Nursing Ethics Network (NEN)

An Ethics Resource for Nurses

Research Reports

Nurse Executives' Response to Ethical Conflict and Choice in the Workplace*

Joan M. Riley, RN, EdD
Professor and Chair, Department of Nursing
Emmanuel College, Boston, MA 02115
email: riley@emmanuel.edu

This study examined ethical reasoning used by nurse executives to resolve ethical conflict in the workplace. The overall goal was to confirm and expand a relational model of influences on ethical conflict. The specific aims of the study were to describe:

• ethical conflict encountered by nurses executives in the workplace
• patterns of ethical reasoning used by nurse executives'
• contextual influences that affect nurse executives' response to ethical conflict
• patterns of ethical education identified by nurse executives.

Carol Gilligan's Moral Orientation Framework was the conceptual framework that guided the study. The study used an interpretive methodology. The assumption of the method is that meaning can be understood by accounting for the context within which it is constructed. Description of the conflict, choices made, implementation of their decision and evaluation of the action are the sub-components of the dilemma description by twenty nurse executives, purposively chosen to maximize diversity within hospital settings and leadership roles. Interview data were analyzed through an interpretive schema of narrative analysis, the Reading Guide Method, developed by Gilligan and associates.

Results of the study indicate:

• Nurse executives experience three types of ethical conflict: Professional Role Conflict, Organizational Conflict, and Interpersonal Conflict.
• Nurse executives use both justice (rules oriented) and care (relationship oriented) voices to solve ethical conflict. For sixty percent (n=12), care was the voice of predominance. For twenty five percent (n=5), justice was the voice of predominance. For fifteen percent (n=3), neither voice predominated.
• Professional Role Influences and Worksetting Influences are the two major types of contextual mediators in ethical conflict experienced by nurse executives. A Relational Model of Influence on Ethical Conflict and Its Resolution for Nurse Executives was confirmed.
• Ethics education, received by seventy five percent (n=15), of nurse executives in their basic educational preparation, decreased to sixty five percent (n=13) in their graduate programs. The most frequently attended continuing education programs selected by nurse executives focused on ethical and legal issues.

This study contributed to the body of knowledge that addresses the intersection of ethical reasoning with ethical decision making.

Ethics and Human Rights Issues in Nursing Practice:
A Survey of Connecticut Registered Nurses*

Principal Investigators
Constance Donovan, MS, RN, FAAN;New Haven, CT
Barbara Redman, PhD, RN, FAAN;Wayne State University College of Nursing;Detroit, Michigan

Purpose: It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify (1) the ethical issues encountered by Connecticut registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed Connecticut registered nurses are by the issues, (4) how Connecticut registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that registered nurses perceive as helpful to their practices.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 3% sample (n=1,219 ) of the 40,211 currently employed registered nurses practicing in Connecticut was conducted during 1999. Two mailings of the survey were done and more than 383 nurses participated in the survey, representing a 32.4 return rate.
Findings: The typical nurse participant in the survey is a 44 year old female with a college degree who is employed full time as a staff nurse and has 19 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for Connecticut registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; providing care with possible risk to the nurse's health; staffing patterns that limit patient access to nursing care; and using/not using physical or chemical restraints. Issues that are the most personally disturbing to Connecticut nurses are: staffing patterns that limit patient access to nursing care; prolonging the living/dying process with inappropriate measures; and not considering the quality of a patient's life. Over 31% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, 93% reported that they discussed the issue with nursing peers while over 74% discussed the issue with nursing leadership. Five percent of the nurses reported that they did not deal with the ethical issue at all. The majority (83%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical practices are: professional issues; the nurses as a patient advocate; patients' rights, autonomy, and informed consent; content-interpretation of ethical codes; and resource allocations and access to care.
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in Connecticut frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Additional research is needed to identify how Connecticut registered nurses use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

* Funded , in part, by Sigma Theta Tau, Delta Mu Chapter, and by the University of Connecticut School of Nursing

