When nurses face ethical challenges and don’t believe they are getting the support they need from their superiors, they are prone to leaving their jobs – and sometimes even the profession, according to the journal "Social Science and Medicine." This is an issue for the American public that relies on nurses to maintain the standards and quality of care they have come to expect. By the year 2020, there is a 20 percent expected shortage of nurses, so all of their dilemmas must be addressed satisfactorily or the entire health care system may be at risk.
Nurses spend significantly more time with patients than any other health care workers and often see patient needs more acutely. They become frustrated and sometimes even physically ill when the constraints of the bureaucracy prevent them from providing the care they believe is appropriate. They face ethical dilemmas when, for example, because of their training and personal knowledge of the patient’s symptoms, they know what the right course of action is but must follow physician and facility orders instead. The conflicts between knowing the best type of care patients need and the actual care patients receive can cause extreme distress and dissatisfaction in their jobs.
Nurses in most every field of treatment face ethical dilemmas at some point in their careers. According to studies reported in "Social Science and Medicine," dilemmas surrounding advanced technology are common among nurses. They grapple with end-of-life decisions, patient rights to self-determination and issues about the quality of life patients deserve and desire. When nurses work in a climate of distrust and don’t share the same values with their organizations, job dissatisfaction increases. Nurses become stressed when they are constantly placed in the position of going against patient wishes, for example, or having to consider the costs of treatment based instead of the necessary care.
Stress Adds Up
In addition to the personal health issues nurses experience when faced with continued ethical dilemmas, patient care suffers when staffing levels go down. Low staff levels lead to additional dilemmas nurses must personally grapple with when considering their futures. On the one hand, nurses know that proper staffing levels reduce the incidence of errors and deaths because of complications. Patients report higher levels of satisfaction with their care when staffing is appropriate. On the other hand, nurses experience burnout and fatigue when constantly working in understaffed conditions and ultimately leave, only exacerbating the problem.
Fear of Retaliation
When nurses face an ethical dilemma, their decisions often are based on fear instead of following their instincts as they’ve been trained to do. Fear of losing their jobs or being written up for insubordination keep them from delivering the kind of quality care they know to be right. Developing moral courage to stand up to the bureaucracy is one of the tenets supported by groups such as the American Nurses Association. Nurse advocates say that ethical challenges are some of the greatest hurdles nurses must face in the workforce, and getting corporate leaders to understand and help to alleviate many of the problems is one step in creating a stable nursing workforce in the future.