Taking a Stand

Answer

Taking a Stand

Introduction

With many definitions of leadership, the question has evolved from ‘what is leadership?' to ‘what are the characteristics of good leadership?’ (Woods, 2014)?" This paper examines the importance of personal ethics in leadership as well as how ethics produces effective leaders. This paper will present a practical approach to ethics that will allow a leader to sustain good leadership and ethical conduct from followers. It addresses the importance of understanding ethics, and developing a plan of action for an organization because of the importance attached to the development of good leadership.  The paper will also introduce an ethical dilemma encountered and how it was resolved using ethical leadership skills as a moral agent for a nurse. These key aspects suggest personal ethics positively affect leadership and when made a priority for leaders will produce ethical and effective leadership.

Qualities of ethical leadership

Ethical leadership needs humility, integrity, understanding, and knowledge of the role of a leader. Leaders have followers, whether as colleagues, peers, direct reports, community, or friends and family. Leaders hold certain responsibilities and also serve as role models; leaders in health care ought to understand their role in creating an ethical environment that is just and honest. A leader in charge of a health care team has an ethical responsibility to create standards of conduct and a culture of integrity across all spheres of influence. According to Marquis & Huston (2015), a code of ethics for the medical profession specifically nursing states explicitly the main obligations, values, and ideals of the profession. Morals, values, and ethical integrity direct the actions of leaders and thus are consistent with principles of leadership. According to Marquis & Huston (2015), nurses have an ethical obligation to address not only the care of the patient, but also the underlying systems issues that may influence patient care. Clearly, this is the key difference between nursing and nursing leadership.

Definition of a Dilemma

A dilemma occurs when an individual is faced with what is perceived to be no alternative, one alternative, or either/or choice situation (Disch, 2014). A dilemma situation leaves an individual with limited, often painful choices. For instance, a patient may be presented with only two alternatives to either have a surgery or die shortly. This can leave the patient powerless, immobilized, feeling subservient, and with no sense of control. Provision of options may assist the person by giving him or her, a sense of freedom in the decision-making process. Whether an ethical dilemma exists or not, the available options should be the first question the nurse asks. Once an ethical dilemma is determined to exist, one can begin a systematic process to open the discourse and start the decision-making process.

Description of a Dilemma

An experienced nurse acting as a preceptor for a new trainee nurse gets upset that she is late to leave work, because the trainee nurse forgets to sign off her medications in the computer. The experienced nurse signs off the medications on behalf of the new nurse, because she assumes the trainee nurse gave them.

Examining the ethical dilemma

The experienced nurse reasons that it is appropriate to document medication administration for the new nurse who forgets to sign of her medication. Although the experienced nurse needs to leave in a timely manner since she has commitments after work, she also has a responsibility of ensuring correct administration of medications, which included appropriate documentation by the new nurse. The experienced nurse, as a preceptor, she also has a responsibility to ensure that the new nurse is educated on policies of the hospital that include documenting medications.  In this situation, she solved her problem by documenting the administration of medication on behalf of the new nurse, but by doing so; she violated hospital policy of the correct administration of medication.

Possible Alternatives

The Possible alternatives for this dilemma include:

(1) If the new nurse was not aware, the experienced nurse should have assisted with the administration of medication.

(2) The experienced nurse should have educated the trainee nurse on hospital policy of medication administration. She could have instructed the new nurse that medications should only be administered with verification on the computer as well as that she should sign off medication as they are being administered.

(3) The new nurse could have been allocated few patients to focus on providing care until she proves she could safely care for more than a few patients.

Ethical Arguments

In this situation, the hospital policy is violated which created essentially to ensure patient safety and positive patient outcomes. The experienced nurse in this case trusted that the new nurse was administering the medications to the patients. Nevertheless, she failed to visualize patient administration in order to be positive. As a preceptor, the experienced nurse also responsible for ensuring the new nurse provide care appropriately including correct documentation of medications.  For the greatest good to the greater number of people, the experienced nurse should ensure the new nurse is documenting medications correctly (Disch, 2014). This will guarantee the new nurse comprehends hospital policy and patients receive proper care. The experienced nurse's personal obligation does not outweigh documenting medications for the new nurse since patient safety comes first. Therefore, the experienced nurse compromised patient safety for her personal needs as she failed to educate the new nurse on proper medical administration, which could result in harming many patients.

