Nurse managers' perspectives on working with everyday ethics in long-term care

Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers' ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care.

The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care.

Qualitative individual interviews were performed with 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data.

The Norwegian Centre for Research Data granted permission for this study.

The analysis resulted in seven subcategories that were grouped into three main categories: managers' perception of the importance of the role, managers' experiences of exercising the role and managers' opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees.

The leaders tended to perceive ethics as a 'personal matter' and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals' vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care.

Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs' ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means.