Critical Analysis of Ethical Issues and Nursing Practice Challenges

This report provides a comprehensive analysis of ethical issues in nursing practice, addressing the challenges faced by both nursing students and registered nurses. It explores ethical dilemmas related to patient confidentiality, autonomy, workplace conflicts, and resource allocation, as well as the impact of moral distress on nurses' well-being. The report examines the nursing code of ethics, ethical awareness, and decision-making processes, highlighting the importance of ethical principles such as autonomy and beneficence. It critically analyzes ethical issues in clinical practice education, emphasizing the unique challenges faced by nursing students and the need for comprehensive education and support. The report also discusses ethical issues faced by registered nurses, including internal and external pressures, and the impact of these issues on their ability to provide quality care. It concludes by emphasizing the importance of ethical awareness, adherence to the nursing code of ethics, and the development of standardized codes to address ethical dilemmas in the field.

Running head: PROFESSIONAL ISSUES IN NURSING 1
Professional Issues in Nursing
Student’s Name
Institution

PROFESSIONAL ISSUES IN NURSING 2
Professional Issues in Nursing
Ethical issues in nursing are professional problems faced by nurses across various
settings within the nursing practice. Nursing students and practicing nurses alike encounter
ethical dilemmas every day with evidence indicating that the former suffer more severe
consequences associated with moral distress. Even though nursing faculty provide the necessary
education on ethics and ethical decision making, studies have revealed that the most appropriate
way to learn ethics by nurses is through clinical practice. As such, in various units nursing
students tend to encounter challenging ethical issues that students are seldom unprepared for.
Hence, student nurses and nurses with few years of experience have been observed to face more
ethical dilemmas. Some of the challenges they face include lack of respect for patients’
confidentiality and autonomy, workplace conflicts and lack of support (Sinclair, Papps &
Marshall, 2016). Likewise, practicing nurses face myriad other ethical problems arising from
both internal and external factors among them including; poor professional relationships, lack of
sufficient healthcare resources, staffing patterns, quality and safety of care and cultural barriers
(Ruston & Stutzer, 2015). The nursing code of ethics has in response been revised and it
continues to guide nurses on how to demonstrate ethical awareness and exercise ethical decision
making when faced with ethical dilemmas.
Ethical Dilemmas
Many ethical problems faced by nursing students and registered nurses in clinical practice
are related to actions of nursing staff towards patients. For nurses, ethical issues are not only
encountered at the bedside, but they also arise from various levels of the organization.
Navigating complex systems in healthcare institutions as well as maintaining collaborative

PROFESSIONAL ISSUES IN NURSING 3
working relations are some of these areas that nurses often encounter ethical problems. Medical
errors, duty delegation, nurse burnout, end of life care and use of technology specifically poise
ethical dilemmas for nurses every day in clinical practice (Epstein & Turner, 2015). The issues
result in moral distress for nurses. Moral distress most worryingly leads to unwanted associated
effects. For instance, it is likely that nurses experiencing moral distress will suffer from feelings
of depression, stress and fatigue or burnout (Gore, 2015). These effects compromise the
emotional wellbeing of nurses a factor which will incline nurses to consider changing profession
and ultimately leaving the nursing practice.
Ulrich et al., (2013) summarized the most prevalent ethical issues faced in nursing
practice. The authors noted that protection of patient autonomy and informed consent to
treatment has become highly challenging. Staffing patterns that resulted in nursing shortages was
also another ethical dilemma that nurses continue to face. Advanced care planning such as goals
for end of life care also compromised personal and professional ethics when societal
expectations were taken into consideration (Ulrich et al, 2013).
One of the most common examples of ethical dilemmas faced by nurses at the bedside
and navigating organizational systems involves discontinuation of care or treatment for chronic
conditions due to financial constraints (Marylyn, 2018). A patient hospitalized for pneumonia for
example, may receive a discharge since the patient has used up the days allotted for the medical
condition. It could also be that the patient has used up all the coverage provided by the insurance
and yet the treatment has not been completed. Upon receiving the discharge order, the nurse in
question becomes aware that he/she is faced with an ethical dilemma. Firstly, the nurse will
acknowledge that the problem arises from the distribution of scarce resources emanating from
limited organizational or societal financing. Secondly, the nurse will struggle to adhere to the

