One of the major challenges that nurses have to face daily due to the nature of their profession is compliance with ethical, moral, and legal rules and standards that have to be observed in the workplace. These principles guide their behavior and help them make decisions taking into account not only their legally documented duties but also their understanding of what is good for the society in general and each patient in particular.
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The common good of the community that each nurse serves is the key reason to rely on ethical and moral leadership that encompasses ethical standards and beliefs while answering the needs of the society (Leach & McFarland, 2014). Nurses are supposed to ground each of their actions in ethics and morals since laws do not provide sufficient guidance to actions. The success of the profession is deeply connected with the sense of truth and responsibility.
However, following the standards and relying entirely on theoretical frameworks is not enough to become an effective leader. Every nurse must be able to identify his/her leadership style to adhere to in decision making (Grace, 2017). Yet, how can this evident manifestation of individuality align with clearly defined ethical standards that are common for every professional operating in the field?
The paper at hand will investigate the issues to find an answer to this question. It will begin by introducing a conceptual framework of ethical standards (proving the advantage of the consequentialist approach over other theories); then, it will pass on to the analysis of a particular situation presenting an ethical dilemma and identify implications of the case. The major purpose of the study is to consider how a personal leadership style (determined with the help of an assessment tool) can act as a barrier or a facilitator in cases when a nurse has to encounter a dilemma in practice.
A conceptual framework can be defined as the major analytical scheme (allowing variations and contexts) that is utilized in practice to organize ideas, make distinctions, and come up with an applicable solution to this or that problem. The conceptual framework of the ethical constructs of ethical, moral, and legal standards is generally aimed to guide the performances and processes by determining whether they are ethical from all the three enumerated perspectives. For this purpose, it must be continuous since all operations performed within one clinical unit are interdependent, which implies that they must rely on one set of values (Grace, 2017).
Although there are a lot of legal issues to be considered, the advanced nursing practice presupposes that the nurse’s actions are guided not only by the law but also by the inner sense of ethics. The most commonly encountered frameworks are rights-based reasoning, duty-based reasoning, utilitarianism, the virtue approach, the divine command theory, the common good approach, and intuitionism. Although a lot of nurses rely on the duty and virtue frameworks that allow developing professional and personal qualities via understanding of one’s duties and personal morals, the consequentialist approach seems the most patient-oriented of the enumerated (Grace, 2017).
The nurse is not made to focus exclusively on his/her obligations but is encouraged to think of the impact of every action on people who are directly involved in the situation. The major ethical standard is therefore to produce the maximum good for all the parties engaged in the ethical dilemma. Being entirely pragmatic, this framework makes it possible to assess the outcomes of one’s actions on real people without theorizing how virtuous and professional one’s conduct is (Chadwick & Gallagher, 2016). It allows reaching a compromise even in the most difficult situations and producing the least harm if it is impossible to avoid altogether.
Applying a theoretical framework in a situation involving real patients with a successful outcome is the best way to prove its effectiveness in clinical settings. I had to encounter an ethical dilemma when I was the Direction of Nursing at a Nursing Home several years ago. An elderly woman was hospitalized as a result of multiple wounds found on every bony prominent of her body due to a neglectful attitude.
The woman’s daughter refused to have her placed in the facility since she used her mother’s pension and social security checks for paying her bills. Hospitalization of her mother would mean that she was going to lose money. Nevertheless, the patient was placed in the Nursing Home by the court’s decision. An ethical dilemma arose when the daughter demanded that her mother be released to her care. Being refused, she got irritated and attempted to remove the patient from the bed, stating that she was taking her home “with or without your permission”.
As the Assistant Director of Nursing and a nurse, I believed it to be my ethical duty to advocate for the good of the patient. I immediately called the police that escorted the woman from the building. I also filed a report on elderly abuse in the state of NJ. As a result, the daughter was permitted to have only supervised visitation.
As a leader, I felt that the situation was a dilemma since I interfered with the family relationship, which was beyond the scope of my practice. My duty was to provide the patient with the assigned care and have her daughter removed from the premises in case of a scandal.