Ethics and Human Rights Issues in Nursing Practice:
A Survey of Maine Registered Nurses*

Principal Investigators
Candace Powell, RN, MSN; Maine Hospice Council, Augusta, Maine
Leslie Nicoll RN, PhD, MBA; University of Southern Maine, Portland

Purpose: It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify (1) the ethical issues encountered by Maine registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed Maine registered nurses are by the issues, (4) how Maine registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that registered nurses perceive as helpful to their practices.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 4% sample (n=564) of the 14,093 currently employed registered nurses practicing in Maine was conducted during 1998. Two mailings of the survey were done and 238 nurses participated in the survey, representing a 43% return rate.
Findings: The typical nurse participant in the survey is a 43 year old female with a college degree who is employed full time as a staff nurse and has 19 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for Maine registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; using/not using physical or chemical restraints; providing care with possible risk to the nurse's health; and staffing patterns that limit patient access to nursing care. Issues that are the most personally disturbing to Maine nurses are: prolonging the living/dying process with inappropriate measures; staffing patterns that limit patient access to nursing care; and implementing managed care policies that threaten quality of care. Over 36% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, more than 87% reported that they discussed the issue with nursing peers while 73% discussed the issue with nursing leadership. Eight percent of the nurses reported that they did not deal with the ethical issue at all. The majority (88%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical practices are: professional issues; patients' rights, autonomy, and informed consent; risk to nurses health; ethical decision-making; and quality of life.
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in Maine frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Additional research is needed to identify how Maine nurses use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

* Funded, in part, by Maine Nurses Association, Maine Bioethics Network, Organization of Maine Nurse Executives,
Maine Oncology Nursing Society, Home Care Alliance, Maine Hospice Council, Community Health Services, Eastern Maine Medical Center, St. Joseph's Hospital, Healthreach , and Marianne Steinhacker, RN.

ETHICS & HUMAN RIGHTS ISSUES IN NURSING PRACTICE:
A Survey of New Hampshire Registered Nurses*

Principal Investigators
Georgina Bru, RN, MA; Dartmouth Hitchcock Medical Center
Aileen Killen, RN, PhD; Dartmouth Hitchcock Medical Center
Peggy Plunkett, RN, MSN; Darthmouth Hitchcock Medical Center
Judith Porelle, MS, RN; Optima Health System; Manchester, New Hampshire

Purpose: It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify (1) the ethical issues encountered by New Hampshire registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed New Hampshire registered nurses are by the issues, (4) how New Hampshire registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that registered nurses perceive as helpful to their practices.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 5.9% sample (n=523) of the 8,809 currently employed registered nurses practicing in New Hampshire was conducted during 1998. Two mailings of the survey were done and more than 243 nurses participated in the survey, representing a 49.6 return rate.
Findings: The typical nurse participant in the survey is a 45 year old female with a college degree who is employed full time as a staff nurse and has 19 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for New Hampshire registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; staffing patterns that limit patient access to nursing care; providing care with possible risk to the nurse's health; and using/not using physical or chemical restraints. Issues that are the most personally disturbing to New Hampshire nurses are: staffing patterns that limit patient access to nursing care; prolonging the living/dying process with inappropriate measures; and working with unethical/impaired colleagues. Over 24% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, more than 91% reported that they discussed the issue with nursing peers while 70% discussed the issue with nursing leadership. Six percent of the nurses reported that they did not deal with the ethical issue at all. The majority (85.3%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical pratices are: professional issues; patients' rights, autonomy, and informed consent; nurses as patient advocate; ethical decision-making; and content-interpretation of ethical codes.
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in New Hampshire frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Additional research is needed to identify how New Hampshire registered nurses use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

* Funded, in part, by Optima Health and Dartmouth Hitchcock Medical Center.

