By Catherine Robichaux PhD, RN, CNS

Is ethical competence as important as clinical expertise in nursing practice? Do undergraduate and graduate nursing programs prepare nurses for day to day ethical concerns and issues complicated by conflicting values, scarce resources, and the technological imperative?  Can nurses identify situations with ethical content, distinguish patient/family issues from organizational ethical issues such as bullying and incivility.  Are continuing ethics education and ethics resources  available to nurses in the workplace?

While I would answer “yes” to the first question, I believe we have a long way to go in responding in the affirmative to the other questions posed. Many nursing programs have either eliminated identified ethics courses or “integrate” content in existing courses which may result in its disappearance from the curriculum. Although ethical quandary issues such as aggressive treatment at end of life may be discussed, the stress of unresolved everyday ethical concerns hinders moral practice. Articles on the pervasiveness of incivility, lateral violence, and overall hostile working environments, fill our journals. A recent study completed by the ISMP found that 75% of the participants (nurses, pharmacists, physicians) believed that their respective organizations did not deal effectively with disruptive behaviors-27% believed these behaviors contributed to patient mortality.

What is the answer? I don’t have one-I do know that since we established a nursing ethics council (interdisciplinary, despite the title) and unit based ethics steward program, nurses report being more knowledgeable about ethical concerns and more empowered to speak out and/ or call for an ethics consultation.

What are your thoughts and answers? What are you doing at your institutions?

Catherine Robichaux PhD, RN, CNS, Alumnus CCRN Assistant Professor, Adjunct Department of Health Restoration and Care Systems Management The University of Texas Health Science Center San Antonio, Texas

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Catherine Robichaux
Nursing Ethics

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3 Responses to “Ethical Competence in Nursing”

  1. Patrick Duffy says:

    Concerning the education of nurses regarding ethics, when I chose to return to nursing school after earning a bachelor’s degree in another field, the one course my program required of me that I had not taken before was a course on ethics. It was a school-wide requirement in order to earn a degree from the institution.

    I like the idea of an ethics council and the concrete delineation of steps a nurse can take to voice ethical concerns. From my perspective, this would create a more equitable power distribution amongst care providers.

  2. Moral distress is defined as occurring when a nurse is unable to appropriately act in an ethical situation or acts in a manner that goes against his or her personal and professional values, undermining their sense of integrity and authenticity (American Association of Critical-Care Nurses, 2008).

    This distress can have negative impacts upon the nurse’s personal and family life, contributes to burnout, and ultimately affects the quality of nursing care. Studies have shown that the time between the 1st and 2nd year of nursing practice is a crucial time in the careers of professional nurses. During this time, nurses begin to feel more comfortable with their new role as professional nurses, and the “newness” of working has begun to wear off. Moral distress begins to take its toll at this point. It is at this point that nurses realize that the high ideals represented by Florence Nightingale’s lamp are tarnished by ethical dilemmas and dented by unhealthy work environments.

    Discussions regarding methods for resolving moral distress should be initiated during nursing school. Nursing orientation and residency programs should include discussions regarding the nurse’s feelings about ethical situations and moral distress. Employers should also target nurses 6-9 months after they have been employed by proving education and resources regarding ethical dilemmas and moral distress as they enter this crucial time in their career.

    American Association of Critical-Care Nurses. (2008). Moral distress [Position statement]. Retrieved from

  3. Patrick and Elizabeth,

    Thank you for your comments! I agree that discussion about acknowledging and dealing with moral distress should begin in nursing school as it cannot be avoided in practice. Actually, our impetus for developing the ethics council and ethic stewards program resulted from a study we did exploring moral distress and the perception of ethical climate among our nurses. Inadequate and incompetent staff were the most distressing items among the nurses working in adult care units. Results will be published in an upcoming issue of DCCN.


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