How to Confront Ethical Challenges

While many of the ethical challenges that nurses confront will have a moral remainder, it is possible for you to shift your perspective and relationship to the reality you are facing.

The potential solution is built on 4Rs: recognize, release, reconsider and restart.

• The first thing nurses should do is recognize the situation for what it is; not what it represents.
• The next step is to release. A nurse who recognizes what’s going on in a particular situation can then look at what is and isn’t his or hers to “hold.” What can and can’t you change or make better?
• Reconsidering the situation might be as straightforward as reframing an issue or looking at it in an entirely new way. It involves being open to new approaches and invites clinicians to understand the perspectives of others to rebuild trust and rapport with the patient, family and team.
• Restart. At this point, nurses might find that they’re asking new questions, feeling empathy and have a fresh focus on how they can help the team and the family move to a place of greater understanding and engagement.

Applying the 4Rs has made it possible for one nurse to continue practicing in the ICU. “In the ICU where I work, it’s a 32-bed unit and we’re full almost all of the time,” she said. “The in-between process from arrival to either discharge or death has a lot of bumps, even under the very best circumstances. That can wear me down or make me hard or detached or in some ways decrease my empathy and compassion for my patients, families and colleagues.”

Instead, when she takes the 4Rs approach of looking at situations through the eyes of others’ and understanding what’s at stake for them, she feels the sadness without feeling depleted or harmed.