How Does the Role of Corporate Values and Obligation to Care Influence Moral Habitability?

A morally habitable environment, is a phenomenon of interest for nurses, in which external constraints to moral agency are minimized, differences between employer and employee are embraced, and moral well-being is promoted through shared responsibility (Musto et al., 2015, p. 97). The moral climate of a health care organization has been defined as the implicit and explicit values that shape the delivery of care in a workplace environment (Rodney, Doane, Storch, & Varcoe, 2006, p. 24), such that the corporate values that are explicit are in coherence with the nurse’s core practice values, such as their need to enact moral agency. Therefore, understanding and negotiation between the values of the organization and the participants is necessary to create a morally habitable environment (Vanderheide et al., 2013, pp. 109-110). Considering that nurses have a pre-conditioned moral motivation and obligation to care (Canadian Nurses Association [CNA], 2017, pp. 5-6; Lutzen & Norden, as cited in Vanderheidi et al., 2013, p. 109), it is implied that corporate values and organizational structure should provide nurses with a moral climate. As it is evident that the relationship between corporate values and agency can have an impact on the moral dimension, it is indicated that the influence of work climate needs to be understood to help nurses inhabit their work environments.

When constraints on healthcare funding and social-cultural phenomena such as workplace incivility manifest in corporate values and organizational structure, conflicts between organizational values and the nurse’s core values of practice may arise, resulting in moral distress (Gaudine, LeFort, Lamb, & Thorne, 2001, p. 757; Kalvemark, Hoglund, Hanssona, Westerholmb, & Arnetza, 2004, p. 1084). Pauly, Varcoe, Storch, and Newton (2009) found an inverse correlation between the intensity and frequency of moral climate and moral distress (p. 561). "The corporate needs of the bureaucracy and the simultaneous role of nurses as moral agents makes caring within the organization complex and complicated (Musto, Rodney, & Vanderheide, 2015, pp. 93-94; Turkel, 2007, p. 58). Corporate values create work dynamics that lead to one of the most difficult conundrums for nurses and other healthcare professionals (HCPs) related to serving corporate needs while also serving humanistic caring needs of the patients (Turkel, 2007, p. 58). Cost containment and workplace incivility are economic and social-cultural forces respectively (Ray, 1989, pp. 32 & 40; Turkel, 2007, p. 59), that lead to workplace adversity, including inability to enact moral agency, and creating morally inhabitable work environments (American Nurses Association, 2015). These forces and the resultant adversity can impact the nurse’s authenticity as moral agents and make their workplaces morally uninhabitable (Vanderheide, Moss, & Lee, 2013, p. 101).

Although healthcare budgets continue to increase in Canada, employers do not hire adequate nursing personnel stating that there is inadequate budget. However, this is in direct contrast to the Canadian Health Services Research Foundation (2006) which states it is the employer’s responsibility to ensure appropriate allocation of resources to enable acceptable staffing mix (p. 21). This discrepancy between the government and employer sheds light on the complexity of the issue of moral habitability. Moreover, the Canadian Institute for Health Information’s (2005) national survey of the work and health of nurses revealed that 44 percent of female nurses and 50 percent of male nurses confided that they were exposed to hostility or conflict from their colleagues (p. 6). Such economic constraints or workplace culture could create stressful work environments. It is imperative to understand that moral distress does not only occur as a consequence of institutional constraints; instead, often there are situations when the staff members follow their moral decisions, but in doing so, their actions may clash with institutional requirements causing moral distress (Kalvemark et al., 2004, p. 1083). Hence, owing to the reciprocity of agency and structure, either way, a disjuncture in moral choice and moral action breeds moral distress.

The author will explore this phenomenon using Ray’s Theory of Bureaucratic Caring (1989) – analyzing how organizational culture influences the nurse’s need for moral agency and recommend strategies to enable the development of moral habitability.