Values that matter, barriers that interfere: the struggle of Canadian nurses to enact their values

Qualitative interviews were conducted with 20 nurses in a Canadian city to explore the moral experience of nurses in their working lives. The participants were asked what they valued in their profession and how well their work lives enabled them act on their values. Almost uniformly, they expressed commitment to the values of helping others, caring, making a difference, patient-centredness, advocacy, professional integrity, holistic care, and sharing knowledge for patient empowerment. They identified several challenges and frustrations experienced in attempting to enact these values. System-level challenges included professional hierarchies, organizational structures, issues in the health-care system, and power dynamics. Removing these barriers cannot be left to nurses alone. It requires complex, wide-ranging strategies: system change, power restructuring, and the creation of ethical climates and cultures that support values that are essential to good patient care.