Facing Ethical Challenges Together

A few weeks ago, I was watching my local news station as I was interested in a nurses’ strike at a hospital in my home area. I wanted to understand the reasons behind the strike. Previous strikes in California and New York were major headlines, mostly focused on patient care issues amid staffing concerns. What resonated with me about the strike in my area was what one of the striking nurses said to the news media. When asked about the strike, this nurse said, “Nurses are leaving the bedside. It’s not because of burnout. It’s because of moral distress.” This nurse further commented, “Every day you come to work, you’re spread too thin. You’re understaffed.” (Lupton, 2026).

Hearing the word “moral distress” from this nurse caught me off guard as it has been a focus of my work and other nurse ethicists’ work for many years. However, it was the first time that I heard the term as a reason for striking and seeking better working conditions so that nurses can provide the care that they are trained to provide. It also made me wonder what resources were available to these nurses and whether a nurse ethicist was part of their organization, someone who could help address the ethical challenges that they face daily. 

Nurses continue to work in environments where patient suffering is part of their work life experience, but the suffering of nurses is something that is often missed, denied, or forgotten as the work of caring for patients and their families must continue. And nurses tend to put others before themselves and not to seek guidance or help. This was all too evident during the COVID-19 pandemic, lest we forget. 

As a nurse ethicist, I have often thought about how to help our nurse colleagues at the bedside and in other healthcare settings. Certainly, evidence is needed to understand the many ethical issues confronting nurses in patient care delivery and how these issues impact the retention and mental health of nurses within today’s organizational systems. Staffing remains a consistent problem. Nurse ethicists can provide support for moral distress when nurses feel as though they are involved in situations that are morally unacceptable and that hinder their ability to provide ethically appropriate care (Hamric & Epstein, 2017; Ulrich & Grady, 2018). Nurse ethicists have also been integral members and leaders of interdisciplinary ethics consultation services, readily addressing ethical conflicts among patients and families and clarifying their preferences and goals of care. They can also help educate and strengthen nurses’ ethical decision-making skills and increase nurses’ confidence about the ethics of clinical care and research.  Nurse ethicists can also contribute to the creation and implementation of policies at all levels—organizational, state, and national—that reflect nursing’s mission on issues of import: informed consent, caring for vulnerable and marginalized people, advancing technologies, pandemic preparation, and much more. 

There are, and will continue to be, many ethical challenges that lay ahead for nurses. As a professional community, let’s work together through the Society for Nursing Ethics International to dialogue, advocate, educate, and facilitate communication across settings, specialties, and cultures to use our voice and collective wisdom for the importance of nursing ethics and the change that is possible within healthcare systems. We all know that without enough nurses, everyone suffers—patients, families, healthcare systems, nurses themselves and the societies that depend on them. 

References

1. Lupton, M. (July 6, 2026). Patient safety concerns, staffing fuel nurse strike at Ascension Saint Agnes. https://www.wbal.com/patient-safety-concerns-fuel-nurse-strike-at-ascension-saint-agnes
2. Hamric, A. B., & Epstein, E. G. (2017). A Health System-wide Moral Distress Consultation Service: Development and Evaluation. HEC forum: An interdisciplinary journal on hospitals’ ethical and legal issues, 29(2), 127–143. https://doi.org/10.1007/s10730-016-9315-y
3. Ulrich, C.M. & Grady, C. (Eds.). (2018). Moral Distress in the Health Professions. Springer. 

Dr. Ulrich is a nurse bioethicist and the Lillian S. Brunner Endowed Chair at the University of Pennsylvania School of Nursing where she is a Professor of Nursing and Medical Ethics and Health Policy. She also holds a secondary appointment in the School of Medicine, Department of Medical Ethics and Health Policy.