You have been there before. You are caring for an individual and something about their situation gives you a bad feeling. Maybe you feel that their care is too aggressive? Maybe you think they do not really understand the implications of their medical decisions? You try to shake it off, but still you keep thinking about it and take it home with you. You may become angry or upset. Over time, these feelings can cause you to disconnect from your passion for nursing and lead to burnout.
If you are feeling burned out due to care that might be unethical, you are not alone. As a nurse, I understand and want to share what I have learned about ethics and burnout with you.
When nurses feel powerless to do anything about unethical situations, they can experience moral distress. “Moral distress occurs when nurses are unable to perform according to what they believe to be ethically correct.” (Browning, 2013). Over time, moral distress will erode your ability to love nursing and perform at your best.
The solution: Apply ethics to your nursing practice
According to Cynda Rushton, a Johns Hopkins professor of bioethics,
“Often, we think about ethics as separate, that thing we do when everything else is done… [however], ethics is part of everything we do. It’s embedded in our choices, in our behavior, in our character, in how we do our work every day. When you think about ethics in that way, it’s important for the foundation of nursing to be grounded in ethical values so that we’ve got a firm [basis from which to operate]. “
What ethics can do for you:
- Ethics give you a framework to understand what specifically is wrong. They enable you to go from something isn’t right to being able to state the exact ethical issue.
- Ethics empower your voice as a nurse.
- Ethical decision-making gives you step-by step guidance for what to do when something seems wrong.
Try using ethical decision-making
Why is making the right ethical decision difficult? If ethics were a simple matter, computers and robots could make ethical decisions for you. While the outcomes of ethical decision-making may vary from nurse to nurse, there is a process that everyone can use to systematically address ethical dilemmas. This process includes six steps:
1. Identify the ethical issue.
This is more important than it seems. By spelling out the issue, it makes it easier to communication to yourself and other members of the healthcare team. What is it exactly that doesn’t seem right? What ethical principle is involved Autonomy? Beneficence?
2. Get the facts and analyze the issue.
Look at the whole picture and try to understand the individual’s history as well as the timeline of the current situation. Talk to those involved in the situation to try to understand their views on the situation.
3. Consider possible actions and the outcomes for each possible action.
The outcome is important. If you take what you think is the correct course of action, but it ends up hurting the patient in end, you likely have picked the wrong course of action. It may be helpful to list your options and then draw an arrow to possible outcomes.
4. Choose the best action.
5. Implement your decision.
6. Review the outcome.
Did the outcome of your decision line up with what you thought would happen? What could you have done differently?
Write it down
It might help to write it out or journal about it. Just get it all out on paper. Sometimes just the process of writing out your thoughts will add clarity. On your next break, try spending 3 minutes writing key words about the situation down on paper. Include how you feel about it, and what you think should happen next.
Get to know your ethics committee
Finally, remember that your organization’s ethics committee is your friend. Introduce yourself to the members. Ask to sit in on a meeting. They are usually very welcoming and excited to see nurses who care about ethics. As you develop a relationship with those on the committee, share your thoughts and experiences with them. They can offer guidance and understanding.