The shortage of nurses and the flaws within the structure of the current health care system are compromising the nurse's ability to provide competent, compassionate care. Nurses are increasingly disturbed because they see themselves as ineffective advocates for their patients. Nurses, unable to take the appropriate ethical actions, feel paralyzed by their situation. The author's recent conversations with staff nurses about their clinical practice suggest that moral distress has become a very pervasive problem. The purpose of this article is to describe ethical practice, moral distress, the imbalance of power, and the nature of an ethical environment. There is a discussion of potential strategies that will help to create and maintain an ethical environment thereby reducing moral distress such as facilitating dialogue, developing a support system, providing opportunities for professional development, and developing and revising institutional policies.
Judith A. Erlen, PhD, RN, FAAN, is a Professor in the Department of Health Promotion and Development, Coordinator of the Doctoral Program, and Associate Director of the Center for Research in Chronic Disorders in the School of Nursing at the University of Pittsburgh in Pittsburgh, Pennsylvania. She is also acting Co-Director of Research at the Center for Bioethics and Health Law.