Moral Reckoning and Nursing Moral reckoning is a process through which nurses navigate ethical challenges and moral distress in their professional roles. This process is particularly significant as it can influence not only individual nurses but also the quality of patient care and the broader health care system. Moral reckoning can be thought of as a critical juncture in the life of a nurse, where they encounter, process, and reflect on ethical dilemmas in their practice. Through this lens, we can gain a deeper understanding of how nurses manage moral distress, how they make decisions in ethically challenging situations, and how they come to terms with their actions in the long run.
This article will explore the concept of moral reckoning in nursing, its three-stage process, situational binds that often serve as triggers, and the stages of resolution and reflection. By understanding this process, we can better comprehend how nurses cope with moral dilemmas, the psychological and emotional impacts of these dilemmas, and how these experiences shape their professional and personal identities.
What is Moral Reckoning?
Moral reckoning refers to the internal and external process through which nurses confront, resolve, and reflect upon ethical dilemmas in their practice. It emerges as a response to moral distress—when nurses are aware of the morally appropriate course of action but are constrained from pursuing it due to institutional, professional, or personal barriers. Unlike moral distress, which focuses on the immediate emotional and psychological effects of such dilemmas, moral reckoning is a broader, long-term process that encapsulates the way nurses come to terms with these challenges.
According to Nathaniel (2003), moral reckoning is a process that nurses undergo after experiencing moral distress, and it is composed of three stages: the stage of ease, the stage of resolution, and the stage of reflection. This process is central to understanding how nurses handle the moral complexity of their work and how these experiences influence their professional and ethical development over time.
Moral reckoning is not limited to any specific nursing specialty or environment. Nurses across various settings, from critical care units to community health, may experience moral reckoning as they face ethical dilemmas, particularly when institutional policies, hierarchical structures, or societal expectations clash with their personal and professional values.
The Three-Stage Process of Moral Reckoning
Moral reckoning is composed of three distinct stages: the stage of ease, the stage of resolution, and the stage of reflection. These stages represent the progression of a nurse’s moral journey from comfort in their practice, through ethical conflict and decision-making, to long-term reflection on their actions and their consequences.
1. The Stage of Ease
The stage of ease is characterized by a nurse’s comfort and sense of satisfaction in their work. During this stage, nurses are motivated by their core beliefs and values, and they feel that these are aligned with the professional and institutional norms of their practice. Nurses in this stage experience a sense of flow, confidence, and fulfillment in their roles. They possess the technical skills required for their work, and they are content with how their personal values intersect with their professional duties.
Nurses in the stage of ease know what is expected of them and how to navigate the systems in which they work. They feel at home in their profession, confident in their ability to provide care that aligns with their ethical principles. As long as there are no significant ethical challenges or conflicts, nurses can remain in this stage for extended periods of time.
However, the stage of ease is often disrupted when nurses encounter ethical dilemmas or morally troubling events. These disruptions lead to situational binds, which serve as the transition point from the stage of ease to the stage of resolution.
2. Situational Binds
Situational binds occur when nurses are confronted with moral dilemmas that challenge their core beliefs and values. These dilemmas often involve conflicts between the nurse’s personal ethics and the expectations or norms of their profession or institution. Situational binds are not simple or straightforward; they involve complex moral and ethical conflicts that can cause significant turmoil for nurses.
There are several types of situational binds that nurses may encounter:
- Conflicts between core values and professional or institutional norms: Nurses may find themselves in situations where their personal values conflict with the policies or expectations of their workplace. For example, a nurse may believe that continuing aggressive treatment for a terminally ill patient is morally wrong, but institutional policies or the wishes of the patient’s family may require them to do so.
- Moral disagreement in the face of power imbalances: Nurses often work in hierarchical environments where physicians, administrators, or other healthcare professionals hold more decision-making power. Nurses may experience moral distress when they disagree with the decisions of those in authority but feel unable to voice their concerns or change the course of action.
