Experience of Ethical Conflict in Advanced Practice Nurses and Nurse Managers

Purpose: There is an increasing of new, advanced clinical or management nursing roles globally. The position in promoting ethical practice, such as preserving human rights and professional integrity may be challenged among these nursing professionals in advanced practice. Thus, this study aimed to describe the experience of ethical conflicts and distress in Advanced Practice Nurses (APN) and Nurse Managers (NM).

Methods: A qualitative inquiry with constant comparative method was used.  A purposive sample of 10 post-graduate nurses in advanced practice, including nurse practitioners, case managers, nurse managers or clinical nurse educators, were recruited in Taipei, Taiwan. Voice-recorded interviews via open-ended questions were conducted and transcribed. Constant comparative method was used across interviews and subsequent data analysis.

Results: The post-graduate APNs or NMs had the age ranging from 32 to 45 and were trained in various specialties, such as ICU, oncology, mental health or management, and practiced in either acute care, community or nursing education setting for 5 to 7 years. The ethical conflict experience characterized as emotional difficulty, distressed or perception of  “professional fatigue,” which evoked by situational factors, institutional culture or policy, and role function in the era of advanced practice nursing within the traditional western medicine system. There were 26 ethical dilemma were identified, included care and nurse-patient relationship, collaboration with nurse and non-nurse colleagues, and conflict between profession and work. The experience challenged their professional accountability, professional value, and was a personal experience.

Conclusion: The APNs and NMs’ ethical conflict were associated with the code of ethic in nursing and the advanced practice, managerial or education role function. The healthcare system and situation factors played an important role. Training in moral justice and resourcing with ethical support may need to support the APNs’ ethical practice.