Healthcare is in a constant state of flux, with exponential changes in technology informing its evolution. Factors like the economy and systemic racism also have an enormous impact on nurses’ careers. And with the most devastating public health emergency in a century, nurses face an array of challenges as we embrace 2021.
Challenge #1: Burnout, compassion fatigue, and COVID-19
The risk of burnout is well-known, and the COVID-19 pandemic has raised that risk to a red alert. According to a recent literature review, burnout is now classified in the International Classification of Diseases — the authors define it as “feeling emotionally drained (emotional exhaustion); adverse and cynical detachment from patients, clients and colleagues (depersonalisation); and a lack of confidence in being able to do one’s job (reduced personal accomplishment).”
With emerging mutations and a slow vaccine rollout, there’s still plenty of illness, suffering, and death that nurses must contend with.
Epidemic burnout was recognized long before COVID-19, and with countless nurses slogging away on the front lines for over a year, we must be on increased lookout for burnout in ourselves and our colleagues.
Challenge #2: The nursing shortage
While a nursing shortage may appear quite positive for those seeking jobs, an ongoing shortage can wreak havoc for those left holding down the fort.
According to an article from the National Institutes of Health, nursing jobs are projected to be the top area of job growth through 2022, and the Bureau of Labor Statistics projects 15% job growth for nurses through 2026.
However, anecdotal evidence reveals nurses reporting difficulty getting hired despite the shortage, as well as disappointing salaries. This is occurring in the context of travel nurses receiving extremely high pay rates to work in hard-hit areas, sometimes in excess of $6,000 per week.
For nurses working in facilities where hiring is stymied by budget constraints, the shortage poses staffing and ratio issues, and this contributes directly to the aforementioned epidemic of burnout.
Challenge #3: Nursing education transitioning online
While distance learning has long been a component of nursing education, it’s become the default. Learning from home may be convenient, but for those with children also attending school remotely — as well as other interruptions and obstacles to learning — new troubles emerge.
With decreased clinical site access, direct patient care is often replaced with digital simulations or socially-distanced skills labs with mannequins that may be low-fidelity and less than realistic. There are understandable worries that new graduates will not have the skills they need to succeed following licensure.
2021 will likely uncover more challenges raised by this major change in nursing education.
Challenge #4: Facing systemic racism in healthcareThe challenges facing the nursing profession regarding the dismantling of systemic racism are multifactorial. Since the murder of George Floyd and the rise of the Black Lives Matter movement, healthcare is responding and nurses must pay attention.
As 2021 began, the National Commission on Racism in Nursing was launched. Led by the American Nurses Association, the National Coalition of Ethnic Minority Nurse Associations the National Association of Hispanic Nurses, and the National Black Nurses Association (NBNA), we hope that the reach of the Commission’s work is both broad and deep in scope. The press release regarding the Commission’s launch states the following:
“Racism is a public health crisis that impacts a person’s mental, spiritual, and physical health as well as overall quality of life. Racism in the nursing profession does not align with The Code of Ethics for Nurses with Interpretive Statements, which obligates all nurses to be allies and to advocate for and speak up against racism, discrimination, and injustice. Nurses of color are often subjected to unfair structural and systemic workplace practices, processes inherent in many health care systems, hospitals, and care settings that must be identified, addressed, and eradicated. In addition to longstanding experiences with racist attitudes and behaviors in the workplace, nurses of color are not exempt from the longstanding disparities and inequities in health care or feeling the brunt of the persistent COVID-19 pandemic. A survey of more than 10,000 nurses conducted in July of 2020 by the American Nurses Foundation, found that Black and Hispanic/Latino nurses were more likely to be in roles providing direct care to COVID-19 patients than White nurses (58% and 63% vs. 49%), and twice as likely to have been diagnosed with COVID-19 (10% and 11% vs. 5%).”
As professionals deeply valued and trusted by the general public, nurses must step up in this time of racial reckoning and become part of the solution for an issue that has been with our country since well before its founding.
Challenge #5: Technological changes to the job search and hiring process
The increasingly technological orientation of the application and hiring process is now fairly ubiquitous. When applying online, nurses complete applications and upload resumes that are then “read” by Applicant Tracking Systems (ATS). The ATS scans for keywords and will reject resumes that don’t measure up — the mystery to unravel is knowing what keywords an ATS is looking for.