- Workplace deficiencies: Situational binds can also arise from systemic issues within the healthcare environment, such as inadequate staffing, lack of resources, or poor communication among healthcare teams. These deficiencies can place nurses in situations where they feel they are unable to provide the level of care that aligns with their ethical standards.
Situational binds are critical junctures in a nurse’s moral reckoning. They force nurses to make difficult decisions and confront the moral and ethical implications of their actions. The way a nurse navigates these binds determines how they move into the next stage of moral reckoning: the stage of resolution.
3. The Stage of Resolution
The stage of resolution is marked by the nurse’s decision-making process in response to a situational bind. At this stage, nurses must confront the internal conflict caused by the ethical dilemma and make a choice about how to proceed. For many nurses, this stage represents a critical turning point in their professional lives, as the decisions made during this stage can have long-lasting effects on their careers and their moral identities.
There are two primary options in the stage of resolution:
- Making a stand: Nurses who choose to make a stand do so by advocating for their ethical beliefs, even in the face of institutional or professional opposition. This may involve challenging authority, voicing concerns, or refusing to participate in actions they believe to be morally wrong. Nurses who make a stand often experience significant personal and professional consequences, but they may also find a sense of moral integrity in their actions.
- Giving up: Nurses who choose to give up may do so for a variety of reasons, including fear of retribution, lack of support, or a belief that their actions will not make a difference. Giving up does not necessarily mean that the nurse agrees with the course of action they are being asked to follow; rather, it signifies a decision to prioritize other considerations, such as job security or professional relationships, over their ethical concerns.
These two options are not mutually exclusive. Many nurses may initially give up, only to regroup and later make a stand. Others may make a stand, only to find that their efforts are unsuccessful and eventually give up. Regardless of the outcome, the stage of resolution represents a period of intense ethical and emotional struggle for nurses.
4. The Stage of Reflection
The stage of reflection is the final phase of the moral reckoning process. This stage involves a long-term, often lifelong, reflection on the decisions made during the stage of resolution and the ethical dilemmas encountered in the nurse’s practice. The stage of reflection is characterized by a deep examination of prior judgments, actions, and their consequences.
During the stage of reflection, nurses may engage in several key activities:
- Remembering: Nurses reflect on the events that led to their moral reckoning, often recalling these incidents with great detail and emotional intensity. These memories may shape the nurse’s understanding of their professional identity and their ethical principles.
- Telling the story: Many nurses feel the need to share their experiences of moral reckoning with others, whether through formal debriefings, informal conversations with colleagues, or personal journaling. Telling the story allows nurses to process their emotions and gain insight into the ethical challenges they faced.
- Examining conflicts: Nurses in the stage of reflection often revisit the ethical dilemmas they encountered, questioning whether they made the right decisions and considering how they might act differently in similar situations in the future.
- Living with consequences: The stage of reflection also involves coming to terms with the consequences of the nurse’s actions, both personally and professionally. Nurses may experience a range of emotions during this stage, including guilt, regret, pride, or a sense of moral integrity.
The stage of reflection is not necessarily a linear process. Nurses may move back and forth between different aspects of reflection as they continue to process their experiences over time. For some, the stage of reflection may lead to a deeper understanding of their ethical principles and a stronger sense of moral integrity. For others, it may result in ongoing feelings of guilt, regret, or unresolved conflict.
Conclusion
Moral reckoning is a complex and deeply personal process that nurses undergo as they navigate ethical dilemmas and moral distress in their practice. The three stages of moral reckoning—ease, resolution, and reflection—offer a framework for understanding how nurses confront, process, and come to terms with the ethical challenges they face in their work. Through moral reckoning, nurses must make difficult decisions, confront internal and external conflicts, and reflect on the long-term implications of their actions.
Understanding the process of moral reckoning is crucial for improving nursing education, practice, and administration. By providing nurses with the tools and support they need to navigate ethical dilemmas, we can help reduce moral distress and promote a more ethical, compassionate, and resilient nursing workforce.