Obstacles and problems of ethical leadership from the perspective of nursing leaders: a qualitative content analysis
,
Abstract
In the nursing profession, leadership plays a significant role in creating motivation and thus enabling nurses to provide high quality care. Ethics is an essential component of leadership qualifications and the ethical leader can help create an ethical atmosphere, offer ethical guidance, and ensure the occupational satisfaction of personnel through prioritizing moralities. However, some issues prevent the implementation of this type of leadership by nursing leaders. The aim of this study was to identify and describe some problems and obstacles in ethical leadership faced by nursing leaders, and to help them achieve more accurate information and broader perspective in this field.
The present study was conducted using a qualitative approach and content analysis. A total of 14 nursing managers and educators were selected purposefully, and deep and semi-structured interviews were conducted with them. Content analysis was performed using an inductive approach.
Three main categories were obtained after data analysis: ethical, cultural and managerial problems. “Ethical problems” pertain to doubt in ethical actions, ethical conflicts and ethical distress; “cultural problems” include organizational and social culture; and “managerial problems” are connected to organizational and staff-related issues.
Nursing leaders put forth various aspects of the problems associated with ethical leadership in the clinical setting. This style of leadership could be promoted by developing suitable programs and providing clear-cut strategies for removing the current obstacles and correcting the organizational structure. This can lead to ethical improvement in nursing leaders and subsequently the nurses.
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13. Golparvar M, Padas F, Atashpoor H. Reinforcing model of feeling of energy, empowerment and employees’ creativity through ethical leadership. Iran Occupational Health Journal. 2010; 7(3): 9–14. [in Persian]
14. Keselman D. Ethical leadership. Holistic Nursing Practice. 2012; 26(5): 259–61.
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27. Winston MD. Ethical leadership and ethical decision making: a meta-analysis of research related to ethics education. Library & Information Science Research. 2007; 29(2): 230–51.
28. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9): 1277–88.
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31. Hendel T, Steinman M. Israeli nurse managers’ organizational values in today’s health care environment. Nurs Ethics. 2002; 9(6): 651–62.
32. Ganz FD, Wagner N, Toren O. Nurse middle manager ethical dilemmas and moral distress. Nurs Ethics. 2015; 22(1): 43–51.
33. Cooper RW, Frank GL, Hansen MM, Gouty CA. Key ethical issues encountered in healthcare organizations: the perceptions of staff nurses and nurse leaders. J Nurs Adm. 2004; 34(3): 149–56.
34. Sinnott-Armstrong W. Moral Skepticism. Oxford University Press; 2007.
35. Rathert C, May DR, Chung HS. Nurse moral distress: a survey identifying predictors and potential interventions. Int J Nurs Stud. 2016; 53: 39–49.
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37. Shirey MR, Fisher ML. Leadership agenda for change toward healthy work environments in acute and critical care. Crit Care Nurse. 2008; 28(5): 66–79.
38. Hoeve Y ten, Jansen G, Roodbol P. The nursing profession: public image, self-concept and professional identity. a discussion paper. J Adv Nurs. 2014; 70(2): 295–309.
39. Aitamaa E, Leino-Kilpi H, Iltanen S, Suhonen R. Ethical problems in nursing management: the views of nurse managers. Nurs Ethics. 2016; 23(6): 646–58.
40. Varaei S, Vaismoradi M, Jasper M, Faghihzadeh S. Iranian nurses self-perception–factors influencing nursing image. J Nurs Manag. 2012; 20(4): 551–60.
41. Tahmasebi S, Ashk-torab T, Ebadi A, Alavimajd H. Professional socialization in clinical nurses-a phenomenological study. Journal of Clinical Nursing and Midwifery. 2013; 2(3): 39–52. [in Persian]
42. Valizadeh S, Fallahi Khoshknab M, Mohammadi E, Ebrahimi H, Arshadi Bostanabad M. Nurse’s perception from barriers to empowerment: a qualitative research. Journal of Nursing and Midwifery Urmia University of Medical Sciences. 2015; 12(12): 1128–38. [in Persian]
43. Takase M, Kershaw E, Burt L. Nurse-environment misfit and nursing practice. J Adv Nurs. 2001; 35(6): 819–26.
44. Nikbakht Nasrabadi A, Emami A. Perceptions of nursing practice in Iran. Nursing Outlook. 2006; 54(6): 320–7.
45. Manoochehri H, Azimi Lolaty H, Hassani P, Arbon P, Shorofi SA. Iranian senior nursing managers’ experiences and understanding of social capital in the nursing profession. Iran Journal Nursing and Midwifery Research. 2014; 19(5): 464.
