Ethical problems in nursing management: Frequency and difficulty of the problems.

BACKGROUND: Nurse managers (NMs) lead the biggest personnel group in health care-nurses. They have various responsibilities in clarifying an organization's values to their staff and overseeing and supporting continuous upholding of ethical standards and nurses' ethical competence. PURPOSE: The purpose of the study was to investigate the frequency and difficulty of the ethical problems NMs encounter in their work and to determine the background factors correlating with the problems. METHODOLOGY: Cross-sectional survey design was used. Ethical problems were approached by five categories related to patients, nursing staff, other professional groups, the organization, and the NMs themselves. The data collected with questionnaires from NMs in ward, middle, and strategic management (n = 214) in Finland from November 2014 to May 2015 were statistically analyzed. RESULTS: The most frequently encountered ethical problems were related to nursing staff and organization: About half of NMs encountered those problems at least weekly. The most difficult ethical problems were related to the organization-the mean value of the sum score being significantly higher compared to the four other sum scores (p < .0001). When combining information on the frequency and difficulty of the encountered ethical problems, organization-related problems were the most significant. The more positively NMs assessed their work-related background factors, the fewer ethical problems they encountered and the easier they considered them. CONCLUSION: Awareness of the frequency and difficulty of ethical problems in nursing, especially those related to organization, needs to be increased in health care organizations to find solutions for dealing with them. PRACTICE IMPLICATIONS: Strengthening resources for ethics, like ethics experts and multiprofessional committees, may be helpful. Ethical consideration and discussion of prioritization should be routinely used in administrative decision-making. Ethics education and instructions for repetitive situations could increase NMs' ability to manage with ethical problems. Support mechanisms are needed for situations where difficult value clashes appear.

Ethical problems in nursing management - a cross-sectional survey about solving problems.

BACKGROUND: Nurse managers encounter a wide range of ethical problems related to patients, staff, the organisation and themselves. However, little is known about the methods they use to try to solve these problems. In this study, our goal is to fill this knowledge gap by investigating the ethical problems encountered by nurse managers, the frequency of use and usefulness of different methods to solve these problems, and the background factors associated with the use of the methods. METHODS: A cross-sectional survey study was conducted in November 2014-May 2015 in Finland. The data were collected from nurse managers in strategic, middle and ward management (n = 214) using a questionnaire developed for this study. The questionnaire consisted of four parts: socio-demographic background factors, frequency and difficulty of ethical problems in nursing management, frequency of use and usefulness of the methods in solving ethical problems, and work-related background factors. RESULTS: Discussions with nurses was the most frequently used method, used by 94% of the nurse managers either often or always in the case of ethical problems, followed by the use of personal values (74%) and discussions with manager colleagues (70%). However, almost all methods in the different groups - discussion and deliberation, use of outside experts, written instructions and ethical principles, acts and degrees as well as work arrangements - were considered somewhat or very useful by more than half of the respondents. The use of outside experts was the least used and the least useful method. CONCLUSIONS: When solving ethical problems, nurse managers use most frequently the same methods as a few decades ago. A more diverse range of methods would be helpful in ethical problem-solving. The use of outside experts, ethics literature and codes of ethics should be combined with ethical reasoning and decision-making to get new dimensions and outside knowledge.

Ethical problems in nursing management: The views of nurse managers.

BACKGROUND: Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited. OBJECTIVE: The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems. METHODS: The data consisted of nine interviews with nurse managers at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis. ETHICAL CONSIDERATIONS: Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. FINDINGS: Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. Problems could also be divided to patient-related, staff-related, organization-related and other problems. DISCUSSION: The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers' ethical problems. New information is produced related to the ethical problems with nurse managers' own courage, motivation and values. CONCLUSION: Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. Further research about the frequency and intensity of nurse managers' ethical problems is needed as well as possible differences in different levels of management.

Ethical problems in nursing management: the role of codes of ethics.

The aim of this study was to identify the ethical problems that nurse managers encounter in their work and the role of codes of ethics in the solutions to these difficulties. The data were collected using a structured questionnaire and analysed statistically. The target sample included all nurse managers in 21 specialized health care or primary health care organizations in two hospital districts in Finland (N = 501; response rate 41%). The most common ethical problems concerned resource allocation as well as providing and developing high quality care. This was the case in different managerial positions as well as in types of organization. Professional codes of ethics were used more often for problems related to patients' care compared with issues of resource allocation. Nurse managers at middle or strategic management levels used codes of ethics more often than those in charge of a ward. More research is required to investigate ethical decision making in nursing management, especially with regard to problem solving. In addition, new guidelines and continuing education in ethics are important for management personnel.