Creating a Culture of Ethical Practice: A Call to Action

This presentation will explain the concept of moral resilience and the impact on individual nursing practice, in addition to describe the components of achieving an ethical and healthy work environment in order to ensure optimal patient outcomes. Moral resilience is an emerging concept proposed as a beginning to alleviate the complex and convoluted psychological symptoms associated with challenging work environments. The call to focus on the cultivation of moral resilience signifies an invitation for individuals, groups, and organizations to work together to transform individual and team distress and the organizational culture to create the conditions in which moral and ethical practice can thrive.

This call to action identifies four promising areas for building individual capacities for moral resilience: ethical competence, ethics in education, self-regulation and mindfulness, and self-care. In addition, the call to action includes specific recommendations for nurse leaders and organizational responsibilities toward fostering a culture of ethical practice. Organizations that have already implemented efforts toward a culture of ethical practice will benefit from guidance on assessment and research initiatives. Research on moral resilience will require a thoughtful and systematic approach.

There is a large body of research focusing on resilience in various contexts: neurobiologic, psychological, social ecological, and clinical practice. However, there is a paucity of evidence related to the broader concept of resilience as a modifiable capacity that healthcare professionals can acquire through individual and organizational resilience interventions. No large randomized, controlled trials currently exist that are adequately powered to determine the effectiveness of resilience interventions on mental health outcomes, or more specifically, on health care professional outcomes such as staff retention and patient safety issues.

While the panel convened to create this call to action recognized and acknowledged the lack of empirical research on moral resilience, the document contains specific information for organizations to implement research, including implantation for organizations that may not have the resources or time to implement a moral resilience project. The implementation of a moral resilience project or program ahead of applied scientific research publication can take years to give results. If research funding is limited or clinical practice nurses are interested in adopting moral resilience projects at their institution or within their specialty unit, program evaluation is an attractive option that can still be evaluated, disseminated, and used for evidence to inform future projects. Determining the impact of moral resilience interventions may benefit both the individual nurse and the health care organization as the profession aims to improve mental wellness and safety; it may also help retain experienced nurses at the bedside. Organizational support for cultivating this research contributes to the strength and benchmarks of an organization and its investment in and commitment to nurses, patients, and the health care system.

Further development of research on moral resilience and interventions is necessary and important to identify the potential overlap between resilience and moral resilience. Determining the impact of moral resilience interventions may benefit both the individual nurse and the health care organization as the profession aims to improve mental wellness and safety. Lastly, this presentation will highlight some of the promising solutions across the country implemented to build individual and organizational capacities for addressing the detrimental impact of moral distress and other forms of moral suffering that contribute to an unhealthy work environment.