Ethics: The Nursing Shortage and Ethics: Up Front and Personal

In the late 1990s, the nursing shortage was becoming more of a reality. In this OJIN ethics column, The Nursing Shortage: Is This Cycle Different? we state: "In times of crisis it is often that values and beliefs and, subsequently, our ethics are challenged" (Silva & Ludwick, 2001, para. 1). Based on that belief and the overwhelming readership and letters to the editor for that OJIN topic, we asked readers to write in and tell us how the shortage was impacting everyday ethical issues in nursing practice. However, we did not receive enough letters to adequately analyze ethical issues. Therefore, we concluded that this anonymous exploratory survey might be a better method to gather online data about ethics and the shortage. To that end, the results of the study that started with this column in 2001 can be found in the 2003 column, Errors, The Nursing Shortage, and Ethics: Survey Results. (August 14, 2003)

In times of crisis it is often that values and beliefs and, subsequently, our ethics are challenged. Authors in OJIN have addressed some of the ethical issues that nurses face in relation to crises in health care. For example, P. J. Maddox (1998) addressed ethical issues surrounding economic constraints and scarce resources. In this current issue of OJIN, Cheryl Peterson (2001) writes of the ethical dilemma nurses face in trying to comply with the Code for Nurses with Interpretive Statement, 1985 in light of the present nursing shortage. We invite you to read these and the other OJIN articles on the shortage and then submit to this column a story about how the nursing shortage has ethically affected you or your patients/clients. Your stories can also be from your personal life (i.e., when you or a family member was a care recipient). You, the reader, can best identify and write stories about ethical issues that you face day to day in your practice as a result of the shortage.

Your stories will help tell about the impact of the shortage and perhaps give insights into ways we can handle ethical dilemmas related to it. We believe that "... ethics is best understood, discussed and informed from issues confronting us in everyday practice, ..." because "Our credibility, strength, and legacy as a profession will be measured by our ethical treatment of patients, families and communities." (Ludwick & Silva, 2001)

Therefore, ask yourself how the shortage has impacted your work. You might consider the hiring practices of employers, whistle blowing, the quality of care provided to patients or personally to you or your family members, issues related to mandatory overtime, pay compression and its impact on the relationship between new hires and long- term employees, and recruitment and retention plans. The stories are meant to bring to life the day-to-day impact of the shortage.

We plan to publish selected stories you send in this Ethics Column. In addition, we plan to analyze many of the submitted stories qualitatively in order to describe the ethical issues related to the shortage and to gain new viewpoints about how issues develop and are resolved. As we face this shortage, we must be vigilant of our practice, as forces inside and outside of health care could threaten our integrity and vigor as individuals and as a profession. Therefore, we hope that you will share your story related to an ethical issue you have faced related to the shortage.

Below are the guidelines for submitting your story and an example.

Writing your ethics story

When writing your ethics story consider describing an incident related to health care and the nursing shortage that stands out because 1) it challenged your values and beliefs, or 2) you felt the patient's best interests were ignored, or 3) staff were jeopardized, or 4) self/family were jeopardized.

Please include with your story:

Your age, gender, position (e.g. staff nurse, nursing student, CNS), Country/State of incident, type of facility/setting (e.g. hospital, clinic, nursing home, patient's home)

Consider these guidelines when writing your story:

Write in the first person.
Use simple phrases, just as you would to a friend.
Include important details that help the reader understand the background in which the experience occurred.
Identify your concerns, thoughts, and feelings as they occurred.
Examine your story for completeness. Is it clear who is involved, what happened, when and where it occurred, how it happened and why?
Identify how the issue was or was not resolved.
Preferred length is 250-500 words.
You can submit more than one story or you may choose to co-author a story with a co-worker

Below is an example of one student nurse's story of how the shortage is impacting health care. Like many students, this student was working in health care as she attended school. She shared the following account as part of a nursing class that had an ongoing listserv discussion about the shortage and mandatory overtime.

In response to {a question about} is mandating safe. I feel that it is not! I also work at this facility that mandates. It not only mandates nurses, but also clinical technicians (nurses aids with more responsibilities- venipunctures, EKGs, etc). Just the other night I got mandated to stay an additional eight hours. I already worked a 3-11 shift and got mandated to stay and work the 11-7 (midnight) shift; mind you I had been up since 6am with my son. By about 4am in the morning I was stumbling over my own feet and drifting off to sleep when I sat periodically to rest my feet. By then I had to start drawing morning labs. I went into one of my rooms with my nurse who was also working a sixteen-hour shift to draw my first patients' blood. I drew his blood and set it on the counter and went to get the other patients' blood. Since I couldn't feel a great vein I asked my nurse to draw his blood. She looked at the order and told me I had the wrong patient's labs. Thank God no labs were put on the blood vials and the two patients had the same order or we would have had to redraw the first patient. Thank God my nurse caught it before we sent the blood to the lab. That is just one example of the dangers to mandating.

Please Continue Reading for Informed Consent

We want to do research on ethics stories from nurses relating to the nursing shortage because we believe that you can help us identify us identify the impact of the shortage in the stories from you work experiences with the shortage. We ask you to participate in this project by submitting a story (250 to 500 words preferred) electronically to the address provided about how the nursing shortage has ethically affected you or your patients/clients. We plan to use the stories submitted for inclusion in data analysis about the shortage, to post selected stories in this Ethics column, and may use the data for professional presentations/publications. Stories chosen for publication in the ethics column will follow OJIN editorial policy and will be edited as needed and, before publication the edited story will be returned via e-mail to the author(s) for approval. Therefore, anonymity from the principal investigator cannot be guaranteed, as e-mail follow-up may be necessary. However, all stories will be reviewed and or published without reference to names or locations of persons or organizations.

The value of your participation is to help tell about the impact of the shortage and perhaps give insights into ways we can handle ethical dilemmas related to the shortage. Taking part in this project is entirely up to you, the reader. If you submit a story and wish to no longer participate, you may stop at any time.

If you wish to know more about this project, please call Dr. Ruth Ludwick (330-672-8820). The project has been approved by Kent State University. If you have questions about Kent State University's rules for research, please call Dr. Walter Adams, Interim Vice Provost and Dean, Division of Research and Graduate Studies, Tel. 330-672-3012.


Dr. Ruth Ludwick, Associate Editor OJIN; Kent State University, College of Nursing
Dr. Mary Silva, Ethics Consultant, OJIN; Director, Office of Health Care Ethics, George Mason University
Dr. Jeanne Sorrell, Special projects Coordinator, Office of Health Care Ethics, George Mason University

© 2001 Online Journal of Issues in Nursing
Article published August 13, 2001

Citation: Silva, Mary Cipriano and Ludwick, Ruth (August 13, 2001). "Ethics: The Nursing Shortage and Ethics: Up Front and Personal" Online Journal of Issues in Nursing Vol. 6 No. 3.