ETHICS & HUMAN RIGHTS ISSUES IN NURSING PRACTICE:
A Survey of Rhode Island Registered Nurses*

Principal Investigator
John Twomey, PhD, RNC; MGH Institute for Health Professions; Boston, MA

Purpose: It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify (1) the ethical issues encountered by Rhode Island registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed Rhode Island registered nurses are by the issues, (4) how Rhode Island registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that registered nurses perceive as helpful to their practices.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 25% sample (n=3,000) of the 11,945 currently employed registered nurses practicing in Rhode Island was conducted during 1997. Two mailings of the survey were done and 546 nurses participated in the survey, representing a 18.2% return rate.
Findings: The typical nurse participant in the survey is a 44 year old female with a college degree who is employed full time as a staff nurse and has 19 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for Rhode Island registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; providing care with possible risk to the nurse's health; using/not using physical or chemical restraints; and staffing patterns that limit patient access to nursing care. Issues that are the most personally disturbing to Rhode Island nurses are: staffing patterns that limit patient access to nursing care; prolonging the living/dying process with inappropriate measures; and patients/families were uniformed/misinformed about treatment, prognosis and medical alternatives. Over 31% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, more than 90% reported that they discussed the issue with nursing peers while 75% discussed the issue with nursing leadership. Five percent of the nurses reported that they did not deal with the ethical issue at all. The majority (85%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical practices are: professional issues; resource allocations and access to care; patients' rights, autonomy, and informed consent; risk to nurses health; abuse and violence toward the nurse; and nurse as a patient advocate.
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in Rhode Island frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Additional research is needed to identify how Rhode Island registered nurses use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

* Funded, in part, by The Nurses Foundation of Rhode Island.

ETHICS & HUMAN RIGHTS ISSUES IN NURSING PRACTICE:
A Survey of Vermont Registered Nurses*

Principal Investigator
Carol Gilbert, PhD, RN; NLN Accrediting Commission: New York City, N.Y.

Purpose:It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify (1) the ethical issues encountered by Vermont registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed Vermont registered nurses are by the issues, (4) how Vermont registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that registered nurses perceive as helpful to their practices.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 9.7% sample (n=573) of the 5,876 currently employed registered nurses practicing in Vermont was conducted during 1998. Two mailings of the survey were done and more than 228 nurses participated in the survey, representing a 47.8% return rate.
Findings: The typical nurse participant in the survey is a 45 year old female with a college degree who is employed full time as a staff nurse and has 19 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for Vermont registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; staffing patterns that limit patient access to nursing care; providing care with possible risk to the nurse's health; and using/not using physical or chemical restraints. Issues that are the most personally disturbing to Vermont nurses are: prolonging the living/dying process with inappropriate measures; staffing patterns that limit patient access to nursing care; and reporting child/spousal/elderly patient abuse/neglect. Over 32% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, more than 91% reported that they discussed the issue with nursing peers while over 68% discussed the issue with nursing leadership. Eight percent of the nurses reported that they did not deal with the ethical issue at all. The majority (83%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical practices are: The nurses as a patient advocate; content/interpretation of ethical codes; ethical decision-making; professional issues; and resource allocations and access to care.
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in Vermont frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Additional research is needed to identify how Vermont registered nurses use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

* Funded, in part, by an Anonymous Donor

ETHICS & HUMAN RIGHTS ISSUES IN NURSING PRACTICE:
A Survey of Massachusetts Registered Nurses*

Principal Investigators
Margaret Mahoney, RN, PhD, CS; Northeastern University College of Nursing: Boston, MA
M. Lucy Feild, PhD, RN; Brigham& Women's Hospital; Boston, MA

