Ethical Dilemmas of Nurse Executives: A Descriptive Study

Abstract

This research was designed to describe the ethical dilemmas and to identify the facilitating and inhibiting factors perceived by nurse executives when making decisions that have ethical implications. As there has been little research in this area the study was a descriptive study one.

A questionnaire was sent to a nationwide random sample of 500 nurse executives who were members of the American Association of Nurse Executives (AONE). Because of the homogeneity of the group, statistical analysis yielded no significant differences. Content analysis of open-ended questions uncovered three major findings: (1) nurse executives experience dilemmas about a wide range of topics, (2) resources used to resolve dilemmas are varied and diverse, (3) dilemmas are experienced in many situations. In addition, it was found that the most important factors influencing decisions that have ethical implications were the superiors of the nurse executives and the politics within the institution. The most frequently encountered ethical dilemmas involved allocation of resources and quality of care issues. These were encountered in such different situations as short-term, long-term and strategic planning, performance appraisal, and other management functions. To resolve their dilemmas, nurse executives most frequently relied on their personal values and those of administrative and nursing colleagues. They used other resources when appropriate. Available resources seemed to be sufficient.

The results have implications for nursing administration, nursing education, and staff development. They underscore the need to know more about ethical decision-making and moral reasoning as they relate to administration and organizational climate. Findings show a need for general ethics and ethical decision-making as well as bioethics to be taught at both graduate and undergraduate levels. Changing the dominate ethos of the profession from the traditional, idealized goal-driven model to a resource-driven model would help to reduce conflict for all nurses. The results also indicate that staff development should incorporate ethical management issues into its programs.