Virtue ethics and the modern-day nurse

A staff nurse enjoys working on a ward for the elderly but ongoing changes to the hospital regime means she has less time to spend with patients.

There are fewer nurses on duty, she grows increasingly frustrated, stops enjoying her job and is worried that patient care is being comprised. The nurse’s worst fears are realised when an elderly man dies without anyone at his bedside to offer comfort.

Far from promising to address recruitment, managers insist staff will have to cope with reduced numbers on the wards if they are to hit their financial targets.

The nurse faces two stark options. She can accept the new policies and try to work as effectively as possible. Or she could speak to her matron – and go to senior management if matters do not improve.

The scenario is one of the moral dilemmas being presented to student nurses and qualified nurses during an investigation into the ethics of the profession being conducted by the Jubilee Centre. The project, Virtuous Practice in Nursing, seeks to throw a spotlight on the role of virtues and values in training the next generation of professionals.

The project is timely, coinciding with well-documented NHS scandals, public disquiet about standards of hospital care and a troubled picture of recruitment and retention of trainee nurses.

Indeed, the moral dilemma focusing on elderly patient care could have been plucked from the real-life caseload examined by inquiry into Stafford Hospital, where there were hundreds more deaths than would have been expected.

At Stafford, cutting costs and chasing targets at the expense of care led to examples of patients drinking from flower vases because they were so dehydrated. Nurses who tried to raise widespread concerns were not supported – and were allegedly told to falsify waiting times.

The lack of care and dignity offered to patients at Stafford sparked a national debate into the standards expected on hospital wards. Part of that discussion has taken place against the backdrop of a nurse training system that sees one in five recruits drop out before they qualify. It costs at least £70,000 to train a nurse, so the cumulative financial loss to the taxpayer, let alone the repercussions for patient care, is significant.

People will choose to walk away from the profession for any number of reasons, but the fact remains that the NHS is losing good trainees who would have become excellent nurses. Students often have a clear picture of what makes an ideal nurse but by the end of their training the picture may have become blurred. It is important that we find out why.

Nursing, like other professions, is also governed by a rule-and-code set of standards but through our research we hope to identify ways in which virtuous behaviours and conduct can inform best practice in the nursing profession. This may, at future junctures, include developing teaching materials and advising on the design of teaching courses.

We plan to question three specific groups of 750 nurses, namely undergraduates, final-year students and experienced professionals with at least five years’ experience. All participants will complete the same 20-minute questionnaire and 25 nurses in each cohort will take part in semi-structured interviews from which we hope to gain more detailed responses.

So far we have surveyed third-year students at the University of Birmingham, the University of Dundee and Buckinghamshire New University. The trainees are just months away from joining wards as newly-qualified staff nurses and are going to face one of the biggest challenges of their careers. One day you are a student, the next you are in charge of patients.

No matter how much practical experience or leadership training nurses have had, there comes a time when they have to rise to the challenge in real life. A lot depends on their training and the support of mentors. Although there is an ethics element to nurse training, insufficient attention may be paid to helping professionals to cultivate their role-relevant virtues. We hope to fill that gap with this project, with real benefits for nurses and patients.

Part of the survey asks trainees and new nurses to reflect on their own character strengths. They are required to choose six from a list of 24, putting them in rank order. The list is an A to Z of the virtues, from “Appreciation of beauty/excellence” to “Zest.”

Participants are also asked to think about the attributes they believe make an ideal nurse, again selecting six from 24. So is honesty more important than love? Does humour matter? And what of perseverance, gratitude and teamwork?

The results will provide a snapshot of nurses’ virtuous self-conception and how this differs, if it does, from their image of a good and virtuous nurse.

The research should reveal a comprehensive picture of what helps or hinders nurses from displaying virtuous practice amid the competing demands of modern-day life on the wards.

Jinu Varghese, Research Fellow, Jubilee Centre for Character and Virtues

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