I do agree with Kleinman (2006) in her statement that ethical breeches occur due to “gradual erosion” over time. I believe she is correct in her assertion of the cause for a number of reasons. First, when a nurse does something small that saves time or effort, and gets away with it, he or she may be more likely to engage in the behavior the next time, as long as the outcome remains positive. Over time, this may become a “new normal” and then from this new set point, more unethical behaviors may begin to occur. At this point, it may be very difficult to judge current ethical behaviors based on this new (drifted) set-point.
Kleinmann (2006) believes we are practicing under very different ethical theories than ever before. Specifically, she states that ethical fragmentation has occurred, and we have moved away from a society that focuses on the masses, and into a society that focuses on the individual. I wholeheartedly agree with her assertion; because Western culture is so individually-focused I feel we have moved into a rather selfish and self-serving culture. I can practice better self-awareness in my own daily duties to prevent drift by assessing myself compared to standards that I learned while in training. Moreover, it may be helpful to practice as though an admired supervisor were watching over me at all times.

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In my opinion, moral courage means doing, and standing up for, what I believe is right, knowing that I may face repercussions for doing so. In reviewing the list of inhibitors of moral courage (Kidder, 2005), I realize that I have, unfortunately, experienced workplaces in which there was a general unwillingness to face the challenge of addressing unethical behaviors. As I consider one situation in particular, I realize that no one in the situation faced the challenge because there was no first-hand evidence that an unethical behavior was occurring. In retrospect, I believe there was a general hesitance to be the one to find out whether an unethical behavior was occurring, because few want the responsibility that comes with having selected information.

    References
  • Kleinman, C.S. (2006). Ethical drift: When good people do bad things. JONA’s Healthcare Law, Ethics, and Regulation, 8(3), 72-76.
  • Murray, J.S. (2010). Moral courage in healthcare: Acting ethically even in the presence of risk. Online Journal of Issues in Nursing, 15(3), 1-10. doi:10.3912/OJIN.Vol15No03Man02