PROFESSIONAL ISSUES IN NURSING 4
ethical principle of justice which designates that all patients should be treated equally (Epstein
&Turner, 2015). In this situation, although the nurse fully demonstrates ethical awareness, the
nurse still wrestles on the best solution to make and this becomes highly problematic when the
decision is not ethically based.
Ethical Awareness
Ethical awareness can be described as a way of identifying and acknowledging the moral
consequences arising from all nursing actions. It is essential that all nurses strive to develop
ethical awareness so that they can ethically advocate for the needs of their patients while
adhering to professional requirements (Milliken, 2018). Nurses are required to utilize the ethical
principles when faced with ethical dilemmas in order to arrive at a decision. This process will
notably involve ethical decision making and it is further recommended that all the available
evidence-based guidelines be incorporated prior to making a decision or undertaking an action
(Cleary & Lees, 2019). For one, adhering to the principles of autonomy and beneficence have
been found to be fundamental in any ethical decision making process. In this case, the respect for
patient’s autonomy will entail respecting the patient’s decision on the choice of care and
treatment even in cases where there is refusal of care from the patient (Parker, 2011). It is
important to note that the nurse advocates for the wishes of the patient even when they contradict
opinions from physicians and family.
Critical Analysis of Ethical Issues in Nursing
Ethical Issues in Clinical Practice Education
Studies indicate that nursing students experience ethical problems in a different way
compared to registered nurses and to them, ethical problems result in more severe moral distress.

PROFESSIONAL ISSUES IN NURSING 5
Ideally, ethical issues faced in nursing or any other area of specialization will inevitably lead to a
corresponding level of distress. A recent study conducted in New Zealand among nursing
students in clinical practice found that only a third of the 400 undergraduate nurses who
participated in the study did not experience breaches in patient’s confidentiality, dignity and
respect. A further 90% reported to having been subjected to unsafe working environments
(Sinclair, Papps & Marshall, 2016). Also, issues involving unsafe working conditions and most
worryingly the lack of support from supervision create a greater level of distress among aspiring
nurses (Savage, 2017).
Similar study conducted in Japan revealed that the will of patients are not respected by
nursing students and that privacy rights are not respected as well. In particular, nursing students
failed to tell patients the truth regarding their medical treatments and expected outcomes.
Another ethical problem faced by nurses was misappropriation of information. The ethical issues
were further exacerbated by the fact that nursing faculty provided little support to the nursing
students facing these challenges (Tsuruwaka, 2017). For such reasons, studies have revealed that
the undergraduate nurses prefer to consult with fellow nurses on the moral issues faced in
clinical practice.
However, the fear of negative evaluation, negative feedback and bullying of nursing
students further intensify the ethical problems encountered by these nurses. In clinical practice
education, a study revealed that disrespectful remarks made towards nursing students by
registered nurses most often result in moral distress and may also create animosity from nursing
students (Cadigan, 2017). Thus, aside from the ethical issues faced by student nurses in clinical
practice education, these individuals receive less support from their nursing faculty a factor

PROFESSIONAL ISSUES IN NURSING 6
which inclines them to seek support from registered nurses who unexpectedly condescend nurses
thereby worsening their situation.
Contrary studies have nonetheless illustrated that nursing faculty and registered nurses
often try to assist student nurses in resolving ethical problems only to the detriment of the
undergraduates’ behaviors. Studies indicate that nursing students tend to maintain unethical
behaviors characterized by lack of respect, self-centeredness and dishonesty. Furthermore, their
communication to patients reflects a lack of respect for patients (Song, 2017). From these
findings, it can be noted that nursing students are perhaps not ethically aware in facing ethical
dilemmas in practice. Hence, from the viewpoint of nursing faculty, there is indeed need for
more comprehensive education for nursing students on how their decisions and actions should be
ethically-centered.
Ethical Issues Faced by Nurses
From the perspective of registered nurses, ethical issues in clinical practice have often
resulted in moral distress. A recent study in NZ conducted in multiple clinical areas found that
more than half of nurses in the country encounter some form of ethical problem while practicing
and almost half of them have considered leaving their jobs. Internal and external factors both
compromised nurses’ beliefs and values on what entailed to be ethically correct in their
workplaces and faced with such dilemmas, nurses almost always reported some form of moral
distress. Internally, pressures from management to reduce costs were found to compromise
nurses’ delivery of quality care (Massey University, 2012). It has also been reported that lack of
continuity of care, professional incompetence, unnecessary physician orders tests and, costly and