If a nurse’s resume makes it through the ATS, the nurse may face a one-way interview in which their responses to questions are recorded on video. This experience can feel foreign and intimidating for those uncomfortable on camera. As artificial intelligence improves, we can expect it to infiltrate the hiring process even more.
Challenge Presents Opportunity
Every challenge presents opportunity. If we’re being interviewed on camera, we must learn to be video-friendly. If our resume is being read by a bot, we master that process. And when we must become more race literate, we seek avenues towards that worthy goal.
Burnout and compassion fatigue are nothing new for nurses, and there is a plethora of resources at our disposal. And if staffing and ratios are problematic, we can agitate for change or seek employment elsewhere. Nurses are natural problem-solvers who know how to get things done. As with any challenge, there are also multiple solutions, and nurses have the critical thinking, emotional intelligence, and presence of mind to solve whatever obstacles they may face.
Advanced Practice Nurse VS Nurse Practitioner – what’s the difference? Learn more!
Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it. Nurse managers, in particular, are susceptible to ethical issues in nursing and moral distress because of their leadership and mentoring roles. Nurses and other medical staff look to nurse managers for appropriate and ethical decisions.
Before stepping into a role as a nurse manager, registered nurses (RNs) should understand the role ethical decision-making plays in the day-to-day work. Through Duquesne University’s Master of Science in Nursing program, students explore the foundations of ethical management and leadership from professors with real-world experience. The coursework not only covers the fundamentals of ethical nursing but delves deep into controversial case studies, giving students the chance to examine alternative viewpoints and develop reasoning skills.
For nurse managers, ethical decision-making stems from the American Nurses Association Code of Ethics, which was developed as a guideline for nursing responsibilities “in a manner consistent with quality in nursing care and the ethical obligations of the profession.” Nurse managers help solve ethical issues in nursing through using their leadership qualities to implement the Code of Ethics in their daily lives.
Nurses’ Code of Ethics
ANA adopted its first Code of Ethics in 1950. Since then, it has undergone several revisions to offset advances and changes in research, technology, law and overall challenges in nursing. The guidelines are divided into nine provisions that cover topics that include human dignity, confidentiality, moral virtue and healthcare as a right. ANA said that each of the provisions covers topics important to the challenges of nursing in the 21st century.
“The code is particularly useful in today’s healthcare environment because it reiterates the fundamental values and commitments of the nurse, identifies the boundaries of duty and loyalty and describes the duties of the nurse that extend beyond individual patient encounters,” ANA said in a statement.
Daily, nurse managers face a barrage of decisions and must maintain ethical fortitude to ensure the health, safety and well-being of their patients and staff. They actively work toward resolving ethical issues in nursing that they find in their workplace.
Examples of Ethical Dilemmas in Nursing
The ANA Code of Ethics provides a standard by which nurse managers can assess ethical issues in nursing. However, the way it addresses ethical dilemmas can vary in different situations. One ethical dilemma that can occur in healthcare facilities is when nurses themselves are not properly equipped to complete their duties. Nurses who notice their coworker’s lack of knowledge face an ethical dilemma of whether they should bring the issue to their nurse manager. To help curb this ethical dilemma, nurse managers can work hard to educate their nurses regarding the Code of Ethics as well as educate them regarding the Code of Ethics for their specific medical facility. Nurse managers can also provide regular trainings for their nurses regarding recurring issues.
One example of a common ethical dilemma nurses deal with is establishing boundaries with patients. Nurses and nurse managers devote their careers to helping patients receive the care they need, so it can often be difficult to establish professional boundaries. Patients should not rely on nurses beyond their professional capacity and should not develop romantic relationships with them or offer them gifts. Nurse managers can intervene in situations where ethical and professional boundaries are crossed by either patients or nurses.
Another ethical issue in nursing pertains to patient privacy. Nurses and nurse managers have access to a patient’s records and medical history and cannot ethically or legally release that information to anyone besides the patient. Nurses should have the best interest of patients in mind, understanding that they need to protect their privacy and medical data.