Purpose: It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify; (1) the ethical issues encountered by Massachusetts registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed Massachusetts registered nurses are by the issues, (4) how Massachusetts registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that Massachusetts registered nurses perceive as helpful to their practices.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 3.4% sample (n=2,657) of the 78,249 currently employed registered nurses practicing in Massachusetts was conducted during 1998. Two mailings of the survey were done and 770 nurses participated in the survey, representing a 29% return rate.
Findings: The typical nurse participant in the survey is a 44 year old female with a college degree who is employed full time as a staff nurse and has 20 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for Massachusetts registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; providing care with possible risk to the nurse's health; using/not using physical or chemical restraints; and staffing patterns that limit patient access to nursing care. Issues that are the most personally disturbing to Massachusetts nurses are: staffing patterns that limit patient access to nursing care; prolonging the living/dying process with inappropriate measures; and not considering the quality of a patient's life. Over 27% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, more than 90% reported that they discussed the issue with nursing peers while 66% discussed the issue with nursing leadership. Six percent of the nurses reported that they did not deal with the ethical issue at all. The three most important factors that influence Massachusetts Rns in developing their own personal code of ethics are: family (47.2%), religion (39%), and life experiences other than work (32.7%). Almost 90% of the Rns indicated that they frequently or sometimes base their practice on the Code for Nurses. The majority (84%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical practices are: The nurses as a patient advocate; patients' rights, autonomy, and informed consent; content/interpretation of ethical codes; professional issues; and resource allocations and access to care.
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in Massachusetts frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Additional research is needed to identify how Massachusetts registered nurses use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

*Funded, in part, by Northeastern University, Faculty Development Fund.

ETHICAL ISSUES IN CLINICAL PRACTICE:
A Multi-State Study of Practicing Registered Nurses*

Principal Investigators
Sara T. Fry, PhD, RN, FAAN; Henry R. Luce Professor of Nursing Ethics;
Boston College School of Nursing
Joan M. Riley, EdD, RN; Professor and Chair;
Emmanuel College Department of Nursing

Purpose: It is widely believed that registered nurses (RNs) frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful in practicing ethically. Thus, the purpose of this study was to identify (1) the ethical issues encountered by RNs in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed RNs are by the issues, (4) how RNs handle ethical issues, and (5) the types of ethics education topics and resources that RNs perceive helpful to them in practicing ethically.
Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 5% sample (n=8,536) of the 159,183 currently employed registered nurses practicing in six New England states (CT, MA, ME, NH, RI, VT) in the United States was conducted during 1997-98. Two mailings of the survey were done and 2,408 RNs participated in the survey representing a 29% return rate.
Findings: The typical nurse participant in the survey is a 44 year old female with a college degree who is employed full time as a staff nurse, has 19 years of nursing experience, and has been in her present position an average of 7.6 years. A preliminary analysis of the multi-state data indicates that the most frequently experienced ethical issues by RNs are: (1) protecting patients' rights and human dignity, (2) respecting/not respecting informed consent to treatment, (3) providing care with possible risk to the nurse's health, (4) using/not using physical or chemical restraints, and (5) staffing patterns that limit patient access to nursing care. Issues that are the most personally disturbing to RNs are: (1) staffing patterns that limit patient access to nursing care, (2) prolonging the living/dying process with inappropriate measures, (3) not considering the quality of a patient's life, (4) implementing managed care policies that threaten quality of care, and (5) working with unethical/impaired colleagues. Over 30% of the RNs surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently experienced ethical issue, more than 83% reported that they discussed the issue with nursing peers while over 66% discussed the issue with nursing leadership. Over 5% of the nurses reported that they did not deal with the ethical issue at all. The majority of the nurse respondents (84.4%) reported that they were quite to moderately knowledgeable about ethics. Over 58% of the RN subjects indicated that they had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to RNs are: the nurse as a patient advocate (92%), professional issues (92%), patients' rights, autonomy, and informed consent (91%), resource allocations and access to care (90%), content/interpretation of ethical codes (90%), ethical decision making and moral reasoning (90%), and quality of life (89%).
Implications for Nursing Practice and Education: It is clear that significant numbers of registered nurses in New England frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. RNs indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist RNs to practice ethically. Additional research is needed to identify how RNs use ethics resources and ethics committees to assist them in handling the ethical issues they encounter in practice.

*In collaboration with the Nursing Ethics Network (NEN).

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