How Nurse Leaders Assess Their Ethical Decision Making Practice, Before and After Ethical Leadership Training

Thursday, 25 July 2019: 3:50 PM

Melissa Cole, DNP, MSW
University Psychiatric Center and College of Nursing, University of New Mexico Hospital, Albuquerque, NM, USA

Health care organizations with strong ethical leadership experience improved patient outcomes, higher employee satisfaction, retention, productivity, and engagement (Cohen, Foglia, Kivong, Pearlman, & Fox, 2015; Donnellan, 2013; Edmonson, 2015). Nurses are known and respected leaders, with 84% of the public placing their ethical standards as “high” or “very high” in 2016. It is a noteworthy gap, that only 57% of nurses report they experienced any type of ethics education (Gallup Inc., 2017; Grady et al., 2008). Birks (2014) and Barina (2014) found ethical leadership fosters an environment of improved and safer patient care. As the US population ages and demands increase to provide more care with fewer resources, nurse leaders benefit from additional tools in the delivery of ethical leadership. IntegratedEthics® (IE) and ethical leadership training, supports nurse leaders in enhancing their ethical decision making ability (Bottrell, Pearlman, Foglia, & Fox, 2013; Foglia, Fox, Chanko, & Bottrell, 2012; Fox et al., 2010). Ethical leadership training has an immediate impact on the participants’ self-assessment of their ethical leadership practice. Initial findings of this completed project (2018) suggest, when nurse leaders share experiences and discuss ethical decision-making, there were significant positive results found in leadership practice, reference to published resources, transparency and collaboration.

The Dunning-Kruger effect (Dunning, 2011), prevalent in American culture, reflects a pattern of over-inflated self-assessments prior to attending an educational event; subsequently, after attending a class or obtaining knowledge, self-assessment drops significantly. As new knowledge integrates into practice, self-assessment scores rise. Of great interest, the results of this study did not endorse the Dunning-Kruger effect. Nurse leaders assessed their ethical leadership abilities even higher upon completion of an ethical leadership class (Summer/Fall 2017). Participants endorsed 6 of the 11 questions on the Ethical Leadership Self-Assessment (ELSA), at “Frequently” or “Almost Always” 90% or higher even prior to attending the ethical leadership training. These scores maintained, and even rose immediately after training. Additionally, comparing increase, decrease, or no change for each answer between pre-training and post-training found statistical significance. “When I need advice on an ethical issue, I refer to published sources” (p = 0.004) and question 8 “When making important decisions, I involve those who will be most affected” (p = 0.01) these noted changes exhibit the power of nurse leaders sharing best practice. Several nurse leaders reported as they discussed their practice in training it promoted their ability to recall initiatives each had implemented. Nurse leaders were able to remember what they knew, yet had forgotten.

This study supports there are high ethical standards reflected in the nursing profession. It is noteworthy, nurse leaders’ benefit from collaboration and sharing best practice. Teaching ethical leadership and decision-making supports nurse leadership provides safe care and elevates professional standards.