Top 5 Ethical Issues in Nursing

September 08, 2021

When caring for a multitude of patients, nurses often face ethical dilemmas. These ethical issues can come in all shapes and sizes. Sometimes these issues come from a patient's discomfort with treatment, refusal of treatments based on cultural or personal ideologies, or when patients and their families must make life or death decisions on their health status. Nurses in these cases not only have to provide quality care, but they also must adhere to the formal Code of Ethics for Nurses.

The American Nurses Association (ANA) established a formal Code of Ethics. Many in the healthcare profession often refer to it as "The Code." The code was put in place in the 1950s to set goals and values for the nursing profession and guide nurses to use them during their daily practice.

This code is regularly updated to reflect the numerous challenges faced by nurses and represents a social contract between nurses and the public. These values and commitments are what nurses should uphold as they identify the boundaries and responsibilities of nurses surrounding patient care.

Overview of Ethical Issues in Nursing and Healthcare

Ethics are essential to the integrity of the nursing profession as it helps ensure better patient care. Nursing is a highly fast-paced job with new challenges arising daily and nurse managers across the country all dealing with similar ethical dilemmas. Many of these situations are rooted in protecting patients' rights, adequate staffing, advanced decision-making, and quality patient care. Unfortunately, with the large number of inexperienced nurses entering the profession, many of them are unfamiliar with dealing with ethical issues in nursing. Therefore, well-experienced nurse managers and CNOs are highly critical in healthcare staff to address these concerns.

If nurses do not adequately deal with ethical issues, the result could be a decline in patient care, tense clinical relationships, and moral distress. Nurse Managers face the most considerable stress regarding ethical issues as they are whom their nurses look up to for their leadership and mentorship during these trying times. Hospital executives need to work together to make sure all appropriate and ethical decisions are made with their patient's best interests in mind while respecting their patients' wishes.

The 5 Current Ethical Issues in Nursing

Informed Consent

Informed consent can sometimes be an ethical battle for nurses. A dilemma can occur when there is concern that patients and their families have not been informed or do not understand the treatments used on a patient. There is a concern as sometimes patients do not feel comfortable asking questions and giving consent without fully realizing the implications of their treatment.   

If patients feel supported and trust their doctors and nurses, they are more likely to follow a treatment plan and experience better outcomes. To avoid ethical dilemmas, nurses should ensure that patients fully understand all the facets of their treatment plans. The details include knowing all the risks and the layout of how a procedure will take place or how certain medications and treatments will affect them. If they do not, this could jeopardize patient health and result in high costs for the hospitals. Therefore, healthcare workers should take every measure to assure their patients understand the treatment plan to obtain informed consent securely.

Protecting Patient Privacy and Confidentiality

Patient privacy and confidentiality are significant ethical issues faced by nurses. If not done correctly, this can have legal ramifications and result in severe consequences for healthcare professionals. With patients' medical information protected by the Health Insurance Portability and Accountability Act (HIPA), there are definite boundaries and guidelines for protecting patients' privacy.

Although nurses must protect their patient's rights and act in their best interest, they are still obligated to respect patient autonomy. Patient autonomy, the right of patients to independently make decisions about their care based on personal or cultural belief systems, is a prime principle of nursing and should be respected by all healthcare professionals. With patient autonomy, patients have the right to refuse medications, treatments, or procedures. Although this may conflict with suggestions made by nurses and doctors, nurses will still have to respect this decision and operate accordingly.

Shared Patient Decision-Making

Shared decision-making is a far more ethical approach to patient care than years ago when healthcare professionals fully controlled patient treatment. Share patient decision-making extends patient autonomy where patients and healthcare professionals work together to make the best decision possible regarding patient care. With shared decision-making, patients and healthcare professionals have open conversations about a patient's background, values, beliefs, and culture, building a trusting relationship between patient and doctor.