Filing a report meant producing far-reaching consequences for the family and spoiling the relationship between mother and daughter. A professional should restrain from involving in any family issues whatsoever (Marquis & Huston, 2017). However, I considered the consequences of my behavior and decided that the patient cannot recover if taken home. The principle of the protection of life is the primary one, according to Dolgoff’s Ethical Principles Screen (Parrott, 2014). Her health was the major consequence guiding my actions.
To assess the effects of one’s conduct, it is required to analyze its moral, ethical, and legal implications.
Moral implications refer to unwritten rules of principles of the right behavior and the distinction between the good and the evil (Chadwick & Gallagher, 2016). In the described situation, I knew that it was my moral duty to interfere since I realized that the woman abused her mother’s position for obtaining her money but not for providing her with better care.
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Ethical implications refer to the standards of the right practice or conduct for the profession. In other words, they imply the consequences of one’s actions as assessed by the code of ethics (Robinson et al., 2014). I was aware of the fact that as a professional I cannot judge the family relationship no matter how unjust the situation might seem to me. Ethics states that family issues should be resolved in the family. However, my professional and personal duty was to act for the good of the patient.
Legal implications refer to the results of actions according to the law (Chadwick & Gallagher, 2016). In this case, my behavior complied with the existing legislation; no law was violated when I filed a complaint.
When encountering a dilemma, it is not enough to rely on documented regulations. Moral agency is also highly important for an effective nurse leader. A moral agent is a person who is capable of separating right from wrong and hold responsibility for his/her decisions. I believe that I was a moral agent since even realizing that the conflict could be brought into court, I acted to the benefit of the patient but not to my convenience.
The outcome of the majority of critical situations depends on the leadership style of the Nursing Director. The assessment tool revealed that my leadership style is democratic. This implies that as a leader I tend to encourage group decisions, openness in all interactions, and personal engagement. Moreover, it makes me flexible in situations that cannot be easily resolved (Hogg, Van Knippenberg, & Rast, 2012).
However, in the described situation this style was rather an obstacle than a facilitator. Being democratic slows down the decision-making process and adds doubts and anxiety. The case required a personalized approach, tolerance, and flexibility of authentic leadership (Cianci, Hannah, Roberts, & Tsakumis, 2014). Yet, having an idealistic temperament, I cannot put up with rudeness, avarice, and disrespect to the elderly. That is why the case was resolved in favor of justice rather than the common good of all the parties.
Having analyzed ethical constructs underlying nursing leadership, I realized that theory is not always applicable in real clinical settings. Some theoretical assumptions have to be modulated to be used to resolve ethical dilemmas. In certain cases, one must step away from one’s leadership style to analyze the case objectively. A nursing leader must be flexible in all situations instead of blindly following the chosen path.
Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Basingstoke, UK: Palgrave Macmillan.
Cianci, A. M., Hannah, S. T., Roberts, R. P., & Tsakumis, G. T. (2014). The effects of authentic leadership on followers’ ethical decision-making in the face of temptation: An experimental study. The Leadership Quarterly, 25(3), 581-594.
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Burlington, MA: Jones & Bartlett Learning.
Hogg, M. A., Van Knippenberg, D., & Rast, D. E., (2012). Intergroup leadership in organizations: Leading across group and organizational boundaries. Academy of Management Review, 37(2), 232-255.
Leach, L. S., & McFarland, P. (2014). Assessing the professional development needs of experienced nurse executive leaders. Journal of Nursing Administration, 44(1), 51-62.
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application. Philadelphia, PA: Lippincott, Williams & Wilkins.
Parrott, L. (2014). Values and ethics in social work practice. Thousand Oaks, CA: Learning Matters.
Robinson, E. M., Lee, S. M., Zollfrank, A., Jurchak, M., Frost, D., & Grace, P. (2014). Enhancing moral agency: clinical ethics residency for nurses. Hastings Center Report, 44(5), 12-20.