Background:Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers.Objective:To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict.Methods:The Ethical Dilemmas in Nursing–Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel.Results:Middle managers report (...) low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas.Conclusion:Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation. (shrink)

Background:Ethical leadership is important for developing ethical healthcare practice. However, there is little research-based knowledge on how to stimulate and educate for ethical leadership.Objectives:The aim was to develop and investigate the feasibility of a 6-week web-based, ethical leadership educational programme and learn from participants’ experience.Training programme and research design:A training programme was developed consisting of a practice part, where the participating middle managers developed and ran an ethics project in their own departments aiming at enhancing the ethical mindfulness of the (...) organizational culture, and a web-based reflection part, including online reflections and coaching while executing the ethics project. Focus group interviews were used to explore the participants’ experiences with and the feasibility of the training.Participants and research context:Nine middle managers were recruited from a part-time master’s programme in leadership in Oslo, Norway. The research context was the participating leaders’ work situation during the 6 weeks of training.Ethical considerations:Participation was voluntary, data anonymized and the confidentiality of the participating leaders/students and their institutions maintained. No patient or medical information was involved.Findings:Eight of the nine recruited leaders completed the programme. They evaluated the training programme as efficient and supportive, with the written, situational feedback/coaching as the most important element, enhancing reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change.Discussion:The findings seem consistent with the basic assumptions behind the educational design, based partly on e-health research, feedback studies and organizational ethics methodology, partly on theories on workplace learning, reflection, recognition and motivation.Conclusion:The training programme seems feasible. It should be adjusted according to participants’ proposals and tested further in a large-scale study. (shrink)