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NHS pressures are hindering ethical practice and caring among nurses, reveals study

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More than one in eight nurses warn that they face barriers to working in a caring and compassionate manner due to the pressure they face in the health service, according to researchers.

Staff reductions, time pressures and “pen-pushing” were leading to moral disengagement – and compromising professional practice, according to the study by the University of Birmingham.

“Many nurses felt their moral obligations to the patients had to be compromised”

Kristján Kristjánsson

Researchers, from the university’s Jubilee Centre for Character and Virtues, said their study provided a “moral snapshot” of the profession at a time of unrivalled pressure on the NHS.

The findings were based on a survey of 696 of first-year undergraduates, final-year students about to enter employment, and established professionals who had been in practice for five years or more.

The researchers also conducted interviews with the survey participants and an additional 10 with educators from UK schools of nursing.

The students involved came from the following universities – Birmingham, Birmingham City, Buckinghamshire New, Dundee, Manchester Metropolitan, Northampton, and Greenwich.

It found that 83% of experienced nurses who responded to the survey reported serious challenges in staying true to their moral character and values due to the demands on their time.

”This fact probably says a lot about the current state of nursing”

Kristján Kristjánsson

The key factors perceived as driving this were staff shortages, time constraints, bed management and administrative tasks, all of which stopped them spending the necessary time with patients.

The research showed a reliance on duty, or rule-based, moral reasoning, that continued throughout the career of nurses, which the authors described as “disconcerting”.  

They said the survey revealed an “unusual picture” due to the “absence of a U-curve where virtue-based reasoning picks up steadily with experience after a dip during years of formal education”.

About 45% of respondents tended to follow the rule book, rather than their own moral compass, when faced with moral dilemmas.

The researchers said that, due to the concerns revealed by the survey, changes were needed to the process and way future nurses were educated.

“Given the somewhat bleak findings about the current psycho-moral state in which many UK nurses seem to find themselves, recommendations can be made for improvements both to nursing education and nursing practice,” they stated in their report – titled Virtuous Practice in Nursing.

For example, they recommended that moral role modelling should be placed at the “heart” of nursing education.

Otherwise, they warned the tendency would be to “go by the book”, circumventing individual reflection and responsibility and doing uncritically whatever the rules or standards of practice say.

The researchers also identified a need for a greater emphasis on ethical theory in the education of nursing students, helping trainees to relate values and virtues to practice.

In addition, they called for a “robust” approach to character evaluation at the interview stage for courses to assess the suitability of candidates for nursing.

However, the researchers noted several positive findings about the profession. For example, trainee nurses consistently identified moral motivators like care and compassion as the principal reason for joining the profession, the survey showed.

Both student nurses and established professionals viewed the job as a “vocation” and, despite significant pressures, nurses felt they could work autonomously and were supported by colleagues.

They also believed it was possible to maintain a level of emotional engagement with patients and their profession, which the researchers said was encouraging, given the motivational role of compassion and care in recruiting the nurses of the future.

University of Birmingham

NHS pressures ‘hindering ethical practice and care by nurses’

Kristján Kristjánsson

Report author Professor Kristján Kristjánsson said the study’s purpose was to “illuminate issues that help, or hinder, the virtuous practice of nursing”.

“Many nurses felt their moral obligations to the patients had to be compromised due to the time constraints and staff shortage,” said Professor Kristjánsson.

He noted: “Many nurses said often there have been times when they come away from patients feeling they did not do as much for those patients as their hearts dictated and that the patients did not receive the care they deserved due to low numbers in staffing.”

He added: “The experienced nurses stand out among all the experienced professionals we have surveyed in previous studies. They are the only professionals where reliance on their own character compass does not pick up as they gain more experience. This fact probably says a lot about the current state of nursing.”

As previously reported by Nursing Times, a major review of standards is currently being carried out by the Nursing and Midwifery Council, which will result in a new education framework for nursing and midwifery education in the UK.

The Birmingham researchers welcomed the regulator’s review as “positive”, saying it provided an “opportunity to shape the future of nursing” and that they hoped their findings would be included.

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  • Speaking as a 2nd year student nurse, unless NHS resources improve and pressures dramatically reduce, then regardless of NMC educational standards or a nurse's 'moral compass' it is almost impossible to deliver the level of compassionate care which people deserve.

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