Nurses experiences of ethical dilemmas: A review

Nurs Ethics. 2020 Feb;27(1):258-272. doi: 10.1177/0969733019832941. Epub 2019 Apr 11.


Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today's hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual's dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses' options to act on the basis of ethical and moral grounds in the individual care situation.

Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today.

Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas.

Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources.

Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse-patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses.

Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses' professional decision-making and forcing them to compromise basic nursing values.

Keywords: Clinical ethics; dilemmas; ethics of care/care ethics; literature review; nurses and disagreements; professional ethics.

Publication types

  • Review

MeSH terms

  • Burnout, Professional*
  • Conflict, Psychological*
  • Decision Making / ethics
  • Ethics, Nursing*
  • Humans
  • Nurse-Patient Relations
  • Nursing Staff, Hospital / ethics*
  • Nursing Staff, Hospital / psychology*
  • Organizational Policy
  • Quality of Health Care / ethics
  • Standard of Care / ethics
  • Workload*