Letter to the Editor by Kimberly R. Howard to Using the AACN Framework to Alleviate Moral Distress by Carol McCue

Moral Courage Amid Moral Distress: Strategies for Action

March 10, 2011

Response by Kimberly R. Howard to "Using the AACN Framework to Alleviate Moral Distress" by Carol McCue (November 9, 2010)

Reply by author

Dear Editor:

Before I read Ms. McCue's (2010) article, I had never heard of the term '˜moral distress.' However, I realized that I had certainly had experienced it. It is good to see that moral distress is now being recognized as an obstacle nurses face when put in positions in which, as Curtin (2007) noted, they need to be committed to personal moral integrity even when organizational factors and goals may oppose their moral values. The nurse executive in this article knew that chemical dependency is a disease that cannot be ignored. She needed to address the staff member's illness, and to do so in a compassionate, fair, and impartial manner. She wisely embraced Watson's Theory of Caring (Watson, 2006) as she worked to provide help and safety to both the nurse and the organization.

In spite of the desires of the nurse executive in this article, decisions were made that were in conflict with this leader's values and beliefs. I respect how she was able both to fulfill her nursing obligation to adhere to the American Nurses Association (ANA) Code of Ethics for Nurses (2001) and also to accept and implement the decision of the hospital senior leadership by using the '˜4A's to Rise Above Moral Distress' (American Association of Critical Care Nurses, 2004). By using these 4A's the nurse executive to avoid friction with hospital executives, to collaborate with other professionals and regulatory agencies, and to arrange support for the impaired nurse through the State Peer Assistance Program. As a result patient safety was maintained, the hospital avoided litigation and negative publicity, and the impaired nurse successfully transitioned back into the workplace.

I recommend that mandatory in-services teaching staff how to use the '˜4A's to Rise Above Moral Distress' be a part of every nurse's orientation. It should also be incorporated into annual ethics seminars and orientation for all new hires. All nurses will continue to face the moral distress that will inevitably arise in our complex work environments.

Kimberly R. Howard, RN
University of Texas at El Paso
Nursing Student, RN to BSN
E-mail: krhoward@miners.utep.edu


American Association of Critical Care Nurses (AACN) from AACN Ethics Work Group. (2004). The 4 A's to Rise above moral distress. Aliso Viejo, CA: AACN.

American Nurses Association. (2001). Code of ethics for nurses with interpretative statements. Washington DC: ANA. Retrieved November 2, 1010 from www.ananursingethics.org/nursingethics.htm.