Without a relationship, it will be extremely difficult for nurses and healthcare professionals to get patients to communicate and cooperate properly. When patients are actively involved in decision-making, they are more likely to be satisfied with their care and trust the doctor's treatment plans. Healthcare professionals should be aware of the importance of educating their patients even if the information shared with them is complex. If a patient fails to understand the treatment, disputes among the patient and staff can occur.

Addressing Advanced Care Planning

Advanced care planning is always a difficult conversation for healthcare professionals to have, predominately when end-of-life care conversations surround it. These conversations are between patients and doctors when they need to make plans for their future health care if they pass away or are left too ill to make their own decisions. Patients will explore, discuss, and document their personal preferences regarding their healthcare. This process helps them identify their personal goals and values about future medical treatment. They also will share who they would like to make decisions on their health care if they can't make decisions for themselves.

Nurses tend to have the difficult task of ensuring these preferences are laid out and honored in a medical emergency. For example, an issue might be if a patient has asked not to be on a ventilator, but their immediate family demands. Despite the problematic scenario, nurses must put the needs and wants of patients first, especially in end-of-life care.

Inadequate resources and staffing

Although this may not be an ethical issue put on individual nurses, healthcare executives and nurse managers should understand the lack of resources and inadequate staffing regarding patient care. As healthcare costs continue to rise, nurse managers are at odds regarding budgeting constraints and patient needs. When medical facilities have scarce resources, patients are at risk of not receiving proper care—leaving nurses to make difficult decisions.

Hard decisions may also need to be made when facilities are faced with inadequate staffing levels. When there is not enough staff for patients, nurses do not have the time to do everything needed for each patient. Patient needs can include recovery times or even addressing the patient's emotional and physical needs. A nurses' moral obligations to patients are compromised due to work restraints and stress overload. They are left with mental struggles trying to decipher where they should focus their priorities.

Dealing with Ethical Issues in Nursing

Dealing with ethical issues is a very complex matter for nurses. Every day, nurses face questions on medical treatments and how to respond to ethical dilemmas. Most of the time, they have to make these decisions on the spot as well. They can learn to respond to these dilemmas through years of experience and interaction with patients. Many nurses have high levels of empathy, which gives them the ability to have open conversations with their patients and establish professional boundaries surrounding their patient care. They should speak truthfully on what decision is best for the patient but always be open to disagreements. The best response to ethical dilemmas in nursing is to review the ANA Code of Ethics and determine a solution to one's unique situation.

The Bottom Line

Dealing with ethical issues can be difficult, which is why it is best to surround oneself with well-experienced, tenured nurses who can help through these situations. While working with international nurses such as those recruited from Avant Healthcare Professionals, hospital staff will experience different backgrounds and cultures, which can help better understand the range of emotions patients express while in the hospital. They can significantly help when patients are reluctant due to their cultural backgrounds, as their experiences may be similar. Also, having a diverse group of nurses allows an environment where conversations on ethical issues occur within their units. These open dialogues will benefit the patients as they feel more welcomed and recognized by their hospital staff. Nurses will find new ways to approach ethical challenges based on the experiences of their international nurses.

Frequently Asked Questions

What are some of the common ethical issues faced by nurses today?

There is currently the severe dilemma of the opioid crisis where nurses must adhere to ethical guidelines when it comes to distributing opioids and narcotics to patients. Nurses will typically struggle if patients ask for more than they are allotted due to increasing pain and being concerned with addiction and reliance on the medication.

Another ethical dilemma for nurses is the refusal of medication and vaccinations from patients and their family members. Vaccinations often become a heated debate, especially when addressing childhood vaccinations. Although it is a parent's right to refuse immunization for their child, healthcare professionals must share the health risks this poses for the future of their child's health. Nurses must provide them with accurate information while also respecting boundaries.

What are the ethical principles in healthcare?

Four main principles lay the foundation for healthcare ethics. They are autonomy: honoring patients' right to make their own decisions; beneficence: doing what is best for the patient; nonmaleficence: making sure no harm is done to patients; and justice: ensuring that patients are always treated equally, fairly, and impartially.