Selected Podcast
Developing Nurse Leaders Moral Muscle through Ethical Self-Assessment
Dr. Stuart Downs discusses the limited methods of ethics education for nurse leaders and how to fill this gap.
Featuring:
Stuart Downs
Dr. Stuart Downs currently serves as the Chief Operating Officer of WellStar Atlanta Medical Center. In collaboration with an integrated system leadership team, Dr. Downs drives implementation of policies and standards across the organization to ensure evidence of high quality in the provision of patient care across all service lines. Inducted as an inaugural fellow in the American Organization for Nursing Leadership (AONL), Dr. Downs is a past member of the AONL Board and currently serves as a member of the Board of Directors for the International Daisy Foundation. He holds a Doctor of Nursing Practice (DNP) from Vanderbilt University, maintains three professional certifications in executive nursing leadership and healthcare quality. Dr. Downs is also a Fellow in the American College of Healthcare Executives. He has been married to LaTanya for 17 years, and together they have two beautiful children, Jaxon Clark and Norah Claire. They reside in Grayson, Georgia. Transcription:
Bill Klaproth: (Host) So why is there a limited method of ethics education for nurses and how can this problem be addressed? Well, let's find out with Stuart Downs, Chief Operating Officer at WellStar Health System, as we discuss how to develop nurse leaders with moral muscle through ethical self-assessment. This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, I'm Bill Klaproth. Stuart, it is great to talk with you, thank you so much for your time. So let me ask you this first, why is there limited methods of ethics education for the continued moral development of nurse leaders?
Stuart Downs: (Guest) First of all, thank you so much. And the American Organization for Nursing Leadership for the opportunity to share our insights and our work related to ethics in nursing leadership. In response to your question, my sense is that two things are happening. First, when people think of ethics education for nurses, it tends to be clinical ethics education, namely helping them identify, think through, and solve moral dilemmas at the bedside. This education in particular often happens in academia during the nurse's educational programs. So we prepped nurses on ethics materials to be nurses at the bedside, but then we never really go back and teach again about ethics education for nurses, maybe once that formal academic preparation is complete. In my particular organization, we take a little different approach. We actually offer nurses of our ethics class and then offer those courses over their careers. The challenge with all of this education, as one might imagine, is that while it's good for bedside nurses, is that it does not really address the mall development piece of nurse leaders and thus our need to create on our program. Secondly, I would say that most leadership development programs, not just of nurses, but of all health care leaders, lack an ethics component. A number of them figure that most people in leadership are moral people. So they have, that stuff maybe down pat already. What we know is that they do not, and we need constant work as leaders in the ethics space to help guide us along our professional journeys. Secondly, most nursing leadership development programs, or at least the ones I've seen simply give a nod to ethics materials and do not really build, and to what an ethical leader looks like and how they can continue to grow as a moral leader.
Host: So it sounds like what you're saying is we teach nurses clinical ethics, but not necessarily moral ethics. So then to fill this gap, you piloted the ethical lens inventory with 30 nurse leaders. So tell us what is the ethical lens inventory?
Stuart: Sure, the ethical lens inventory, that's an assessment tool that helps one understand the values that guide his or her decision making. And most importantly, how we as individuals prioritize these values. Leaders who undergo this particular assessment, are often able to more accurately identify their ethical lens and how to effectively use it with the teams they lead on a day to day basis. The ultimate goal of the ethical lens inventory is to stimulate ethical self-reflection and provide a decision model for future ethical situations. The ethical lens inventory has also been used in ethics education as a tool for both professional curriculums and continued educational context.
Host: So, this is really important for self-development and self-awareness because you said they identify their ethical lens, right? So they really learn something about themselves and then they're able to translate that to the teams they lead, is that right?
Stuart: That's absolutely right, you're spot on. We ask all of the nurse managers at our facility to participate in the program. All of them agreed to do so. Before an inpatient discussion or lecture, each nurse manager was sent this inventory to take privately and complete the assessment. As part of the assessment, participants were also provided with a pretest to assess their comfortability in identifying ethical issues, frequency and assessing ethics resources within the system, and also asked to identify their ethical lens before even taking the inventory. Whether they could identify their blind spots and moral decision making is really what we were looking for. Over 50% of the participants also attended a two-hour didactic session that provided an overview of the ethical lens inventory results, the components to ethical leadership, moral decision making, and potential blind spots. Following that didactic though participants were giving a post-evaluation to determine levels of comfortability in identifying and addressing mall issues.
Host: Stuart, this sounds like a great program and really important as well. So let me ask you this, after these nurse leaders go through this self-assessment so far, what have been the results?