46. Ardichvili A, Kuchinke KP. Leadership styles and cultural values among managers and subordinates: a comparative study of four countries of the former Soviet Union, Germany, and the US. Human Resource Development International. 2002; 5(1): 99–117.
47. Elenkov DS, Manev IM. Top management leadership and influence on innovation: the role of sociocultural context. Journal of Management. 2005; 31(3): 381–402.
48. Elenkov DS. Effects of leadership on organizational performance in Russian companies. Journal of Business Research. 2002; 55(6): 467–80.
49. Kwantes CT, Boglarsky CA. Perceptions of organizational culture, leadership effectiveness and personal effectiveness across six countries. Journal of International Management. 2007; 13(2): 204–30.
50. Block L. The leadership-culture connection: an exploratory investigation. Leadership & Organization Development Journal. 2003; 24(6): 318–34.
51. Toor SR, Ofori G. Ethical leadership: Examining the relationships with full range leadership model, employee outcomes, and organizational culture. J Bus Ethics. 2009; 90: 533–47.
52. Fradd L. Political leadership in action. J Nurs Manag. 2004; 12(4): 242–5.
53. Farrell GA, Shafiei T. Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study). Int J Nurs Stud. 2012; 49(11): 1423–31.
54. Khadjehturian RE. Stopping the culture of workplace incivility in nursing. Clin J Oncol Nurs. 2012; 16(6): 638–9.
55. Mikaelian B, Stanley D. Incivility in nursing: from roots to repair. J Nurs Manag. 2016; 24(7): 962–9.
56. Gilbert RT, Hudson JS, Strider D. Addressing the elephant in the room: nurse manager recognition of and response to nurse-to-nurse bullying. Nurs Adm Q. 2016; 40(3): E1–11.
57. Lee YJ, Bernstein K, Lee M, Nokes KM. Bullying in the nursing workplace: applying evidence using a conceptual framework. Nurs Econ. 2014; 32(5): 255–67.
58. Griffin M. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. J Contin Educ Nurs. 2004; 35(6): 257–63.
59. Embree JL, White AH. Concept analysis: nurse‐to‐nurse lateral violence. Nurs Forum. 2010; 166–73.
2. Mannix J, Wilkes L, Daly J. Attributes of clinical leadership in contemporary nursing: An integrative review. Contemp Nurse. 2013; 45(1): 10–21.
3. Mannix J, Wilkes L, Daly J. “Good ethics and moral standing”: a qualitative study of aesthetic leadership in clinical nursing practice. J Clin Nurs. 2015; 24: 1603–10.
4. Storch J, Makaroff KS, Pauly B, Newton L. Take me to my leader: the importance of ethical leadership among formal nurse leaders. Nurs Ethics. 2013; 20(2): 150–7.
5. Anonymous. People-Centred Health Care: A policy framework.http://www.wpro.who.int/healthservices/people_at_the_centre_of_care/documents/ENGPCIPolicyFramework.pdf (accessed on 2016).
6. Gallagher A, Tschudin V. Educating for ethical leadership. Nurse Educ Today. 2010; 30(3): 224–7.
7. Brown ME, Treviño LK, Harrison DA. Ethical leadership: a social learning perspective for construct development and testing. Organizational Behavior and Human Decision Processes. 2005; 97(2): 117-34.
8. Kangasniemi M, Vaismoradi M, Jasper M, Turunen H. Ethical issues in patient safety Implications for nursing management. Nurs Ethics. 2013; 20(8): 904–16.
9. Makaroff KS, Storch J, Pauly B, Newton L. Searching for ethical leadership in nursing. Nurs Ethics. 2014; 21(6): 642–58.
10. Poikkeus T, Leino-Kilpi H, Katajisto J. Supporting ethical competence of nurses during recruitment and performance reviews–the role of the nurse leader. J Nurs Manag. 2014; 22(6): 792–802.
11. Bell J, Breslin JM. Healthcare provider moral distress as a leadership challenge. JONAS Healthc Law Ethics Regul. 2008; 10(4): 94–7.
