"What Nurses Talk About When They Are Talking About Ethics" (Ethical Issues, November 2017) offers a typology that will help nurses in their thinking about ethical situations.

Going beyond thinking about these situations, though, sometimes requires great courage. While "calling out wrongdoing is a powerful inducement to action," it may also, no matter how diplomatically done, be a powerful inducement to administrative reaction. In some cases, acting ethically may present a threat to one's livelihood.

I agree that "nurses may be allowed to decline participation in certain activities, such as assisted suicide or abortion, that violate their personal moral values." But declining to endorse unsafe staffing levels or insufficient support structures (too many units per manager, for example) may put an individual nurse at odds with hospital administration.

An inept administration may see this as a threat to their control, or seek to ostracize the nurse by characterizing her as "not a team player." Leggett and colleagues explain that moral distress occurs when a person believes she or he knows the ethical ideal or right action to take, but is prevented from doing so because of internal or institutional barriers.1

Individual values that diverge from those of the profession are one set of ethical issues. Values that diverge from those of the administration are another. It would be helpful to explore the moral and ethical dimensions of hospital administration as they intersect with nursing practice.

Francis X. Holt, PhD, RN

Fruita, CO

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