Recommended Alternative

By The best immediate solution to this dilemma is to allocate the new nurse fewer patients, until she proves she is able to complete patient care safely on a smaller assignment, while studying hospital policies with the experienced nurse.

Review of the Ethical Dilemma and Examining the Outcomes while Reflecting on the Ethical Decision

Applying utilitarianism by taking patients away from the new trainee nurse may cause varied emotions for the new nurse. However, this is the best immediate solution to this dilemma since patient safety is ensured and it is the priority. Rather than the experienced nurse, wrongly documenting what she thinks is being done by the new nurse, which by looking at the whole picture, the new nurse would recognize there are missing pieces to the conclusion of safe patient care. The primary belief of individuals who have adopted and applied the utilitarian position is that the most ethical practical action is the one that results in the greatest good for the greatest number (Martin, 2014). In our dilemma, adopting this position seems the best thing to do. This is so since corollary to this notion would be that the best action is the one that causes the slightest harm to the fewest people. Therefore, the leadership style adopted here does not interfere with the solution of the dilemma rather it is the best thing to do.  To a utilitarian, the paramount thing is not so much on the good will toward others, but the consequences that result from the action taken. Determining the action to take requires that all potential actions in the situation and the potential results of each be examined for every individual who may be involved (Martin, 2014). After weighing and balancing the different outcomes, the action that leads to the best outcome for the most people is taken. In this case, the action to be taken is to reduce the number of patients that the new nurse attends.

Many pressing issues facing the healthcare profession are tackled by ethical decision-making. All healthcare professionals involved need specific tools to assist in this endeavor in order to chart a problem-solving course.  The healthcare profession is prepared by understanding the ethical shoptalk necessary for the extraordinary demands of today's high-tech medical environment. Nurses are consistently challenged to make ethical decisions about life and death issues in providing care to individuals, families, and communities (Marquis & Huston, 2015). To be relevant and ethical, their decisions need to be considered in the broader context of personal, cultural, societal, and professional values as well as ethical principles. The nursing profession primarily uses codes of ethics, regulatory mechanisms, and other means to ensure ethical behavior. (Martin, 2014) research addressed conflicts that arise when nurses' commitment to the organization is misaligned with their responsibility to patients. Disch (2015) reported that this continuing conflict ultimately leads to lasting stress for patient care providers.

Moral distress can lead to burn out, causing disengagement, as well as the lack of focus on the primary work of nursing. Disch (2015) referred to the inability to resolve moral distress successfully as the stories that haunt the nurses. These stories often define situations related to patient advocacy, futile treatment, end of life, and role conflict based on values. Disch (2015) further noted that since nurses act as moral agents in the healthcare system, the nurse, patient, and organization all benefit from nurses' deeds of moral courage. These deeds have the potential to promote patient comfort, increase nurse retention, relieve patient suffering, and thereby enhancing the reputation of the organization. Although moral agony among direct-care nurses has been explored well, the moral distress among nurse leaders is almost absent in the nursing literature (Cianci et al., 2014). The stories that haunt direct-care nurse and nurse leaders often emerge from the same situations. Therefore, it is important that nurse leaders offer support to direct care nurses in facing these situations and address these scenarios in their own work by demonstrating moral courage(Cianci et al., 2014).

Martin (2014) has described the concept of professional moral courage as a competency in management. He found that the leader who considers more than policies and rules, who shows determination and hardiness, and who is self-directed toward the good and moral normally, displayed acts of moral courage. Cianci et al., (2014) described the courage to take the appropriate action in a morally distressing situation as acting to alleviate the moral distress initially felt by nurses in morally conflicted scenarios. Cianci et al., (2014) shared that nurses must find their voice of agency to act with courage, capacity, and conviction. This courage to speak up is supported by most state nurse practice acts that entail nurses to carry out their professional duty as agents of patient safety, protect patient rights, and maintain professional practice boundaries.

Conclusion

In conclusion, since the nurses have the special relationship as care providers to their patients, they are active participants in ethical decision making concerning the patients, families, and the community. The community and the profession require that nurses possess certain virtues that will promote trust and just in all their professional relationships. It is clear that the value of understanding the principles of ethical leadership is that it offers the starting points for thinking through as well as developing the frame of reference for the practice of nursing. It is evident that nurse leaders require certain values in solving the dilemmas that they encounter during execution of their obligations.