As the U.S. population ages, the proportion of hospitalized patients older than 65 years will continue to increase with a significant number likely to have some degree of cognitive impairment. Because of the high rate of falls-related traumatic injury among older adults, many will require orthopaedic services. These patients may have multiple comorbidities and are at increased risk for complications. Varying degrees of cognitive impairment in combination with possible postoperative complications including delirium places these patients at risk for decreased decisional capacity and can create ethical dilemmas during the provision of bedside care. This article explores some everyday ethical dilemmas that nurses face in their care of hospitalized older adults, and offers nurses strategies to preserve patient dignity and self-determination while providing high-quality, evidence-based nursing care.