12. Zhu W, May DR, Avolio BJ. The impact of ethical leadership behavior on employee outcomes: the roles of psychological empowerment and authenticity. Journal of Leadership and Organizational Studies. 2004; 11(1): 16–26.
13. Golparvar M, Padas F, Atashpoor H. Reinforcing model of feeling of energy, empowerment and employees’ creativity through ethical leadership. Iran Occupational Health Journal. 2010; 7(3): 9–14. [in Persian]
14. Keselman D. Ethical leadership. Holistic Nursing Practice. 2012; 26(5): 259–61.
15. Bjarnason D, LaSala CA. Moral leadership in nursing. Journal of Radiology Nursing. 2011; 30(1): 18–24.
16. Reave L. Spiritual values and practices related to leadership effectiveness. The Leadership Quarterly. 2005; 16: 655–87.
17. Wong CA, Cummings GG. The influence of authentic leadership behaviors on trust and work outcomes of health care staff. Journal of Leadership Studies. 2009; 3(2): 6–23.
18. Larijani B, Zahedi F, Malek Afzali H. Medical ethics in the Islamic Republic of Iran. East Mediterr Health J. 2005; 11(5-6): 1061–72.
19. Barkhordari-Sharifabad M, Ashktorab T, Atashzadeh-Shoorideh F. Ethical competency of nurse leaders: a qualitative study. Nurs Ethics. 2016. pii: 0969733016652125.
20. Shahriari M, Mohammadi E, Abbaszadeh A, Bahrami M, Fooladi MM. Perceived ethical values by Iranian nurses. Nurs Ethics. 2012; 19(1): 30–44.
21. Nasrabadi AN, Lipson JG, Emami A. Professional nursing in Iran: an overview of its historical and sociocultural framework. J Prof Nurs. 2004; 20(6): 396–402.
22. Valizadeh L, Zamanzadeh V, Habibzadeh H, Alilu L, Gillespie M, Shakibi A. Experiences of Iranian nurses that intent to leave the clinical nursing: a content analysis. J Caring Sci. 2016; 5(2): 169–78.
23. Fooladi MM. Gendered nursing education and practice in Iran. J Transcult Nurs. 2003; 14(1): 32–8.
24. Shirazi M, Emami AH, Mirmoosavi SJ, et al. Contextualization and standardization of the supportive leadership behavior questionnaire based on socio-cognitive theory in Iran. Med J Islam Repub Iran. 2014; 28: 125.
25. Gustafsson LK, Stenberg M. Crucial contextual attributes of nursing leadership toward an ethic care. Nurs Ethics. 2015. pii: 0969733015614879.
26. Eneh VO, Vehvilainen-Julkunen K, Kvist T. Nursing leadership practices as perceived by Finnish nursing staff: high ethics, less feedback and rewards. J Nurs Manag. 2012; 20(2): 159–69.
27. Winston MD. Ethical leadership and ethical decision making: a meta-analysis of research related to ethics education. Library & Information Science Research. 2007; 29(2): 230–51.
28. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9): 1277–88.
29. Tafreshi MZ, Pazargadi M, Abed Saeedi Z. Nurses’ perspectives on quality of nursing care: a qualitative study in Iran. International Journal of Health Care Quality Assurance. 2007; 20(4): 320-28.
30. Searing E.A.M, Searing D.R. Practicing Professional Ethics in Economics and Public Policy. Springer; 2016, p. 215–21.
31. Hendel T, Steinman M. Israeli nurse managers’ organizational values in today’s health care environment. Nurs Ethics. 2002; 9(6): 651–62.
32. Ganz FD, Wagner N, Toren O. Nurse middle manager ethical dilemmas and moral distress. Nurs Ethics. 2015; 22(1): 43–51.
33. Cooper RW, Frank GL, Hansen MM, Gouty CA. Key ethical issues encountered in healthcare organizations: the perceptions of staff nurses and nurse leaders. J Nurs Adm. 2004; 34(3): 149–56.
34. Sinnott-Armstrong W. Moral Skepticism. Oxford University Press; 2007.
35. Rathert C, May DR, Chung HS. Nurse moral distress: a survey identifying predictors and potential interventions. Int J Nurs Stud. 2016; 53: 39–49.
36. Gaudine A, Beaton M. Employed to go against one’s values: nurse managers' accounts of ethical conflict with their organizations. Can J Nurs Res. 2002; 34(2): 17–34.
