A Nurse Practitioner Ethicist: A Nurse’s Journey to Advanced Practice and Clinical Ethics

We have all faced the challenges of moral distress and ethical dilemmas as nurses. As a young pediatric ICU nurse, I saw medicine and nursing help patients in their most vulnerable moments. I also occasionally saw health care extend suffering when palliation and relational care should have been prioritized. Those distressing moments are the ones that still haunt me.

Many nurses burn out and leave nursing after experiencing moral distress, especially in ICU settings. Others realize that nursing is a calling, and that gaining additional experience and knowledge can deepen our resiliency and our ability to give back to patients and health care colleagues.

I realized early on that I wanted to gain more decision-making authority and training in clinical ethics to provide my patients with the best care possible, to relieve the moral distress of colleagues, and to practice ethically. These aims led me on a journey to become a nurse practitioner (NP) and eventually to discover the role of the NP ethicist to provide a unique perspective to patient care.

The journey to a unique […]

2025-11-13T13:21:44-05:00November 13th, 2025|Nursing|0 Comments
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Telling Patients About Staffing Levels: Transparency or Self-Interest?

ethicsscreenshotIt’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?

The situation above is an ethical conundrum because values are in conflict. On one hand, transparency is good and patients have a right to know about administrative factors affecting their care. On the other hand, care should stay focused on a patient’s problems, not the nurse’s.

As the article excerpt above suggests, nurse staffing is a contentious issue having to do with both patient safety and job satisfaction for nurses. We’ve covered this issue many times in the past, most recently in a blog post that got quite a few comments back in January.

But should a nurse ever tell a patient about inadequate staffing? This is […]

2018-03-13T10:49:19-04:00May 9th, 2013|Ethics, Nursing, safe staffing|7 Comments
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Want to Achieve the ‘Greatest Good’? Listen to Your Patients

Ethical dilemmas abound in nursing practice. Consider these commonplace scenarios:

* An angry patient threatens to leave the hospital against medical advice. Should you hold him against his will?

* A cancer patient fears chemotherapy. Should you give less detailed information about the effects of anticancer drugs?

* An obese home care patient with pressure ulcers refuses to cooperate in turning. Should you turn her anyway?

Such conflicts between the patient’s wishes and the nurse’s perception of the patient’s best interests occur regularly. That doesn’t make these ethical dilemmas any easier to resolve, but how nurses approach them can significantly affect clinical outcomes. Taking the time to listen to patients—and to integrate relationship skills with principles of ethical practice—can help nurses achieve solutions that are both ethical and appropriate for individual patients.

ky olsen/via Flickr

That’s from the February issue of AJN, in which nurse–ethicist Doug Olsen (who has in the past written for this blog on ethical issues related to mandated H1N1 vaccinations for nurses) offers a thoughtful discussion that may resonate for all nurses who’ve ever faced a situation like those in the above examples. It may seem obvious or cliched to say that listening to patients can help solve apparently intractable problems—but just because listening as a skill is hard to measure doesn’t mean that it’s not sometimes effective where more rigid tactics would fail.

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2016-11-21T13:19:32-05:00February 9th, 2010|Ethics, Nursing, patient engagement|0 Comments
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Nurses Express Safety Concerns About H1N1 Vaccine

By Jacob Molyneux, blog editor

Nurse blogger Not Nurse Ratched has written a post on her decision not to get the H1N1 vaccine shot until she is more convinced of its safety.

I’m just urging caution against the knee-jerk fear reaction that is, no doubt, going to make hordes of people swarm out to clamor for this vaccine. I’ll be watching for more data on it and might modify my decision, but for now I’m going to just say no.

Judging from responses to a recent post we ran on the topic (“cancel my subscription” appeared more than once), the loudest clamor may be from those who are driven by fear of the vaccine rather than fear of the H1N1 virus. In the post in question, Doug Olsen, a nurse ethicist, examined the ethical side of the question of whether or not nurses should get vaccinated. 

(Whether or not you agree with Olsen’s guarded conclusion in favor of vaccination, his post demonstrated how a professional ethicist uses a set of concepts as tools—not to come up with a definitive answer that can be called “right” or “wrong” but instead to examine the moral dimensions of a decision. We hope that some of the concepts he used will be seen as tools to help nurses make their own informed decisions.) 

By way of update, here’s an addendum we received from Olsen that addresses some of the concerns about vaccine safety expressed in the various comments:

Any obligation of nurses to protect the patient by getting flu vaccine depends on trust in the science and in the system […]

2016-11-21T13:22:41-05:00September 9th, 2009|Ethics, nursing perspective|10 Comments
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Nurse Ethicist Weighs in on Nurses Who May Have Helped Merck Hawk Vioxx

By wonker, via Flickr. By wonker, via Flickr.

According to a story in The Australian, the drug company Merck has been accused of paying nurses to sift through patient medical records in search of potential candidates for the drug Vioxx.  Here’s what nurse ethicist Douglas Olsen, who recently wrote a two-part article (here’s part one; part two is here) for AJN on nurses and the pharmaceutical industry, wrote to us about the story:

The news report demonstrates the public’s visceral sense that the Merck program in Australia was unethical. Nurses, as well as doctors and pharmacists, can anticipate righteous indignation whenever their clinical deliberations appear compromised by a company’s desire to sell a particular drug. […]

2016-11-21T13:28:15-05:00May 19th, 2009|Ethics, Nursing, patient safety, Public health|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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