Which of the following is the best example of an ethical dilemma faced by the nurse?

We often discuss nursing skills in terms of an RN's clinical knowledge and expertise, but understanding and managing various questions of nurse ethics is an equally important part of your skill set. Not only is it important for protecting your patient, but coping with dilemmas and feeling confident enough to speak up is critical for your own well-being. Here is a basic overview of nurse ethics and some examples of ethical dilemmas in nursing that you may encounter in your daily practice.

Understanding nurse ethics

Nurses are consistently ranked by Americans as having the highest level of honesty and ethical standards among all occupations. In 2018, they topped the Gallup poll for the 17th consecutive year, followed by medical doctors, who took second place.

Nurses are in a unique position when it comes to ethics in healthcare because of their close relationship with patients. An article in John Hopkins Magazine discusses how nurses may have special insight into how patients and families are feeling and the questions they're struggling with. They may be better able to act as an advocate than other healthcare workers because of time spent with patients.

The trust the public places in nurses is not taken lightly. To help guide you through questions of nurse ethics, the American Nurses Association has created a Code of Ethics for Nurses that all RNs should be familiar with.

Examples of ethical dilemmas in nursing

An article in the Journal of Advanced Nursing surveyed nurses on the ethical issues they face in their daily work. Respondents cited the following as their most frequently experienced dilemmas: 

• Protecting patients' rights (64%)
• Autonomy and informed consent to treatment (61%)
• Advanced care planning (41%)
• Staffing patterns that negatively impact work (37%)
• Surrogate decision making (32%)
• End-of-life decision making (26%)

Other responses include breaches of confidentiality, conflicts of interest and organ donation and transplantation.

Protecting the rights of your patient

Respondents in the survey felt patients' rights were the ethical issue that arose most frequently. This can cover a broad range of situations, including:

• Uncertainty that a patient fully understands a course of treatment, but not wishing to cause conflict with another healthcare provider.
• Feeling that a doctor may be dismissing your patient's pain symptoms but not knowing how to advocate for your patient.
• Concern that a patient is concealing information that may impact their health, but wishing to respect their privacy.

Having the resources to do your job

Nurses are responsible for providing optimal care to a patient, but in a climate where nursing shortages are common, inadequate staffing can make it difficult for RNs to care for patients in terms of patient safety, communication and relationship building. Staffing patterns that negatively impact a work environment were cited by respondents as the most stressful ethical dilemma.

• What do you do if poor staffing means you're overwhelmed and exhausted, and it impacts your ability to care for patients?
• What are the options if you feel that your managers aren't offering solutions?

How can you best approach nurse ethics?

Nursing is by nature stressful and demanding. Research has shown that moral distress over ethical questions takes a toll on nurses. The time and anxiety spent working through questions of nurse ethics can lead to frustration and burnout. Younger nurses, and those with less experience, tend to report higher levels of moral distress.

Cynda Rushton, a professor of clinical ethics, writes that while ethics are often thought of as separate from patient care, nurses must have a thorough understanding of ethical guidelines so they're prepared and grounded when dilemmas arise. Being well-versed in ethical principles helps you to avoid the stress that comes from being reactive to situations. Learning to foster moral resilience helps you best carry out your work in patient care.

For more resources to support you in ethical work through all aspects of your nursing career, explore the American Mobile archive of nursing ethics articles.

Nurses face many occasions when they need to call on ethical principles in nursing to deal with difficult situations and resolve common ethical dilemmas.

“Every day, nurses in all hospital departments face a variety of ethical issues and they need to reconcile their own values with their nursing professional obligation,” said Marian Altman, RN, MS, CNS-BC, CCRN-K, clinical practice specialist with the American Association of Critical-Care Nurses (AACN). 

“There are a variety of reasons that nurses are not able to reconcile this conflict, such as lack of resources to do so and lack of time,” she added. “Not addressing ethical issues is a problem. If the nurse ignores the issue, it may lead to burnout and their leaving the unit and/or the nursing profession.”

Nurses who do not heed the nursing Code of Ethics could also find themselves with disciplinary charges or in legal trouble. 

Every nurse should become familiar with the Code of Ethics for Nurses, developed and released by the American Nurses Association (ANA). It provides ethical principles in nursing.

“It’s a framework for helping nurses with issues that might arise,” said Connie M. Ulrich, PhD, RN, professor of bioethics and nursing at the University of Pennsylvania School of Nursing and Medicine in Philadelphia and author of Nursing Ethics in Everyday Practice.

