Ethical Issues of Rural Nurses

The purpose of this investigation was to examine the frequency of ethical issues encountered by nurses working in two rural hospitals in a Midwestern state, comparing staff nurses and nurse managers. Previous studies reported that these issues occurred regularly in clinical practice, and in the daily decisions required of nurse managers. A partial replication of the New England Ethics Network studies (Damrosch & Fry, 1994; Duffy, 1997) was conducted; using the Ethics and Human Rights Issues in Nursing Practice Survey Part A that was developed, tested and used for these studies. The research questions established for this investigation were: (1) What is the incidence of ethical issues encountered by nurses who are active in clinical practice in rural hospitals, and (2) Does the incidence of ethical issues encountered by nurses differ between staff nurses and their nurse managers? The theoretical framework for the investigation was the ethical theory of deontology. A quantitative, nonexperimental descriptive design was used. Part A of the Ethics and Human Rights Issues in Nursing Practice Survey (EHRINPS-A) and the Claus Demographic Survey was distributed to all registered nurses in two Midwestern hospitals. The return rate was 31% (N=77). A frequency statistic was computed to answer research question one. To evaluate whether the frequency of occurrence of ethical issues between staff nurses and nurse managers differed, t-testing was used. The frequency and type of ethical issues that were reported in the sample were similar to those reported in previous uses of the EHRINPS-A instrument. The typical subject was female, between the ages of 42-52, with 0-5 years experience in the current position held and in work experience, who was prepared at the associate’s degree level and worked in the medical/surgical area. The top ethical issues by frequency of occurrences reported were: patient’s rights, staffing patterns that limit access to care, providing care that involves a health risk to the nurse, respecting/not respecting informed consent, and ordering too many or too few procedures or tests. Statistically significant differences were found between the nurse manager and staff nurse groups in six of the 35 survey items when compared by t-test. One difference showed a higher occurrence in the nurse manager group, and five other differences showed a higher occurrence in the staff nurse group. The nurse manager group showed a difference in the issue of resource allocation; staff nurses’ differences were related to patient care issues. Limitations included small sample size, a distribution of subjects that did not represent the actual number of nurses in the hospitals’ clinical practice areas, differences in planning for survey distribution by the nurse executives, and error by subjects in completion of the EHRINPS-A instrument. Generalizations of the findings or conclusions could not be made beyond the sample. Recommendations included: conducting further investigations to examine ethical issues of nurses who work in rural hospitals and relationships between staff nurse and nurse manger ethical issues, forming a committee or task force to examine and resolve nurses’ ethical issues, and providing education about ethical issues as a part of hospital wide focuses on promoting quality patient care