Nursing Leaders as Change Agents in Healthcare


Ross, Fitzpatrick, Click, Krouse, and Clavelle (2014) point out that there is a need for resilient and proficient nursing leadership that fosters organizational and personal change. Nurses’ role in making ethical, legal, and moral decisions is crucial as they are the first people with whom individuals can discuss their concerns. Moreover, sometimes caregivers are asked to express the will of their patients. Unfortunately, nurses often face moral distress caused by challenging ethical dilemmas and need to have the moral courage to solve them (Hutchinson, Daly, Usher, & Jackson, 2015).

A study by Moffat (2014) suggests that to manage this negative aspect of clinical practice, nurses should incorporate a creative approach to patient advocacy and meaningful interventions. To follow this strategy, I will try to view all ethical situations as unique ones and make decisions according to both legal regulations and the aspects of the problems. To manage stress, I will practice mindfulness, attending yoga classes and educational programs.

I have chosen this strategy because I value every patient as a person. I believe that all individuals deserve compassion and commitment, and I strive to provide them with the best quality of care. It is necessary to consider personal factors along with legal ones while making ethical decisions. Moreover, I will take care of my mental and physical health as well as it can contribute to establishing the good relationships with the patients.

Comparing Ethical Principles

To make the right decisions, caregivers should be sensitive to ethical issues because neglecting them does not correspond with the values of nursing (Esmaelzadeh, Abbaszadeh, Borhani, & Peyrovi, 2017). In my opinion, one of the principles that apply to ethical decision-making is autonomy or respect of patients’ wishes. Heale and Shorten (2017) also consider it a significant and necessary aspect of caregiving.

They point out that patients’ welfare should precede the interests of the nurses. I believe that the second ethical principle that nurses should apply to their practice is beneficence. The study by Vryonides, Papastavrou, Charalambous, Andreou, and Merkouris (2015) shows that it is one of the fundamental principles nurses should follow. It is crucial for nurses to have compassion and strive to do their best while working with their patients. This is the core principle I follow in my practice as well.

These ethical principles correspond with one another as they both acknowledge patients’ significance. In my opinion, being respectful of individuals’ wishes ensures that caregivers make the right moral decisions as they consider the patients’ perspective. Having compassion is also core for ethical decision-making as it allows care providers to consider ethical issues behind the problems and reflect on them. If I face an ethical-legal dilemma, these principles are the fundamental ones I follow.

Advanced Practice Nursing Decisions that Cause Moral Distress

Nurses face many ethical-legal dilemmas as their work is based on communication with patients (Balan, Trifan, Savin, Balan, &Gologan, 2016). In my practice, I have experienced several issues that caused moral distress, a condition that affects many healthcare professionals (Whitehead, Herbertson, Hamric, Epstein, & Fisher, 2015). One of them occurred when I was providing care to a 78-year-old patient. He received treatment because he had fallen down the stairs at his house.

When the patient was admitted to the hospital, he insisted that he did not want his family members to know about his conditions. However, after the surgery, he was in a coma and his family contacted the hospital to learn about his conditions. I knew that the patient did not want me to disclose the circumstances to his relatives because they were not in good relationships and he did not want to see them again.

The situation was challenging to me as, on the one hand, I realized that I had to protect my patient from undesirable visitors. I had to consider his desire and needs, as they were my priority. On the other hand, I knew that the family was concerned about the man’s conditions, and I had the legal right to disclose those to them because he was incapable of making decisions (Uses and disclosures, 2002). This situation was challenging and stressful for me.

Evaluation of Ethical Models and the Ethics Committee

Hajibabaee, Joolaee, Cheraghi, Salari, and Rodney (2016) note that ethics committees are designed to make medical professionals aware of the ethical issues they have to make. To do so, they should consider the dilemmas which care providers face, study them, and report on them. In the presented case, the committee’s contribution is to prioritize either the legal or the ethical aspect of the conflict. Priority setting decisions are a significant contribution of such institutions, as dilemmas arise at all levels of care providing (Magelssen, Miljeteig, Pedersen, & Førde, 2017). In my dilemma, there is a conflict of patient’s and his family’s interests.

I would like the committee to consider the principles of deontology. I believe that medical professionals should do good to their patients. In this case, it means that I should concentrate on the ethical aspect of the problem and follow the patient’s request. The study by Voltelen, Konradsen, and Østergaard (2018) proves that it is necessary to take ethical considerations into account when disclosing personal information to patients’ family members. It means, that according to the deontological approach, I should prioritize my patient’s wish and defend his interests, as otherwise I will cause harm.

Clinical Criteria for Determining Danger to Self

Legally, the state has a right to intervene on behalf of the woman, as she cannot act in her interest (Johnson& Stern, 2014). However, it is necessary to point out that her husband has a personal interest in admitting her to the psychiatric unit as it can help him in processing custody of their children. According to the legal implications and considering the state’s laws, the physicians’ actions are rightful. However, it is necessary to refer to the ethical aspects of the case as well. It is clear that the woman cannot defend herself, and her circumstances are unfavorable. She might be intoxicated because she does not want a divorce.

Williams, Cohen, and Ford (2014) report that in New York State, the law does not reference substance use as a mental health disorder. It means that there is no legal reasoning to admit the woman to the psychiatric unit. Moreover, according to the research by Rüsch et al. (2014), compulsory admission to the psychiatric unit can have a severe adverse effect on the woman’s mental state. I believe that it is possible to prove that such decision will be harmful to the patient. I will explain to the husband that we should investigate if his wife is a danger to herself or others. If the hospital concludes that she has no mental health disturbances, it will be illegal to admit her.


Balan, G. G., Trifan, A., Savin, C., Balan, A., &Gologan, E. (2016). Beneficence and behavior control: Ethical dilemmas in gastroenterology. Revista de Cercetare si Interventie Sociala, 55, 244-259.

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Rüsch, N., Müller, M., Lay, B., Corrigan, P. W., Zahn, R., Schönenberger, T.,… &Rössler, W. (2014). Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness. European Archives of Psychiatry and Clinical Neuroscience, 264(1), 35-43.

Uses and disclosures requiring an opportunity for the individual to agree or to object, 45 C.F.R §164.510 (2002).

Voltelen, B., Konradsen, H., & Østergaard, B. (2018). Ethical considerations when conducting joint interviews with close relatives or family: An integrative review. Scandinavian Journal of Caring Sciences, 32(2), 515-526.

Vryonides, S., Papastavrou, E., Charalambous, A., Andreou, P., & Merkouris, A. (2015). The ethical dimension of nursing care rationing: A thematic synthesis of qualitative studies. Nursing Ethics, 22(8), 881-900.

Whitehead, P. B., Herbertson, R. K., Hamric, A. B., Epstein, E. G., & Fisher, J. M. (2015). Moral distress among healthcare professionals: Report of an institution‐wide survey. Journal of Nursing Scholarship, 47(2), 117-125.

Williams, A. R., Cohen, S., & Ford, E. B. (2014). Statutory definitions of mental illness for involuntary hospitalization as related to substance use disorders. Psychiatric Services, 65(5), 634-640.