Top 7 Nursing Ethics Dilemmas Faced by ICU Nurses


nursing ethics dilemmas faced by nurses

By Alana Luna, Contributor

Being an ICU nurse comes with a plethora of responsibilities, including understanding and abiding by a nursing code of ethics. When difficult situations arise, understanding the most common dilemmas in critical care and learning how to cope can protect nurses and patients alike.

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7 Ethics Dilemmas ICU Nurses Face

1. Dealing with verbally abusive patients

Patients who are injured, ill or suffering from mental disorders are rarely at their best. Nurses are regularly the object of sarcasm and name-calling, and their position as the most visible and available person on a patient’s care team puts them directly into the line of fire. In Ontario, for example, health workers account for a mere 10 percent of the workforce yet they are the subject of 30.6 percent of violence-related workplace injuries.

Incidents have become so common National Nurses United petitioned Thomas Perez, U.S. Secretary of Labor,and David Michaels, Assistant Secretary of Labor for OSHA, to create a federal standard protecting healthcare workers. The goal: to protect nurses from patients while also ensuring other patients aren’t neglected because nurses are focused on coping with disruptions.

2. Communicating with difficult doctors

One study found that 51 percent of patient errors occurred because of conflicts between nurses and patients, as discussed above, or between nurses and physicians. While managing verbally abusive patients is undeniably taxing, being on the receiving end of condescension or disrespect from a physician is arguably even worse.

Doctor-led bullying is a real concern in the healthcare industry, with witnesses reportedly seeing nurses berated, physically threatened and even assaulted by physicians. Reporting a supervisor or other person with authority is difficult in any professional situation, but ICU nurses may have addition questions and concerns:

  • Will administrators believe revenue-generating hot-shot doctors over nurses?
  • Will speaking up result in blowback or retaliation against the nurse who reported the offense?
  • If a nurse chooses not to speak up, could a strained professional relationship or a doctor’s offensive actions lead to patient harm?

Nurses are challenged to make the right call even when there is no clear-cut way to decide how to proceed.

3. Professional loyalty versus patient care

Some ethics dilemmas involve a tug of war between what nurses feel is right for their careers and what needs to happen to ensure patients are properly cared for. Often there’s overlap between the two, but sometimes nurses are tasked with a stressful choice.

Dr. Monica Starkman is a psychiatrist who was on staff at a University of Michigan hospital when the nursing union called a strike. When that happens, says Starkman, “Nurses then must choose whether to cross picket line to staff their unit or show solidarity with colleague nurses and stay out.”

As nurses fought for professional autonomy and expressed concerns over insufficient staffing, Starkman witnessed both sides attempt balance. While those patients who could be moved to other hospitals were quickly relocated, the union also allowed nurses to staff crucial areas such as the burn unit.

4. Fighting burnout in ICU nurses

Up to one-third of critical care nurses show signs of severe burnout syndrome, and a staggering 86 percent show signs of exhaustion, reduced personal accomplishment and/or depersonalization —three classic characteristics of burnout. These numbers —some of the highest amongst healthcare clinicians —indicate that ICU nurses could be especially prone to burnout-related complications, including: 

  • Reduced quality of care
  • Decreased patient satisfaction
  • Higher rates of infection
  • Higher 30-day patient mortality rates

ICU nurses should go through training that focuses on recognizing their physical and mental limitations so patients aren’t put at risk.

5. Pinpointing and addressing knowledge deficits

Nobody likes to admit they don’t know something important. ICU nurses who are called out by patients or doctors can feel embarrassed, inadequate or even angry, but ethically they must put their emotions aside and put patient care first. Though some research indicates that not all healthcare professionals use continuing education (CE) credits, as mandated by licensing bodies, to fill in knowledge gaps, ethically they probably should.

6. Expressing dissenting opinions

Patient care is a team effort, but when a patient’s medical team disagrees on a course of treatment, things can get tense. Even when faced with resistance, ICU nurses advocate for patients by fighting for the treatment option they believe in most —the American Nurses Association Code of Ethics demands it.

7. Navigating end-of-life situations

As much as ICU nurses focus on healing, mortality and critical care are perpetually intertwined. When the quest for recovery turns into a discussion of end-of-life care, a nurse’s code of ethics is forced into the spotlight.

One study of 507 ICU patients found that 26 percent of those admitted died still in the unit. Of those 132 patients who passed, 53 died after the medical team made a “comfort care decision,” 28 had signed do not resuscitate (DNR) orders and 14 were under limited-therapy plans.

For an ICU nurse who is so focused on bringing patients back from the brink, accepting a patient’s decision to decline treatment or abstaining from resuscitation attempts in accordance with a patient’s wish can feel wrong. Nurses must act ethically even when their own moral code or belief systems are at odds.

Having a nursing code of ethics that outlines an ICU nurse’s core values, duties and obligations in difficult situations can go a long way toward providing a reliable standard of care. It also helps nurses feel comfortable in their roles and make more confident decisions, both of which should have positive effects on patient care.

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