What are the sources of ethical dilemmas for nurse leaders?
Ethical dilemmas among nurse leaders may arise from various sources such as how the nurse leader reacts to a situation, the environment’s complexity, the duration and continuation of the distress-causing situation and the characteristics of the situation and nurse leader causing the distress. Failure to act in countering or resolving these characteristics and sources of ethical dilemma may result in the nurse leader developing frustration, anger, and regret over time (Edmonson, 2010). Such feelings of frustration and anger could then be turned on the nurse leader leading to job satisfaction, self-hate, and low self-esteem.

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On the other hand, these feelings of frustration and anger could be turned on other people, which leads to horizontal violence against the offending source or the at the nurse leader’s peers. Ethical dilemmas, therefore, permeate the nursing profession due to a complex healthcare environment which entail competition in the healthcare industry, an aging population, advancement of technology, finite and scarce resources, and performance expectations (Edmonson, 2010).

How should nurse leaders handle these issues?
There are several ways in which the nurse leader can handle these ethical issues, despite the fact that these ethical dilemmas tend to be a part of the profession. There are various position statements on human rights and ethics offered by the American Nursing Association that can help the nurse leader overcome nursing challenges on a wide range of issues including DNRs, as well as other specific ethical problems (Edmonson, 2010). In addition, the nursing leader may rely on the ethics committee in the healthcare facility, in which they have the opportunity to access helpful resources and voice concerns. Moreover, there are principles on which nurse leaders must base their decision making to ensure it is ethical; including regulatory mechanisms that ensure the nurse leader meets the highest ethical standards possible. In this case, the ICN’s Code of Ethics provides that nursing leaders should respect the patient’s right to dignity, life, choice, culture, and respect (Edmonson, 2010).

Explain how the 4-As Framework recommended by the Association of Critical Care Nurses
The 4-As framework is a model that nurse leaders can use to reduce or confront moral distress. The first step in this framework is to ‘Ask’, where the nursing leader has the opportunity to identify how the stress manifests internally in terms of their spiritual, behavioral, emotional, and physical domains of their lives. In this case, the nursing leader should seek to become personally aware of how they are morally distressed through reflection and introspection (Black et al., 2014). The second step in the framework is to ‘Affirm’, in which the nursing leader should stress on their responsibility both to the nursing profession and to them-selves as individuals so as to address the causes of this moral distress.

The nursing leader should validate their personal situation and feelings through social networking, as well as discussing the problem with a support network including colleagues. The third step of the framework is ‘Assess’, where the leader should leverage their critical assessment and higher reasoning skills in order to identify, characterize, and prepare actions to counter the stress source (Black et al., 2014). Finally, the fourth step I ‘Acting’, in which the nursing leader should create an environment and opportunity that provide the most opportunity for successful resolution of the problem.

What are the recommendations that can increase moral courage in nurse leaders?
Nursing leaders should comprehend the moral distress which others are experiencing through the use of specific tool that can assist in the identification of opportunities that will support moral courage, including the Professional Moral Courage Scale or the Moral Distress Scale (Black et al., 2014). Secondly, the nursing leader may also strive to implement a culture of professionalism in the workplace where others are reminded of the importance of following healthful practices in the delivery of care, which enhances the opportunity and presence of moral courage. Furthermore, the nursing leader should determine a model for the enhancement of moral courage, specifically one which aligns with the nursing department’s strategic vision and promotes professionalism in the practice environment. Finally, the nursing leader should become more conversant with practices involving ethical decision making, as well as ethical theory, in order to become more aware of how to solve and get through ethical dilemma (Black et al., 2014).

  • Black, S., Curzio, J., & Terry, L. (2014). Failing a student nurse: A new horizon of moral courage. Nursing ethics, 21(2), 224-238
  • Edmonson, C. (2010). Moral courage and the nurse leader. Online J Issues Nurs, 15(3), 1-12