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Department: Editorial

Doing the right thing

Editor(s): Raso, Rosanne DNP, RN, NEA-BC, FAAN, FAONL

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Nursing Management (Springhouse): September 2021 - Volume 52 - Issue 9 - p 5
doi: 10.1097/01.NUMA.0000771748.83573.47
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We often read about how managers “do things right” and leaders “do the right thing,” with the message that there's a difference—perhaps following rules versus following values. Often, we need both in our leadership practice, assuming of course the rules are worthy or, at the very least, necessary. Martin Luther King, Jr., said, “The time is always right to do what is right.” Doing the right thing is akin to the North Star, always there and leading the way. It turns out that determining the right thing isn't so easy, and at times it's fraught with conflicting perspectives. What's the right thing?

It's definitely not the easiest or simplest answer, although it could be. Do you float from an overstaffed unit to an understaffed one? Easy, assuming competencies of course. Do you float from an understaffed unit to a more understaffed unit? Not so easy. Do you pursue corrective action for an employee who has been coached several times and still has multiple instances of verified patient complaints over several months? Easy. Do you pursue corrective action for a star employee with multiple patient complaints on one shift with various challenging situations? Not as easy. Do you make policy exceptions for safety protocols? Easy, no. Do you make policy exceptions for overnight family visitation? Not so easy.

Leah Curtin, long time Nursing Management editor-in-chief, wrote almost 30 years ago about this topic, identifying a series of logical steps for ethical decision-making: information gathering, determination of ethical issues, values clarification, and group involvement, with respect, fairness, and caring as the foundation. But what if there are significant headwinds, differing perspectives on the right thing, or more than one “right” answer? Which value is the “right” one? Authentic leaders lead with their own internal values, transformational leaders with their vision, servant leaders for the people. Is one right and another wrong? Of course not.

There's a definite element of moral courage here. Advocating for what you believe in is always the right thing for you; it may or may not be right for the situation. This isn't to say it's the wrong thing, just that your voice and influence may not align with other perspectives. Respectfully disagreeing with an organizational decision takes courage, and in a healthy work culture you would be heard and appreciated for your opinion. You followed your values. It doesn't mean that the organizational position is wrong, which is most likely based on values too. The right thing isn't always easy to uncover because it may be right for some and not as right for others.

An example is visitation in the pandemic world. Whether in acute or long-term care, patients, families, and healthcare teams all struggled with restrictions. Adverse effects have been documented, including the moral distress of nurses who became surrogate family and innovated using virtual means. It was clearly not the right thing for patients. It was the right thing through the public health lens during the height of infection spread, especially when personal protective equipment (PPE) wasn't available. In response, Planetree International and the American Nurses Foundation recently published a Family Presence Policy Decision-Making Toolkit for Nurse Leaders. It lays out the important data needed to make the right decision: evidence for risk of harm, local epidemiologic conditions, available resources (staff, PPE, and so on), and equity considerations.

In the end, we must stay true to our values and use them in decision-making, seeking and appreciating other perspectives. And, yes, doing the right thing is far from easy.

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