Chapter 4 Leadership

A—Affirm position and act.

Develop the implementation strategy

Intuitionist (deontological)

Each case weighed on a case-by-case basis to determine relative goals, duties, and rights

Fidelity

Need to keep promises

Paternalism

One individual assumes the right to make decisions for another

Autonomy

Promotes self-determination and freedom of choice

Standards of Practice for Nurse Administrators

The nurse administrator integrates ethical provisions in all areas of practice. Measurement Criteria 1. Incorporates Code of Ethics for Nurses with Interpretive Statements (ANA, 2015) to guide practice 2. Assures the preservation and protection of the autonomy, dignity, and rights of individuals 3. Maintains confidentiality within legal and regulatory parameters 4. Assures a process to identify and address ethical issues within nursing and the organization 5. Participates on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes 6. Demonstrates a commitment to practicing self-care, managing stress, and connecting with self and others

Management Ethical Responsibilities

-Understand the ethical problem-solving process -Be familiar with ethical frameworks and principles -Know ethical professional code

Traditional problem-solving process

1. Identify the problem 2. Gather data to analyze the causes and consequences of the problem 3. Explore alternative solutions 4. Evaluate the alternatives 5. Select the appropriate solution 6. Implement the solution 7. Evaluate the results

Strategies to Promote Ethical Behavior as the Norm

1. Separate legal and ethical issues. 2. Collaborate through ethics committees. 3. Use institutional review boards appropriately. 4. Foster an ethical work environment

American Nurses Association (2015) Code of Ethics for Nurses

1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 2. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. 4. The nurse has the authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. 6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. 7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Professional Code of Ethics

A set of guidelines describing how members of a particular profession will pursue their common ideal so that each does his or her best to serve clients or patients, contribute to the good reputation of the field, and avoid pressures to engage in unethical behavior. The first Code of Ethics for Nurses was adopted by the ANA in 1950 and has been revised five times since then. This code outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse.

Ethics

A system of moral conduct and principles that guide a person's actions in regard to right and wrong and in regard to oneself and society at large The systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment The justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are

Nonmaleficence

Actions are taken in an effort to avoid harm

Beneficence

Actions are taken in an effort to promote good

Ethical Principles

Autonomy Beneficence Nonmaleficence Paternalism Utility Justice Veracity Fidelity Confidentiality

L—Look back. Evaluate the decision making.

Evaluate the process

Competencies for Making Ethical Decisions as a Nurse-Manager

Having knowledge of ethical principles and frameworks Using a professional approach that eliminates trial and error and focuses on proven decision-making models Using available organizational processes to assist in making such decisions

Confidentiality

Keep privileged information private

Integrating Leadership Roles and Management Functions in Ethics

Leadership roles in ethics focus on the human element involved in ethical decision making. Leaders are self-aware regarding their values and basic beliefs about the rights, duties, and goals of human beings. As self-aware and ethical people, they role model confidence in their decision making to subordinates. Leaders also are realists and recognize that some ambiguity and uncertainty must be a part of all ethical decision making. In ethical issues, the manager is often the decision maker. Because ethical decisions are so complex and the cost of a poor decision may be high, management functions focus on increasing the chances that the best possible decision will be made at the least possible cost. The manager must become an expert at using systematic approaches to problem solving or decision making.

Types of Ethical Issues

Moral Indifference Moral uncertainty or conflict Moral distress Moral outrage Ethical dilemmas

The MORAL Decision-Making Model

M—Massage the dilemma. O—Outline options. R—Review criteria and resolve. A—Affirm position and act. L—Look back. Evaluate the decision making.

Nurses as Agents

Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals.

Veracity

Obligation to tell the truth

Utilitarian (teleological)

Provide the greatest good for the greatest number of people

Justice

Seek fairness; treat "equals" equally and treat "unequals" according to their differences

Utility

The good of the many outweighs the wants or needs of the individual

R—Review criteria and resolve.

Weigh the options against the values of those involved

Duty based (deontological)

a duty to do something or to refrain from doing something

Moral uncertainty or conflict

an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is

Moral Indifference

an individual questions why morality in practice is even necessary

Rights based (deontological)

individuals have basic inherent rights that should not be interfered with

Moral outrage

occurs when an individual witnesses the immoral act of another but feels powerless to stop it

Moral distress

occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action

Ethical dilemmas

situations in which none of the available alternatives seems ethically acceptable

O—Outline options.

what can be done? who can do it? what pros/cons? outcomes? Identifying alternatives

M—Massage the dilemma.

what is the problem? who is involved? Collecting data about the problem