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. (shrink)

This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after (...) whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions. (shrink)

Background:Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous.Objective:This article is an analysis of the concept (...) of moral courage in nursing.Design:Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis.Data sources:The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis.Ethical considerations:This study was conducted according to good scientific guidelines.Results:Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment.Discussion and conclusion:This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice. (shrink)

Research on whistle-blowing has been hampered by a lack of a sound theoretical base. In this paper, we draw upon existing theories of motivation and power relationships to propose a model of the whistle-blowing process. This model focuses on decisions made by organization members who believe they have evidence of organizational wrongdoing, and the reactions of organization authorities. Based on a review of the sparse empirical literature, we suggest variables that may affect both the members' decisions and the organization's responses.

In Israel, whistleblowing in the nursing profession has been largely ignored. This topic is neither part of the professional—ethical discourse nor a subject for research. Focusing on the divide between internal and external whistleblowing, this article presents a study that explores nurses’ willingness to disclose an act that could jeopardize the rights or safety of patients. Internal disclosure entails reporting wrongdoing to an authority within the organization. External disclosure involves reporting the offense to an outside agency, such as a professional (...) organization or the press. The study’s findings indicate that the nurse respondents viewed both the harmful misconduct of a colleague and that of a manager as being very serious. In such dilemmas the nurses reported a desire to correct the wrongdoing and a concomitant willingness to act. They were, however, much more likely to whistleblow internally rather than externally. This study revealed a pattern of nurses’ progressive retraction as the circle of disclosure widened. (shrink)

Health‐care and public sector institutions are high‐risk settings for workplace bullying. Despite growing acknowledgement of the scale and consequence of this pervasive problem, there has been little critical examination of the institutional power dynamics that enable bullying. In the aftermath of large‐scale failures in care standards in public sector healthcare institutions, which were characterised by managerial bullying, attention to the nexus between bullying, power and institutional failures is warranted. In this study, employing Foucault's framework of power, we illuminate bullying as (...) a feature of structures of power and knowledge in public sector institutions. Our analysis draws upon the experiences of a large sample (n = 3345) of workers in Australian public sector agencies – the type with which most nurses in the public setting will be familiar. In foregrounding these power dynamics, we provide further insight into how cultures that are antithetical to institutional missions can arise and seek to broaden the debate on the dynamics of care failures within public sector institutions. Understanding the practices of power in public sector institutions, particularly in the context of ongoing reform, has important implications for nursing. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

This paper examines the moral arguments for and against employees' blowing the whistle on illegal or immoral actions of their employers. It asks whether such professional dissidents are justified in disclosing wrongdoing by others while concealing their own identity. Part I examines the concept of anonymity, distinguishing it from two similar concepts — secrecy and privacy. Part II analyzes the concept of whistleblowing using recent definitions by Bok, Bowie and De George. Various arguments against anonymous whistleblowing are identified and evaluated. (...) The author concludes with a defense of the practice in terms of social benefits — primarily the redressing of wrongdoing. (shrink)