Additionally, Altman suggested nurses contact “the hospital's ethics committee, the hospital code of conduct or a variety of educational resources. Some organizations have an ethics consultation service whose members round and proactively assist staff to discuss potential and/or real ethical issues.”

Addressing 4 Dilemmas in Nursing Ethics

1. Informed Consent

Informed consent requires the patient or surrogate know about the risks, benefits and other options for treatment. The person signing the form must freely agree to the treatment plan. It pertains to the nursing Code of Ethics’ “Right to Self-Determination.”    

Apprehension that patients and their families have not been fully informed about their treatments or clinical prognosis is a common ethical dilemma in nursing, Ulrich reported.

“It can create great concern for nurses,” Ulrich said. “Patients feel more comfortable asking the nurse to decipher what was said [by the doctor]. But it’s an ethical issue about how much they should convey.’

This is especially true about end-of-life decision making, she said. Nurses play a role in helping their patients understand and achieve their treatment goals, whether aggressive treatment or comfort care. They must respect a patient’s decision making, even if they disagree.

However, nurses may not feel prepared to have this discussion. Ulrich suggested building a strong interdisciplinary team to help deal with these ethical issues in nursing.

2. Disclosing Medical Conditions

Another example of an ethical dilemma in nursing is telling the truth to a patient vs. being deceptive, Altman said.

“Sometimes families request that patients not be told about their medical condition or diagnosis,” Altman added. “The nurse must consider the patient’s right to know. How does the nurse know what the family is saying is true?”

The nurse has an obligation to the patient and the ethical principles of nonmaleficence and fidelity—the obligation to prevent harm and the obligation to be faithful to your colleagues, Altman said, adding, “The nurse’s own value of truth-telling must also be considered.”

The nursing Code of Ethics requires truth-telling, promise-keeping and fulfilling commitments.

A 2004 article in Journal of Hospice & Palliative Nursing reported, “Patients and their families want to know the truth about their illness” regardless of whether it is good or bad news, and healthcare professionals have an ethical obligation to share with them the truth, which allows the patient to make informed decisions.   

3. Incompetence Among Peers

Another ethical issue in nursing occurs when a nurse notes incompetence in a fellow health care team member and struggles with speaking up or staying silent, said Sarah Delgado, RN, MSN, ACNP, clinical practice specialist with AACN.

“They may feel the behavior should be reported because of the threat to patient safety but hesitate to do so because it would worsen inadequate staffing,” Delgado said. “Some dilemmas can be framed as competing obligations, such as protecting the patient on one hand and protecting the staff on the other.”

The nursing Code of Ethics states that “nurses must protect the patient, the public, and the profession from potential harm when practice appears to be impaired.” It goes on to say nurses should reach out to supervisory personnel, follow organization policies, and show compassion to colleagues.

The ethical principles in nursing to consider are nonmaleficence and fidelity. Resolving what appear to be competing obligations often requires thinking creatively, Delgado added.

“Solutions often become apparent when we stop and consider all the possible actions available to us,” she explained. “Beyond report or don’t report, may be an option to talk to the individual in question, assess his or her awareness of the incompetence, and encourage further training, education or practice.”

4. Broader Ethical issues

According to Liz Stokes, JD, MA, RN, senior policy advisor at the ANA’s Center for Ethics and Human Rights, other ethical issues in nursing include:

• Creating and maintaining an ethical work environment. Provision 6 of the nursing Code of Ethics states that the nurse holds a responsibility individually and collectively to maintain and improve ethical work environments, which are “conducive to safe, quality healthcare.”
• Supporting social justice, such as opposing capital punishment, within provision 9 of the Code of Ethics. It encourages nurses to take action to influence legislatures, government agencies and other entities to address social determinants of health, and unjust systems and structures.
• Recognizing moral distress and building moral resilience. Moral distress occurs when nurses’ integrity is compromised or the ethical environment has eroded. Nurses must build resilience and develop moral courage to speak up for the ethical principles in nursing.

The Call to Nursing Ethics

Ethical practice is a constant challenge. Every day, nurses may face any of these or other ethical issues in nursing. Nurses should refer to the nursing Code of Ethics for guidance. The code makes clear nurses’ duty to protect people’s health.  

Find a nursing job you can be proud of with NurseChoice, a leader in short-term travel nursing assignments. Get connected with a recruiter by submitting our quick application.

Search Jobs     Apply Now

What is an example of an ethical dilemma in nursing?

Which of the following is best example of an ethical dilemma faced by the nurse?

What is an example of an ethical dilemma in healthcare?

Which of the following is an example of an ethical dilemma?