Abstract
This issue paper aims to establish that strong ethical leadership is required to promote ethical healthcare. With the increasing demand for nurses, that dramatically affects patient care and work satisfaction; the need to promote ethical healthcare remains, as it is a professional responsibility of a Registered Nurse. Ethical leadership has been identified as a vital element in promoting ethical behaviors in nurses. There are many leadership styles and theories, but the promotion of ethical behavior is the essence of an effective leadership style. It is through ethical leadership that a manager can role-model behaviors and promote a culture where it is safe to discuss moral dilemmas and that staff will feel supported as the leader places a higher emphasis on human dignity and safety. There are factors such as ethical, cultural, and managerial issues that act as barriers to ethical leadership; as well as the high emphasis on non-emotional forms of reasoning to arrive at moral judgments. It is through leadership that one can promote organizational change to address these barriers.
Keywords: ethical leadership, ethical healthcare
Leadership in Promoting Ethical Healthcare
Canada’s health care system is a point of pride; however, the system has failed to adapt to Canadian’s changing needs resulting in an expensive health care system that delivers mediocre results as it faces several challenges such as long wait times, chronic diseases, and an aging population to name a few (Simpson, Walker, Drummond, Sinclair, & Wilson, 2017). Health care organizations are expected to enhance patient services, elevate patient satisfaction, and improve productivity; however have difficulties addressing issues of nurses such as heavy workload, lack of resources, workplace violence, poor work-life balance resulting in health issues, and low autonomy over practice (Barkhordari-Sharifabad, Ashktorab, & Atashzadeh-Shoorideh, 2017; Statistics Canada, Health Canada, and Canadian Institute for Health Information, 2006). Despite the issues surrounding the work and health of nurses, there is the expectation that nurses ethically treat patients and put ethics first in their day to day professional performance, using tools such as the Code of Ethics for Registered Nurses to guide their ethical decision-making (Canadian Nurses Association, 2017). The most effective and essential method of promoting ethics in health care and nursing practice is the practice of ethical leadership by managers.
Ethical Leadership
Ethics
There is no universally accepted definition of ethics, but Ciulla (2014) provides the most quoted definition:
“Ethics is about how we distinguish between right and wrong, or good and evil in relation to the actions, volition, and characters of human beings. Ethics lie at the heart of all human relationships and hence at the heart of the relationship between leaders and followers.”
Leadership
Leadership is defined as the art of persuading a follower to want to do the things, activities that the leader sets as goals; the role of leaders is therefore in the process of directing the individual’s behavior towards the desired goal (Mihelic, Lipicnik, & Tekavcic, 2010). It is important to note that ethical behavior is the critical component in several leadership theories and that researchers such as Brown, Trevino, and Burns (as cited in Bedi, Alpaslan, and Green 2014) have argued that the essence of effective leadership is ethical behavior. The importance of effective healthcare leadership is difficult to overestimate as leadership not only improves significant clinical outcomes in patients but also improves provider well-being by promoting workplace engagement and reducing burnout (Hargett et al., 2017).
Ethical Leadership
Brown and Trevino (2006) defined ethical leadership as “the demonstration of normatively appropriate conduct through personal actions and interpersonal relationships, and the promotion of such conduct to followers through two-way communication, reinforcement, and decision making.” Bedi, Alpaslan, and Green (2014) stated that according to Bandura’s Social Learning Theory and Blau’s Social Exchange Theory, nurses learn ethical behavior through their own experiences and by observing others. Ethical leaders demonstrate integrity and demonstrate high ethical standards that employees emulate (Brown & Trevino, 2006).
Ethical leaders supports their subordinates and promotes ethical behaviors by providing an ethical environment where staff are free to discuss their moral dilemmas and that ethical competence of nurses are supported by leaders by fostering respect for human dignity and patient safety, and reinforcement of fair and just decisions (Barkhordari-Sharifabad et al., 2017, 2018).
Ethical leadership is distinct from other leadership models such as transactional (reward for excellent performance) and transformational (intellectual stimulation, inspirational motivation, and idealized influence) leadership, as it is ethical behavior is a crucial component of many leadership theories such as authentic leadership and servant leadership, to name a few. Ethical leadership allows the reward of excellent ethical performance, something that an authentic leader would not (Downe, Cowell, & Morgan, 2016).
Importance of Ethical Leadership
Job loss, risks to life and health, psychological damage to individuals and groups, social injustice and exploitation, and even environmental devastation are some of the common consequences of unethical workplace behaviors (Lindebaum, Geddes, & Gabriel, 2017). In the news, we have heard of unethical practices where doctors who work for both the public system and private clinics, would bill patients and the public health care system for necessary medical treatment; an illegal act called “extra-billing” which is, unfortunately, an increasing phenomenon as waitlists for consults and surgeries tend to be very long (Bracken, Lum, & Bassett, 2017). Nurses are not immune to ethical dilemmas and committing unethical acts, despite being rated by the public as the most honest and ethical profession in the 2018 Gallup Survey (Brenan, 2018). Murray (2010) speaks of moral courage in healthcare, where nurses should be committed to stand up for/act upon one’s ethical beliefs despite threats to their reputation, retaliation from employers, and social isolation. Weak leadership, along with inadequate staffing levels and other cost containment measures have escalated these ethical dilemmas; hence, it is essential for the healthcare industry to develop influential leaders with ethical values, integrity, and moral courage (Murray, 2010). Supportive behaviors of leaders, as well as the high trust of staff towards management, empowers staff to express their concerns and to provide recommendations to improve their work environment and improve patient care (Barkhordari-Sharifabad et al., 2017).
Barriers to the Implementation of Ethical Leadership
Nursing leaders have provided several problems with ethical leadership in the clinical setting. The top three issues faced by nursing leaders are ethical, cultural, and managerial problems (Barkhordari-Sharifabad et al., 2017). “Ethical problems” pertain to doubt in ethical actions, ethical conflicts, and moral distress; “cultural problems” include organizational and social culture; and “managerial problems” are connected to organizational and staff-related issues (see Appendix).
Another critical issue for ethical leadership is achieving a balance between analytical reasoning (task-positive network) and socio-emotional reasoning; organizational culture relies heavily on non-emotional forms of reasoning and risk dehumanizing patients (and colleagues), and become more task-oriented (Rochford, Jack, Boyatzis, and French, 2016).
Despite the barriers discussed above, ethical leadership is still feasible as long as leaders work towards the correction of social and organizational culture that promotes these issues (Barkhordari-Sharifabad et al., 2017; Rochford et al., 2016). Organizations that exhibit consistently good conduct have multiple leaders who exercise ethical leadership (Downe et al., 2016).
Conclusion
With the increasing demands in health care, nurses are faced with heavier workloads but are still expected to practice ethically. There are many challenges in promoting ethical healthcare; however, it is through strong leadership that staff are supported and where organizational change is advocated for. There are many leadership styles, but the promotion of ethical behavior is the crucial component of effective leadership.
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