PROFESSIONAL ISSUES IN NURSING 7
extensive lifesaving actions that prolong the dying process will also create moral distress among
many practicing nurses (Rushton & Stutzer, 2015).
Study by Park et al., (2014) revealed that one of the most disturbing and common ethical
issues among practicing nurses is conflict especially one arising from physician-nurse
relationships. The findings of the study further revealed that it became ethically challenging
when the staffing patterns limited patients’ access to nursing care (Park et al., 2014). Critical care
nurses also face ethical challenges when striving to balance their personal and professional
values with their commitment to providing patient care (Gore, 2015). It is also more challenging
to cater for inter-professional colleagues, the organization and the expectations from the society.
Faced with these issues, nurses are likely to face feelings of despair, powerlessness and
ultimately moral distress (Rushton & Stutzer, 2015).
Similar findings have indicated that nurses’ integrity is threatened by internal and
external pressures ranging from quality and safety of care to disparities in healthcare access and
distribution of healthcare resources. These circumstances will aggravate the level of moral
distress and as such lead to negative consequences such as withdrawing from providing care,
distancing from the patient and leaving the nursing professions (Tineker et al., 2017). Such
findings illustrate the connection between ethical issues that seemingly nurses are unprepared for
and the prevalence of moral distress.
It can alternatively be stated that different conflicts and constraints exist which hamper
nurses from observing their ethical responsibilities while in practice. Accountability issues
towards patients, societal perception towards nurses and uncooperative colleagues are some of
the aspects that explain the conflicts and obstacles to maintaining ethical responsibility. In a

PROFESSIONAL ISSUES IN NURSING 8
study conducted in Pakistan by Hamid et al., (2016), the findings indicated that conflicts were
prevalent in hospital admission procedures, in informed consent by the patient, and false
accusations made by patients. Lack of amenities, imbalanced care and deficiency in medicine
were also significant barriers to fulfilling ethical requirements. Existing cultural barriers and
diverse patient expectations also reflected the different perceptions held by society and which
contradicted moral expectations from nurses (Hamid et al., 2016).
The Nursing Code of Ethics
Following the ethical issues faced by nurses in clinical practice, myriad numbers of
studies have called for education on nursing ethics and development of standardized code of
ethics that would enhance the comprehension, resilience and ability to accordingly respond to
ethical dilemmas. In every setting, a professional code of ethics will guide nurses in to develop
ethical awareness and as such be able to implement ethical decision making in all challenges that
they encounter in the workplace (Hoskins, Grady & Ulrich, 2018). Nursing code of ethics is a
critical document that is specifically tailored to guide nurses in negotiating complexities in
various situations in their clinical settings.
NZMA Code of Ethics
To create a meaningful process to manage challenging ethical and professional issues, the
NZMA code of ethics was recently revised and released by the nursing council in NZ. This code
provides clear-cut direction that nurses should take in conducting themselves professionally and
as expected. On this note, nurses are expected to uphold certain behaviors which are confounded
on sound professional values while tending to their patients. Emphasis is also placed on building
trust among patients (NZNO, 2012). It is worthy to note that following the release of this code,

