Nursing is more than a career—it’s a calling to care for others in some of the most critical and vulnerable moments of their lives. Alongside the technical skills and clinical knowledge required, nurses often face ethical dilemmas that demand compassion, integrity, and strong decision-making skills. These dilemmas are not only emotionally taxing but can also impact patient care, workplace relationships, and the nurse’s own sense of professional identity.
Ethical challenges may arise from difficult patient choices, family dynamics, conflicting values, workplace conditions, or unclear policies. In this blog post, we explore nine of the most common ethical dilemmas nurses face and offer guidance to help navigate these complex situations with professionalism and confidence.
One common ethical dilemma occurs when a patient refuses a treatment that their family wants them to receive. This can create tension between honoring the patient’s autonomy and addressing the family’s wishes. Nurses must respect the patient’s right to make informed decisions about their care, provided they are mentally competent. It’s important to ensure the patient fully understands their choices and consequences and to communicate this clearly and compassionately to the family. If the situation escalates, involving an ethics committee or nurse manager may help resolve the conflict (American Nurses Association [ANA], 2015).
End-of-life care often presents ethical challenges, especially concerning Do Not Resuscitate (DNR) orders. Nurses may find themselves in situations where the family demands resuscitation despite a valid DNR, or they may personally disagree with a patient’s or family’s decision. In these cases, it’s crucial to follow institutional policies and legal guidelines while showing empathy to grieving families. Clear, calm communication and confirming documentation are key to navigating these situations ethically (Epstein & Turner, 2015).
Another increasingly relevant dilemma involves patient privacy and the use of social media. Even seemingly harmless posts that do not include names or photos can violate the Health Insurance Portability and Accountability Act (HIPAA). Nurses must resist the temptation to share any patient-related information online and should serve as role models in protecting patient confidentiality. Encouraging colleagues to follow best practices and reminding them of social media policies can help prevent breaches (Lachman, 2016).
Caring for patients with different cultural, religious, or personal beliefs may challenge a nurse’s own values or understanding. Ethical care means respecting the patient’s perspective and providing unbiased, culturally sensitive care. Nurses should take time to listen, learn, and adapt their approach to meet the patient’s needs. Continuing education and cultural competence training can be invaluable tools for navigating these situations effectively (Numminen, Repo, & Leino‐Kilpi, 2017).
Nurses often face moral distress when staffing shortages lead to unsafe patient loads. Being asked to care for more patients than is safe can lead to burnout and ethical conflict. Nurses have a duty to advocate for safe working conditions, both for their patients and for themselves. This includes documenting incidents, speaking with supervisors, and understanding state regulations or union protections related to staffing ratios (Gallagher, 2010).
Another dilemma involves professional boundaries. While strong nurse-patient relationships are essential, crossing boundaries—such as accepting gifts or forming personal relationships—can lead to ethical complications. Nurses must maintain professionalism and avoid dual relationships, especially when they can interfere with objectivity or patient trust. If unsure, consulting the facility’s policy or an ethics committee is a wise step (ANA, 2015).
Whistleblowing is one of the most difficult decisions a nurse may face. Reporting unsafe practices or unethical behavior by colleagues can be intimidating and may cause fear of retaliation. However, nurses have a professional responsibility to protect patients. Concerns should be reported through appropriate channels, such as a supervisor or risk management team, with documentation of dates, actions, and any potential harm. Knowing legal whistleblower protections can give nurses the confidence to do the right thing (Gallagher, 2010).
Nurses may also experience distress when asked to carry out a provider’s orders that go against their personal or professional values. For example, they may be asked to continue aggressive treatment that they believe to be harmful or futile. In these cases, respectful dialogue with the healthcare team is essential. If the issue remains unresolved, nurses can request reassignment or consult the ethics committee for guidance and support (Epstein & Turner, 2015).
Discrimination is another ethical issue that may impact both patients and staff. Nurses must be vigilant in identifying and addressing discrimination based on race, gender, religion, or other factors. Every patient deserves to be treated with dignity and respect. Similarly, if nurses experience or witness workplace discrimination, they should report it and support a culture of inclusion and fairness. Encouraging open conversations and promoting diversity can improve care outcomes and workplace morale (Lachman, 2016).
To strengthen ethical decision-making, nurses can take several steps. First, becoming familiar with the American Nurses Association Code of Ethics provides a strong foundation for daily practice. This code outlines the profession’s core ethical responsibilities, including respect for patient autonomy, commitment to advocacy, and professional integrity (ANA, 2015).
Second, ongoing education in nursing ethics helps keep nurses informed about best practices and emerging issues in healthcare. Courses focused on ethics, legal accountability, and cultural competence can deepen a nurse’s understanding and confidence in ethical decision-making.
Third, mentorship is a valuable tool for navigating difficult situations. Discussing ethical concerns with a trusted colleague, manager, or mentor can offer new perspectives and emotional support. Ethics committees and clinical chaplains can also be helpful when facing especially challenging decisions.
Fourth, nurses can build moral courage by actively participating in conversations and committees that address ethical issues. Volunteering to join a hospital’s ethics committee or quality improvement team provides hands-on experience and contributes to a culture of ethical awareness (Numminen et al., 2017).
Finally, self-care is essential. Ethical stress can weigh heavily on a nurse’s emotional health. Practices such as regular reflection, journaling, prayer, or mindfulness can help nurses stay grounded and resilient.
In conclusion, ethical dilemmas in nursing are inevitable, but they are also opportunities to grow in character, compassion, and courage. When faced with a difficult decision, remember that you are not alone. There are tools, people, and resources available to support you. Acting with integrity not only improves patient outcomes—it strengthens your professional identity and empowers others to do the same.
Your role as a nurse is powerful. Trust your training, lean on your support system, and stay committed to doing what is right. Every choice you make can be a step toward healing, justice, and excellence in care.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/coe-view-only
Epstein, E. G., & Turner, M. (2015). The nursing code of ethics: Its value, its history. Online Journal of Issues in Nursing, 20(2). https://doi.org/10.3912/OJIN.Vol20No02Man04
Gallagher, A. (2010). Ethical issues in patient safety and whistleblowing. Nursing Standard, 24(42), 35–39. https://doi.org/10.7748/ns2010.06.24.42.35.c7835
Lachman, V. D. (2016). Applying the ethics of care to your nursing practice. MEDSURG Nursing, 25(1), 55–58.
Numminen, O., Repo, H., & Leino‐Kilpi, H. (2017). Moral courage in nursing: A concept analysis. Nursing Ethics, 24(8), 878–891. https://doi.org/10.1177/0969733016634155
