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HealthApril 12, 2021

Exploring the frequency and difficulty of ethical problems in nursing management

By: Sarah Handzel, BSN, RN
Ethical concerns are no stranger to the nursing profession—all nurses face some type of ethical dilemma at some point in their careers.

Nurse managers deal with a wide range of ethical challenges involving patients, staff members, the healthcare organization they work for, and themselves. But ethical leadership in healthcare is associated with more positive outcomes for all, and a strong ethical work culture is linked to a lower prevalence of ethical dilemmas and stress.1

It is generally recognized that nurse managers regularly deal with ethical problems. Ethical problems encountered by nurse managers include:

  • How to allocate resources
  • Physicians’ practice or attitudes influencing multiprofessional teamwork
  • Quality of patient care
  • Substance abuse among nursing staff

Previous research has identified four categories of ethical conflicts between nurse managers and their organizations, including voicelessness, where money should be spent, the rights of the organization vs. the rights of the individual, and unjust practices on the part of senior administration or the organization. Other studies link these ethical conflicts to experiences such as conflicts in practical situations, lack of appreciation, and disregard of the problems.

While these studies have shown that nurse managers can readily describe ethical conflicts, there are limited studies on the frequency and difficulty of ethical problems. A new study published in Health Care Management Review1 seeks to answer questions related to these issues, including:

  • What are the most often encountered ethical problems of nurse managers’ work?
  • What are the most difficult ethical problems in nurse managers’ work?
  • What kind of background factors associate with the frequency or difficulty of nurse managers’ ethical problems?

Study design and methods

The authors of the study designed a cross-sectional nationwide study using a structured questionnaire known as the Ethical Problems of Nurse Managers (EProNuMa) to gain feedback from nurse managers in different levels of healthcare organizations. These included both specialized hospital care and primary care facilities. Data was collected from November 2014 to May 2015. The EProNuMa was developed based on literature review and interviews.

The survey was distributed to over 1,000 nurse managers, and 214 questionnaires were eventually returned. The first part of the survey captured sociodemographic background information, while the second portion consisted of a compilation of possible ethical problems divided into five subscales and their subgroups. The last part of the EProNuMa was made up of nine statements of work-related background factors concerning job satisfaction and the nurse managers’ understanding of the ethical conditions and values within their organization’s management system.

Study results and findings

Survey results ultimate indicated that nurse managers encounter a variety of ethical problems related to various aspects of their work. Ethical problems related to nursing staff and the healthcare organization as a whole were among the most frequently encountered problems. Except for personnel and financial resource problems, ethical issues concerning the normal work and working conditions of nursing staff were most frequently cited.

Respondents agreed that the most difficult ethical problems were organizational-related problems, such as how limited financial resources should be allocated. While nurse managers are in influential positions within their organizations, they are often not able to solve these issues themselves without other professional groups and managers.

In contrast, ethical problems related to nursing staff and patients were considered easier to handle. However, the ethical issues surrounding patient care were also listed among the most important to nurse managers’ work.

The study authors conclude that nurse managers face a variety of ethical concerns in their work, with organizational-related issues being the most frequent and most difficult to solve. Making these sorts of ethical challenges more visible may help to reduce their frequency and severity. Follow up with nurse managers is key to understanding their work-related ethical issues and encouraging them to bring these issues forward.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. Aitamaa, Elina, et al. “Ethical Problems in Nursing Management: Frequency and Difficulty of the Problems.” NursingCenter, 2021,
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