PROFESSIONAL ISSUES IN NURSING 9
all nurses have been expected to mandatorily complete professional development on the code of
conduct as part of their ongoing professional requirements.
Like many other codes of ethics in nursing, the code of ethics in NZ is based on the eight
ethical principles namely; autonomy, beneficence, justice, fidelity, non-maleficence,
professionalism, confidentiality and guardianship of the environment. Notably, these principles
are supposed to be utilized by nurses to resolve ethical issues and they further reinforce the need
for a supportive environment for both student nurses and practicing nurses. Another noteworthy
aspect of the principles is that they strive to ensure that optimal care is provided by nurses to
their patients at all times (NZMA, 2013).
There are other four core values that shape this code including trust, respect, integrity and
partnership. Under these values, nurses are expected to make provision of care for patients their
main primary concern while maintaining professional boundaries (NZNO, 2012). Fostering
relationships among colleagues, patients and the patient’s families is reliant on nurses
demonstrating improved awareness of their professional responsibility.
When nurses align their practice with the stipulated and recognized code of ethics, it is
expected that they will be able to effectively manage challenging issues in their units. For one,
ethical issues can be addressed using the ethical model in the document. Nurses can also promote
and be able to respect informed decision making by patients ensuring that patients of sound mind
are able to make their own or independent decisions regarding their choice of care. Such
autonomy can further be reflected by nurses’ ability to allow patients to get involved in risky
activities provided that they are informed of the associated risk. Similarly, nurses should be able
to respect their patients’ right to live as well as some patient’s will to die in dignity (NZMA,

PROFESSIONAL ISSUES IN NURSING 10
2013). In addition, respect can also be demonstrated by nurses under this code in light of
patients’ diverse cultural backgrounds including their held beliefs and values which may
contradict established clinical treatments and goals of care.
Additionally, the code also elucidates on matters regarding patient protection,
professional skills and medical resources. All individuals involved in clinical practice are not
supposed to exploit patients in their care in any manner. Medical practitioners are further
required to protect private patient information throughout their life and even in death unless
issues of public safety arise. Professionally, practitioners are expected to continuously improve
their knowledge and skills for the benefit of the patient’s wellbeing and this can be done by
relying in the current evidence-based clinical practice or guidelines (Ockelford, 2012). However,
one should be wary of the limitations in their skills and seek intervention or support from others.
Finally, it is the responsibility for all medical practitioners to advocate for adequate provision of
medical amenities so that access to care is not limited to any member of the society or
community (NZMA, 2013). These provisions collectively help to address ethical issues faced by
nurses in multiple areas of conflict. Most importantly, they can enable nurses to fulfill their
ethical responsibility by making ethical-based decisions when faced with ethical dilemmas.
Recommendations
Although, it is expected that the NZMA code of ethics should be able to resolve all
ethical issues faced by nurses in their clinical settings, evidence suggests that there are fractions
within the code that needs improvement. For instance, there has been rising concerns regarding
the heavy reliance on the principle of autonomy especially professionally. Specific concerns
have been pointed to the notion that when doctors adhere to autonomy in their settings, it

PROFESSIONAL ISSUES IN NURSING 11
becomes problematic to establish inter-professional collaborative efforts. The importance of
collaboration in practice can be seen when managing chronic conditions which comprise the
highest proportion of illnesses and deaths in NZ. With limited collaboration among clinicians
since they operate autonomously, mismanagement of chronic diseases leading to unnecessary
readmissions, preventable deaths and high medical cost will consequently become inevitable
(Gray 2014). Thus, even though autonomy is a critical element of the code, there is need to
redefine how professional autonomy should be observed so as to protect collaborative
relationships among medical practitioners.
Conclusion
Ethical dilemmas faced in clinical nursing education as well as in nursing practice is
challenging for both nursing students and registered nurses. Undergraduate nurses while in
clinical practice face issues related to patients’ confidentiality and respect and professional
conflicts. Minimum support is provided by nursing faculty and practicing nurses on how these
issues can be resolved. However, nursing students also demonstrate lack of respect for patients
and failure to protect patient information. Adherence to NZ code of ethics for nurses can guide
these students on how to conduct themselves professionally in the process respecting the
patients’ rights to confidentiality and autonomy. Practicing nurses also face multiple ethical
problems such as workplace and professional conflicts, lack of healthcare amenities, goals of
care, quality and safety of care, and compromised delivery of care. The code can guide nurses on
how to resolve these issues by conforming to the principles of ethics especially autonomy and
beneficence. The code also guides nurses on how they can improve their professional skills and
seek physician intervention with minimal conflict. Improvements however remain to be made on

PROFESSIONAL ISSUES IN NURSING 12
how professional collaboration can be fostered when nurses are expected to operate
autonomously.