Common Ethical Situations for Nurse Managers and Nursing Ethics Examples
Even though nursing is a fast-paced job with new challenges daily, many nurse managers report facing similar ethical dilemmas. A recent study found that the most frequently occurring and stressful ethical situations are protecting patients’ rights, staffing, advanced care planning and decision-making. Exacerbating the problem is the large number of inexperienced nurses entering the field, many who have never faced ethical issues in nursing. Such challenges make experienced nurse managers all the more critical to daily healthcare needs nationwide.
The following are some other examples of common ethical situations that nurse managers face:
- Honesty vs. withholding information. Family members may want to withhold medical information from sick patients to protect their emotions. However, patients have the right to know about their medical conditions. Deciding how to share this information, especially if it goes against the family’s beliefs, can be a touchy situation. ANA advocates for truth telling, or veracity, as a key factor in nurse-patient relationships.
- Science vs. spirituality. Healthcare, which is science-based and results driven, can impede religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering and to allow patients to concentrate on self-care. For patients or their families with strong religious or spiritual convictions, the focus may be on adhering to a strict set of guidelines. The ANA Code of Ethics states that nurses should respect the “unique differences of the patient,” including “lifestyle, value system, and religious beliefs.” However, respect for the belief “does not imply that the nurse condones those beliefs or practices on a personal level.”
- Healthcare needs vs. resource allocation. The rising cost of healthcare is increasingly putting nurse managers at odds with budgeting constraints and patient needs. A large number of medical facilities have scarce resources, which puts patients at risk for not getting the care they need. These resources range from medical equipment to healthcare staff. Research suggests that nurse leaders must include staff in the budgeting process so that they can better understand the needs and demands.
- Autonomy vs. beneficence. Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care. ANA highlights that it is important for nurses and nurse managers to understand patient backgrounds and individual circumstances to inform the patient of the medical necessity. ANA explains: “Using ethical principles to arrive at a solution should be done in an atmosphere of caring, respect, openness, and honesty. This process should be based on a sound ethical, decision-making model, using the best evidence-based-practice guidelines available.”
How to Deal With Ethical Dilemmas in Nursing
Nurses undergo many years of education and clinical training before they can become certified nurses, and yet, dealing with real ethical issues in nursing can be far more complex than solving hypothetical issues in textbooks. Nurses can learn how to deal with ethical dilemmas in the workplace through gaining experience and interacting with patients over time. Although nurses have great levels of empathy, it can benefit them to establish professional boundaries with each of their patients at the outset of their careers. Whenever nurses struggle to identify whether something is ethical, they can review the ANA Code of Ethics.
Nurses can also benefit by surrounding themselves with well-seasoned nurses as well as experienced nurse managers. They can rely on the guidance of nurse managers when it comes to situations they may not know how to address. Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges.
Help Avoid Ethical Dilemmas in Nursing
The Duquesne University School of Nursing’s MSN program integrates ethical problem-solving and decision-making to help MSN graduates explore and address ethical issues. Students in each of Duquesne University’s MSN tracks — Adult-Gerontology Acute Care Nurse Practitioner, Family (Individual Across the Lifespan) Nurse Practitioner, Psychiatric-Mental Health Nurse Practitioner, Executive Nurse Leadership and Health Care Management, Forensic Nursing and Nursing Education and Faculty Role — learn how ethics and problem-solving play distinct roles in nursing.
U.S. News & World Report ranked Duquesne University’s online MSN program among the Best Online Graduate Nursing Programs in 2017. If you are interested in advancing your career as a nurse manager, explore how Duquesne University’s Master of Science in Nursing program can help you pursue your professional goals and help you avoid ethical issues in nursing.
Recommended Readings
Family Nurse Practitioners and Professional Liability Insurance
Importance of Nurse Manager Resilience
Using Escape Rooms for Nurse Education
Sources
American Nurses Association, View the Code of Ethics for Nurses
Houston Chronicle, “Legal & Ethical Issues That Health Care Professionals Face”
Lippincott Solutions, Best Practices for Ethical Nursing Leadership
Medical Records Info, Top 10 Most Prevalent Ethical Issues in Nursing
National Center for Biotechnology Information, “Ethical Problems in Nursing Management —A Cross-Sectional Survey About Solving Problems”
NurseChoice, “4 Common Nursing Ethics Dilemmas”