Academic journal article Online Journal of Issues in Nursing

Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk

Academic journal article Online Journal of Issues in Nursing

Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk

Article excerpt


Healthcare professionals often face complex ethical dilemmas in the workplace. Some professionals confront the ethical issues directly while others turn away. Moral courage helps individuals to address ethical issues and take action when doing the right thing is not easy. In this article the author defines moral courage, describes ongoing discussions related to moral courage, explains how to recognize moral courage, and offers strategies for developing and demonstrating moral courage when faced with ethical challenges

Citation: Murray, J. S., (Sept 30, 2010) "Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 2.

DOI: 10.3912/OJIN.Vol15No03Man02

Key words: Moral courage, ethics, ethical dilemmas, developing moral courage, Code of Ethics for Nurses, Nursing's Social Policy Statement, cultural diversity

"Stand up for what is right even if you stand alone." Anonymous

Examples of unethical behaviors are seen today in academia, politics, sports, entertainment, banking, and the legal system (Gallup, 2009; Kidder, 2005; Murray, 2007a; 2007b; Zangaro, Yager & Proulx, 2009). professionals working in clinical practice, education, research, administration are not immune to these unethical behaviors. They ethical dilemmas on a regular basis. Shortages in the numbers of to deliver patient care, inadequate staffing levels, cost containment measures, consolidation of healthcare organizations, and ineffective leadership have resulted in the escalation of ethical dilemmas nurses face today in healthcare environments (Clancy, 2003: Einarsen, Aasland & Skogstad, 2007: Murray, 2008: 2007a: Zangaro et al., 2009). How individuals respond to these ethical dilemmas depends on their previous experiences with unethical behavior, their individual personality traits, and their ethical values, as well as their knowledge of ethical principles (Clancy, 2003). Moral courage is needed to confront unethical behaviors. The following exemplar demonstrates moral courage in clinical practice.

Emily was a novice nurse employed at an academic medical center. Her peers respected her and described her as an attentive and meticulous nurse with strong work values. Over time Emily noted a behavior in the work setting that concerned her and conflicted with her ethical principles. She had observed her supervisor falsifying training records of nurses still on orientation so that these new nurses could begin earlier to work independently, thus improving staffing levels. When Emily brought this behavior to the attention of the more senior nurses on the unit, they explained that they experienced retaliation if they even mentioned this misconduct. After much deliberation, Emily felt that she had an ethical responsibility to take action and bring this matter to the attention of the hospital administration. As soon as she did this, her supervisor began to berate her in staff meetings, change her work schedule unfairly and without notice, withhold needed information, set unreasonable deadlines, and prevent her opportunities for professional advancement. Recognizing that nurses have an obligation to always demonstrate the highest professional and ethical standards, Emily sought guidance from the medical center's nurse ethicist. This guidance and support helped her to stand firm and stay resolute in her determination to do what was right.

There are few articles addressing moral courage in today's healthcare literature. What is available indicates a lack of moral courage on the part of healthcare professionals when they are faced with ethical challenges (Aultman, 2008). Sekerka and Bagozzi (2007) have encouraged healthcare organizations to promote 'ethical fitness' so as to increase providers' level of moral courage in daily organizational activities. Healthcare agencies and professional organizations need to articulate, encourage adherence to, and act on shared values as they provide an environment in which moral behaviors are welcomed and expected. …

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