Nurse middle manager ethical dilemmas and moral distress.
BACKGROUND
Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers.


OBJECTIVE
To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict.


METHODS
The Ethical Dilemmas in Nursing-Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel.


RESULTS
Middle managers report low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas.


CONCLUSIONS
Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation.
Hadassah Hebrew University School of Nursing, Faculty of Medicine, Jerusalem, Israel Freda@hadassah.org.il.
Freda D
FD
Ganz
Israel National Nurses' Association Ethics Bureau, Israel.
Nurit
N
Wagner
Hadassah Medical Organization, Israel.
Orly
O
Toren
D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D004993:Ethics, Nursing; D006801:Humans; D007557:Israel; D009014:Morals; D009718:Nurse Administrators / Q000523:psychology*; D009726:Nurses / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology*; D011795:Surveys and Questionnaires
Ethical dilemma; moral distress; nurse middle manager