Name
Chamberlain University
NR-446 Collaborative Healthcare
Prof. Name
Date
When a nurse transitions from a bedside role to a leadership position, the scope of responsibility broadens to include both legal and ethical dimensions. Nurse leaders must influence policy, safeguard patients and colleagues, understand healthcare laws, and advocate for nursing practice. In doing so, they set professional standards for their teams while ensuring care aligns with regulations such as those enforced by the U.S. Equal Employment Opportunity Commission (EEOC). Importantly, while leaders are accountable for maintaining safe environments, each staff member retains responsibility for their own actions. Thus, leaders must promote awareness of personal accountability across teams.
During clinical situations, such as when a nurse prepares multiple medications simultaneously, nurse leaders must balance key ethical principles: nonmaleficence (avoiding harm), fidelity (upholding professional standards), and confidentiality (addressing errors privately). Paternalistic decisions are only justified in urgent cases requiring immediate intervention to protect safety.
Nurse leaders empower others by engaging in ethical behaviors that benefit both patients and the profession.
| Action | Who Benefits | Rationale |
|---|---|---|
| Educating clients on managing health | Client | Promotes autonomy and informed decision-making |
| Supporting policy that expands nurse practice | Profession | Enhances access to care through beneficence and utility |
| Volunteering in underserved areas | Client | Improves health equity and justice |
| Obtaining informed consent | Client | Upholds autonomy |
| Supporting whistleblowers | Profession | Shows integrity and veracity |
| Advocating for nursing policies | Profession | Encourages systemic change |
The American Nurses Association (ANA, 2015) emphasizes that while all nurses uphold ethical standards, leaders carry additional responsibility to model these behaviors and guide teams fairly.
| Direct Care Nurse Action | Ethical Principle | Nurse Leader Action |
|---|---|---|
| Provides patient education | Autonomy | Follows fair disciplinary procedures |
| Manages pain effectively | Beneficence | Encourages professional growth |
| Avoids harmful medications | Nonmaleficence | Plans fair scheduling |
| Prevents self-harm | Paternalism | Assigns staff according to expertise |
| Assists with duties | Utility | Prevents ill colleagues from working |
| Delivers equitable care | Justice | Bases pay increases on performance |
| Discloses medication errors | Veracity | Shares policy changes openly |
| Keeps promises | Fidelity | Honors staff commitments |
| Maintains privacy | Confidentiality | Protects sensitive information |
Nurse leaders and managers must act as ethical role models by promoting risk awareness, protecting human rights, and encouraging ethical practices.
Develop self-awareness of beliefs and values.
Accept uncertainty in ethical decision-making.
Model ethical conduct and set behavioral expectations.
Promote autonomy for patients and staff.
Represent nursing in interdisciplinary ethics committees.
Apply ethical frameworks to decision-making.
Recognize legal aspects of ethical issues.
Monitor and address staff moral distress.
Intervene in unethical practices.
Recognize ethical contributions by staff.
The National Academy of Medicine (2021) highlights five goals for nurse leaders in shaping health policy:
Advance health equity.
Support nurse well-being.
Promote inclusive data practices.
Expand education.
Prepare for public health emergencies.
Nurse leaders are encouraged to integrate social determinants of health and advocate for equitable access to care.
Since the Nurse Practice Act was introduced, both leaders and managers share responsibility for ensuring safe, legally compliant practice.
Protect client welfare and informed consent.
Model professionalism.
Create inclusive, compliant workplaces.
Pursue continuing education.
Report unsafe care and foster respect.
Stay updated on laws and regulations.
Align policies with state laws.
Educate staff on consent and confidentiality.
Monitor staff credentials and equipment safety.
| Legal Domain | Impact on Nurse Leaders |
|---|---|
| Licensing/Certification | Ensure staff licenses are valid |
| Collective Bargaining | Advocate for safe conditions |
| Employment Laws | Maintain EEOC standards |
Advocacy is central to leadership, requiring leaders to amplify client voices, facilitate ethical dialogue, and support staff concerns.
Build a culture of advocacy and transparency.
Collaborate with policymakers.
Encourage safe practices and whistleblower protections.
Empower colleagues in ethical action.
Prioritize client values.
Ensure staff are legally protected.
Provide supportive environments for ethical conduct.
| Consideration | Priority? | Rationale |
|---|---|---|
| ICU experience | Yes | Ensures safe care by skill-matching |
| Nurse preference | No | Client safety overrides preferences |
Autonomy: Right to informed decision-making
Beneficence: Acting for good
Nonmaleficence: Avoiding harm
Justice: Fair treatment
Veracity: Truthfulness
Fidelity: Keeping commitments
Paternalism: Protective decisions in urgent cases
Confidentiality: Respect for privacy
The MORAL model provides structured ethical guidance:
Massage the Dilemma: Identify issues and stakeholders.
Outline Options: List solutions.
Review and Resolve: Weigh pros and cons.
Affirm and Act: Implement the decision.
Look Back: Evaluate outcomes.
| Branch | Responsibility | Examples |
|---|---|---|
| Legislative | Creates laws | Senate, House of Representatives |
| Executive | Enforces laws | President, Cabinet |
| Judicial | Interprets laws | Supreme Court, Federal Courts |
Administrative agencies (e.g., HHS, DOJ) ensure these laws are enforced. Court rulings (legal precedence) also shape interpretation, while executive orders provide supplemental guidance.
Nurse-client relationship exists.
Standard of care was not met.
Harm was foreseeable.
Injury occurred.
| Example | Malpractice | Negligence |
|---|---|---|
| Correct drug with side effect | No | No |
| Wrong dosage given | Yes | Yes |
Boards of Nursing regulate practice through state-specific Nurse Practice Acts (NCSBN, n.d.).
Steps after an error:
Notify provider immediately.
File incident report.
Document accurately.
Inform supervisors.
Advocacy requires protecting client rights and providing unbiased care, especially for vulnerable populations. Scenarios include ensuring informed consent, supporting refusal of care for religious reasons, and equitable care for marginalized groups.
Case: Leeland Hospital System used data (exit interviews, sick call logs, demographics) to identify staffing challenges.
| Potential Issue | Policy Action Needed |
|---|---|
| High back injury rates | Update safety protocols |
| Diversity imbalance | Adjust recruitment policies |
| High turnover | Improve work culture |
| Employment Type | Characteristics |
|---|---|
| Full-Time Hourly | 36+ hours/week, W-2 benefits |
| Part-Time Hourly | <36 hours/week, reduced benefits |
| Salaried | Set pay regardless of hours |
| Consultant | Independent, paid via 1099 |
Employers cannot inquire about protected categories (e.g., age, disability, parental status).
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks.org.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press.
National Council of State Boards of Nursing. (n.d.). Nurse Practice Act. https://www.ncsbn.org/npa.htm
National Academy of Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press.
U.S. Department of Labor. (n.d.). Employment law guide. https://www.dol.gov/general/aboutdol/majorlaws
U.S. Government. (n.d.). Branches of the U.S. Government. https://www.usa.gov/branches-of-government
