Ethical Decision-Making and Nursing Leadership: Addressing Moral Distress in the Emergency Room

Introduction:
Hello to everyone. My name is Mauricio, and I work as an Emergency Room (ER) nurse focusing on emergency treatment. As a charge nurse in the emergency department, I am responsible for providing leadership and making ethical-legal and moral decisions that safeguard the well-being and safety of patients and the healthcare team. In this discussion, I will offer my thoughts on the role of a nursing leader in making ethical decisions, reducing moral discomfort, and supporting the principles that govern my activities.

Ethical Decision-Making as a Nursing Leader:
As a nursing leader, it is critical to prioritize patient-centered care and advocate for patients’ best interests while keeping ethical standards and legal requirements in mind. In the fast-paced and high-stress setting of the ER, moral quandaries frequently arise, necessitating immediate and considered decision-making. My responsibility as a nursing leader is to promote open communication, cultivate an ethical culture, and ensure that ethical considerations are integrated into clinical practice.

Moral discomfort can emerge when healthcare workers feel restrained from following their moral ideals due to organizational or systemic constraints. To reduce moral pain, I intend to take the following steps:

1. Encourage Interprofessional Collaboration: Collaboration among healthcare professionals, such as physicians, nurses, and other members of the healthcare team, can aid in the resolution of ethical quandaries. We can work towards honest solutions and alleviate moral anguish by developing a culture of teamwork and open conversation.

2. Provide Education and Training: Ongoing education on ethical principles, legal frameworks, and conflict resolution procedures can equip nurses and the healthcare team with the confidence to manage ethical problems. We can address moral quandaries with a shared understanding and explore ethical decision-making frameworks if we improve the team’s knowledge and skills.

3. Seek Ethical counseling: Ethical counseling can provide useful insights and guidance in challenging circumstances where ethical quandaries persist. Working with ethics committees or consultants can assist in analyzing multiple points of view, investigating ethical alternatives, and making well-informed judgments consistent with patient-centered care.

Principles That Guide My Actions: As a nurse leader, I base my decisions on integrity, compassion, and respect. I place a premium on patient autonomy, decency, and confidentiality. I work hard to communicate openly and honestly with patients, their families, and the healthcare team. By respecting these ideals, I hope to foster a welcoming environment where ethical decision-making is appreciated and moral anguish is minimized.

To summarize, my position as a nursing leader as an ER nurse and charge nurse is making ethical-legal and moral decisions that emphasize patient well-being and safety. I aim to reduce moral anguish and encourage ethical decision-making within the healthcare team by encouraging open communication, providing education and training, seeking honest guidance, and supporting fundamental principles. Through these efforts, I hope to foster an environment that promotes ethical practice and, as a result, improves the quality of care offered to our patients.

References:
1. The American Nurses Association. A Code of Ethics for Nurses with Interpretive Statements. URL: https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
2. Epstein, E. G., and A. B. Hamric. Moral anguish, moral residue, and the crescendo effect are all factors to consider—20 (4), pp. 330-342 in the Journal of Clinical Ethics.
3. Lachman, V. D., and J. S. Murray (2019). Ethical Issues in the Transformation of Health Care. Nursing Clinics, vol. 54, no. 2, pp. 149-162.

doi: 10.1016/j.cnur.2019.01.011.