37. Shirey MR, Fisher ML. Leadership agenda for change toward healthy work environments in acute and critical care. Crit Care Nurse. 2008; 28(5): 66–79.
38. Hoeve Y ten, Jansen G, Roodbol P. The nursing profession: public image, self-concept and professional identity. a discussion paper. J Adv Nurs. 2014; 70(2): 295–309.
39. Aitamaa E, Leino-Kilpi H, Iltanen S, Suhonen R. Ethical problems in nursing management: the views of nurse managers. Nurs Ethics. 2016; 23(6): 646–58.
40. Varaei S, Vaismoradi M, Jasper M, Faghihzadeh S. Iranian nurses self-perception–factors influencing nursing image. J Nurs Manag. 2012; 20(4): 551–60.
41. Tahmasebi S, Ashk-torab T, Ebadi A, Alavimajd H. Professional socialization in clinical nurses-a phenomenological study. Journal of Clinical Nursing and Midwifery. 2013; 2(3): 39–52. [in Persian]
42. Valizadeh S, Fallahi Khoshknab M, Mohammadi E, Ebrahimi H, Arshadi Bostanabad M. Nurse’s perception from barriers to empowerment: a qualitative research. Journal of Nursing and Midwifery Urmia University of Medical Sciences. 2015; 12(12): 1128–38. [in Persian]
43. Takase M, Kershaw E, Burt L. Nurse-environment misfit and nursing practice. J Adv Nurs. 2001; 35(6): 819–26.
44. Nikbakht Nasrabadi A, Emami A. Perceptions of nursing practice in Iran. Nursing Outlook. 2006; 54(6): 320–7.
45. Manoochehri H, Azimi Lolaty H, Hassani P, Arbon P, Shorofi SA. Iranian senior nursing managers’ experiences and understanding of social capital in the nursing profession. Iran Journal Nursing and Midwifery Research. 2014; 19(5): 464.
46. Ardichvili A, Kuchinke KP. Leadership styles and cultural values among managers and subordinates: a comparative study of four countries of the former Soviet Union, Germany, and the US. Human Resource Development International. 2002; 5(1): 99–117.
47. Elenkov DS, Manev IM. Top management leadership and influence on innovation: the role of sociocultural context. Journal of Management. 2005; 31(3): 381–402.
48. Elenkov DS. Effects of leadership on organizational performance in Russian companies. Journal of Business Research. 2002; 55(6): 467–80.
49. Kwantes CT, Boglarsky CA. Perceptions of organizational culture, leadership effectiveness and personal effectiveness across six countries. Journal of International Management. 2007; 13(2): 204–30.
50. Block L. The leadership-culture connection: an exploratory investigation. Leadership & Organization Development Journal. 2003; 24(6): 318–34.
51. Toor SR, Ofori G. Ethical leadership: Examining the relationships with full range leadership model, employee outcomes, and organizational culture. J Bus Ethics. 2009; 90: 533–47.
52. Fradd L. Political leadership in action. J Nurs Manag. 2004; 12(4): 242–5.
53. Farrell GA, Shafiei T. Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study). Int J Nurs Stud. 2012; 49(11): 1423–31.
54. Khadjehturian RE. Stopping the culture of workplace incivility in nursing. Clin J Oncol Nurs. 2012; 16(6): 638–9.
55. Mikaelian B, Stanley D. Incivility in nursing: from roots to repair. J Nurs Manag. 2016; 24(7): 962–9.
56. Gilbert RT, Hudson JS, Strider D. Addressing the elephant in the room: nurse manager recognition of and response to nurse-to-nurse bullying. Nurs Adm Q. 2016; 40(3): E1–11.
57. Lee YJ, Bernstein K, Lee M, Nokes KM. Bullying in the nursing workplace: applying evidence using a conceptual framework. Nurs Econ. 2014; 32(5): 255–67.
58. Griffin M. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. J Contin Educ Nurs. 2004; 35(6): 257–63.
59. Embree JL, White AH. Concept analysis: nurse‐to‐nurse lateral violence. Nurs Forum. 2010; 166–73.
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| Issue | Vol 10 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Ethical leadership Nursing Content analysis Qualitative research | ||
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How to Cite
1.
Barkhordari-Sharifabad M, Ashktorab T, Atashzadeh-Shoorideh F. Obstacles and problems of ethical leadership from the perspective of nursing leaders: a qualitative content analysis. J Med Ethics Hist Med. 2017;10.
