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  1. Pavlish, Carol PhD, RN, FAAN
  2. Brown-Saltzman, Katherine MA, RN
  3. So, Loretta MSN, RN, CGRN
  4. Heers, Amy MSN, RN, CNL
  5. Iorillo, Nicole MSN, RN


OBJECTIVES: The aims of this study were to explore nurse leaders' experiences with ethically difficult situations, perceptions about risk factors, and specific actions for ethical conflicts.


BACKGROUND: Research indicates that nurses are reluctant to bring ethical concerns to nurse leaders for fear of creating trouble, and yet, nurse leaders are key figures in supporting ethics-minded clinicians and cultures.


METHODS: The critical incident technique was used to collect descriptions from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and counted.


RESULTS: End-of-life situations accounted for the majority of incidents. Most situations had 3 to 4 ethical issues. Healthcare provider and system-level factors were perceived to increase the likelihood of ethical conflicts more often than family and patient factors. Respondents were more likely to identify leader actions that address specific situations rather than specify system-level actions addressing root causes of conflicts.


CONCLUSIONS: Findings can be used to help leaders create ethics competencies, policies, and education.