stress, arguments, fear of termination or isolation from coworkers. These risks can be imagined or real, and the key to maintaining moral courage is to understand these risks and be willing to face them. Having a resource, such as a “sacred space,” where individuals are able discuss topics openly without the fear of any negative repercussions, is beneficial. These spaces help foster a community among nurses, given that they are supporting one another and working collectively for a sound resolution.
Finding Moral Solutions for Nursing Staff
The American Association of Critical-Care Nurses (AACN) developed the framework known as the 4 A’s to promote moral courage. The foundation, “Ask, Affirm, Assess and Act,” offers a blueprint for nurse leaders to assess a courage-testing situation ethically and compassionately. The action plan is as follows:
- Ask – One must identify the cause of distress through proactive internal and external questioning. The nurse must consider her reaction to the situation, as well as that of those around her. This step allows one to take a moment, step back from the situation and understand what specifically is causing tension.
- Affirm – Once distress has been identified, one must make a resolution to address the problem. This resolve can help be facilitated by speaking with other nurses who form a support system or a mentor.
- Assess – After having confirmed that one is going to take action, an individual needs to what exactly their plan for speaking up will be. This involves noting the pros and cons of an action and what will be done to form a resolution.
- Act – With a course of action planned, one must now find the appropriate time and setting for the greatest success. This step is by far the hardest, given that many will be hesitant due to the fear of acting. But it is key for one to have resolve and move forward.
For any action, there will be pros and cons, but it is important for nurses to have confidence and remember that their actions are not selfish and will ultimately benefit their patients.
Furthering Nurse Leadership Education
The right training can help nurses who wish to lead despite moral dilemmas. When pursuing an Master of Science in Nursing degree, nurses receive additional education that can help them not only achieve leadership positions, but further their courage when it comes to dilemmas in the workplace. The online MSN with a Clinical Nurse Leader track at Queens University of Charlotte prepares students for the challenges of nursing leadership through a comprehensive curriculum designed to mold students into interdisciplinary leaders. MSN program courses, such as Professionalism and Ethics in Clinical Leadership, teach nurses to deal with moral distress and ethical issues in their facilities.
It’s paramount that nurses understand training is available to them, and those looking for further information or training on these subjects should consider continuing their education with a Master of Science in Nursing degree.