Nursing Students and Ethical Dilemmas^[1]

An integrative literature review performed by Albert, Younas, and Sana in 2020 identified ethical dilemmas encountered by nursing students in clinical practice settings. Three themes were identified:

1. Applying learned ethical values vs. accepting unethical practice

Students observed unethical practices of nurses and physicians, such as breach of patient privacy, confidentiality, respect, rights, duty to provide information, and physical and psychological mistreatment, that opposed the ethical values learned in nursing school. Students experienced ethical conflict due to their sense of powerlessness, low status as students, dependence on staff nurses for learning experiences, and fear of offending health care providers.

2. Desiring to provide ethical care but lacking autonomous decision-making

Students reported a lack of moral courage in questioning unethical practices. The hierarchy of health care environments left students feeling disregarded, humiliated, and intimidated by professional nurses and managers. Students also reported a sense of loss of identity in feeling forced to conform their personal identity to that of the clinical environment.

3. Whistleblowing vs. silence regarding patient care and neglect

Students observed nurses performing unethical nursing practices, such as ignoring client needs, disregarding pain, being verbally abusive, talking inappropriately about clients, and not providing a safe or competent level of care. Most students reported remaining silent regarding these observations due to a lack of confidence, feeling it was not their place to report, or the fear of negative consequences. Organizational power dynamics influenced student confidence in reporting unethical practices to faculty or nurse managers.

The researchers concluded that nursing students feel moral distress when experiencing these kinds of conflicts:

• Providing ethical care as learned in their program of study or accepting unethical practices
• Staying silent about patient care neglect or confronting it and reporting it
• Providing quality, ethical care or adapting to organizational culture due to lack of autonomous decision-making

These ethical conflicts can be detrimental to students’ professional learning and mental health. Researchers recommended that nurse educators should develop educational programs to support students as they develop ethical competence and moral courage to confront ethical dilemmas.^[2]

Read more about ethics education in nursing in the ANA’s Online Journal of Issues in Nursing article.