Ethics described in terms of relationships in an organization can be a useful perspective for nurses.  This understanding of ethics as relationships has language roots in the Greek word ethos that means a “stable or barn”. Ethics, therefore, is the framework within which people live and work together, and identifies obligations that flow from these relationships.

This in-depth case study describes and interprets lessons learned from a mission and ethics-driven culture transformation in a large community medical center. Nursing leadership using the relationship ethos perspective empowered nurses and created a healthy environment for the provision of professional care. Ethics discussion and discernment are now part of the fabric of the organizational culture.  Features of the organization include the strong mission-driven culture that served as the foundation for the ethics framework, the infrastructure including ethics core curriculum, Ethical Decision Making Model specific to the institution, ethics consult teams, Center of Excellence for Health Care Ethics, policies and procedures and administrative discernment built on a mission–ethics synergistic partnership and a collective understanding of ethics as framework of relationships, expectations and obligations.