At some points in their careers, nurses may face serious ethical dilemmas in which there is a threat to them of losing their jobs or harming their patients. However, ethical considerations are something incorporated into nurses’ work, and there are smaller ethical dilemmas that nurses may face every day. For example, no universal answer exists for cases in which patient autonomy conflicts with such a principle of nursing ethics as beneficence.
If a nurse knows that a patient should take a certain prescribed medication, but the patient refuses for whatever reason, should it be the responsibility of the nurse to encourage the patient to take the medication? Or should the nurse respect the patient’s decision and refrain from insisting? According to DeKeyser Ganz and Berkovitz (2012), nurses’ perception of ethical dilemmas is that, in each case, analysis is needed to decide what a nurse should do.
Another example is sharing information with patients. In end-of-life care, patients are sometimes protected by their health care providers and families and not told the truth about their conditions. However, honesty is an important principle of nursing ethics, and nurses often have to decide what they think a patient should know about his or her state or treatment despite the fact that this awareness can cause harm.
In both examples, an important consideration is an accountability. It is stressed in the nursing academic literature that accountability is one of the most important components of nurses’ work; however, the concept does not have a clear definition. Upon completing a comprehensive literature review, Krautscheid (2014) defines nursing accountability as “taking responsibility for one’s nursing judgments, actions, and omissions as they relate to lifelong learning, maintaining competency, and upholding both quality patient care outcomes and standards of the profession while being answerable to those who are influenced by one’s nursing practice” (p. 46).
Nurses are responsible for the quality of nursing care, and their decisions should comply with the professional and ethical standard of ensuring the best outcomes for patients because patients (and not even facility administrators) are those to whom nurses are primarily accountable.
DeKeyser Ganz, F., & Berkovitz, K. (2012). Surgical nurses’ perceptions of ethical dilemmas, moral distress, and quality of care. Journal of Advanced Nursing, 68(7), 1516-1525.
Krautscheid, L. C. (2014). Defining professional nursing accountability: A literature review. Journal of Professional Nursing, 30(1), 43-47.