Purpose:  To gain insight into how mid-career nurses define and respond to ethical dilemmas, qualitative focus groups were used with small groups of nurse leaders in the southwestern United States. Fifteen nursing doctoral students, ranging in age from their mid-thirties to late fifties, participated in focus group discussions regarding experiences with ethical dilemmas in nursing practice. These well-seasoned nurses functioned in practice roles as clinical specialists, nurse practitioners, administrators, and educators.

Method: Focus group exercises for this study were based on a community-based participatory research (CBPR) model which was adapted to include a series of qualitative-based, iterative exercises designed to encourage dialogue about how mid-career nurses defined and responded to ethical dilemmas and the obstacles to dilemma resolution. 

Findings: Mid-career nurses characterized ethical dilemmas as “ones you never forget,” charged with emotional intensity and conflict.  Participants viewed ethical dilemmas differently than other practice problems noting there was “no oracle to go to.” Participants had energetic discussion around barriers to resolution, sharing previously undisclosed and unresolved dilemmas.  While mid-career nurses drew on a greater number of resources for dilemma resolution, they still felt considerable anguish. 

Discussion: Although mid-career nurses identified similar ethical dilemmas as less experienced nurses, they possessed more sophisticated mechanisms for resolution. However, dilemmas still possessed a gut wrenching emotional impact that made some consider leaving nursing positions. Information seeking and dialogue posed the most potent methods for approaching dilemma resolution.

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