Stuart: Interestingly enough, we found that the majority of nurse leaders did not correctly identify the ethical perspective or their ethical biases. Interestingly, because we often think we know how we approach problems, but when we were tested and measured on how we do it, we find that what we thought to be true may not actually be. It's also extremely important because the lens by which we look at the world and address our moral issues impacts how the features we will see as morally silent and what biases we may have in resolving them. The report is comfortability and identifying ethical dilemmas rose in our research from 3.71 to 4.0 while the reported comfortability and addressing ethical dilemmas dropped from 3.82 to 3.54. While statistical significance cannot be analyzed given the small sample size and also given the variation in the data, the exploratory nature of this study intended to highlight potential trends. And what is particularly interesting is that from our perspective, once we made nurse leaders aware of their lens and biases, their comfortability in addressing issues went down. We think this is due to an overconfidence that generally all of us have in addressing moral matters. We also completed qualitative interviews with the participants, due to the novelty of the study's educational intervention, we collected and analyzed qualitative data using a grounded theory approach. During interviews, we were looking for potential factors that contribute to the participant's ethical approaches and the perceived impact for the study. Three themes emerged from those interviews. One, theory and language for reflection, organizational support, and parallel methods of ethical development. The one that really set out for us with theory and language for reflection.
Host: I love how deep you're going into all of this. You also mentioned the virtual conference. Can you tell us about your session at the virtual conference? What will people walk away with and will they have the tools to implement this on their own?
Stuart: Yeah, so the session at the 2020 AONL virtual conference, will certainly be very thought-provoking and hopefully ignite a spirit of inquiry among the participants to want to learn more about ethics in nursing leadership. Specifically, the participant can expect to lead the session with the ability to recognize the key components of moral decision making and how it relates to ethical leadership development. And secondly, he, or she will have a keen understanding of how the ethical lens inventory contributes to the nurse leader's moral awareness of his or her leadership style. Lastly, there'll be thought-provoking questions that will certainly cause the nurse leader to want to look deep within and take a self-introspective inventory, how they approach ethical dilemmas during the day to day operations of nursing leadership. You also ask, will, people walk away with the tools to implement this at their own hospitals. Absolutely. Any nurse leader can use the ethical lens inventory. It's a product that one can purchase, but it's also important to note that there are other ethical lens and leadership assessments that can be used for free. The point in all of this for us is that nurse leaders began to develop their ethical muscles. I would encourage the nurse leaders to find a tool to begin the conversation, tap into epics resources, to help them implement it and watch their nurse leaders flourish at a higher level of ethical decision making. After all, our goal is to help develop nurse leaders to the point that his or her judgment on ethics has come to be trusted by a specific community and of utmost importance is expressed in some way that makes it possible for others to mimic or represent that judgment.
Host: This is going to be a great session. Developing nurse leaders, moral muscle through ethical self-assessment. Stuart, thank you so much for your time and talking to us about this today, thank you again.
Stuart: Thank you so much, I appreciate it.
Host: That Stuart downs. And for more information, please visit AONL.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.
Bill Klaproth: (Host) So why is there a limited method of ethics education for nurses and how can this problem be addressed? Well, let's find out with Stuart Downs, Chief Operating Officer at WellStar Health System, as we discuss how to develop nurse leaders with moral muscle through ethical self-assessment. This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, I'm Bill Klaproth. Stuart, it is great to talk with you, thank you so much for your time. So let me ask you this first, why is there limited methods of ethics education for the continued moral development of nurse leaders?
Stuart Downs: (Guest) First of all, thank you so much. And the American Organization for Nursing Leadership for the opportunity to share our insights and our work related to ethics in nursing leadership. In response to your question, my sense is that two things are happening. First, when people think of ethics education for nurses, it tends to be clinical ethics education, namely helping them identify, think through, and solve moral dilemmas at the bedside. This education in particular often happens in academia during the nurse's educational programs. So we prepped nurses on ethics materials to be nurses at the bedside, but then we never really go back and teach again about ethics education for nurses, maybe once that formal academic preparation is complete. In my particular organization, we take a little different approach. We actually offer nurses of our ethics class and then offer those courses over their careers. The challenge with all of this education, as one might imagine, is that while it's good for bedside nurses, is that it does not really address the mall development piece of nurse leaders and thus our need to create on our program. Secondly, I would say that most leadership development programs, not just of nurses, but of all health care leaders, lack an ethics component. A number of them figure that most people in leadership are moral people. So they have, that stuff maybe down pat already. What we know is that they do not, and we need constant work as leaders in the ethics space to help guide us along our professional journeys. Secondly, most nursing leadership development programs, or at least the ones I've seen simply give a nod to ethics materials and do not really build, and to what an ethical leader looks like and how they can continue to grow as a moral leader.
Host: So it sounds like what you're saying is we teach nurses clinical ethics, but not necessarily moral ethics. So then to fill this gap, you piloted the ethical lens inventory with 30 nurse leaders. So tell us what is the ethical lens inventory?
Stuart: Sure, the ethical lens inventory, that's an assessment tool that helps one understand the values that guide his or her decision making. And most importantly, how we as individuals prioritize these values. Leaders who undergo this particular assessment, are often able to more accurately identify their ethical lens and how to effectively use it with the teams they lead on a day to day basis. The ultimate goal of the ethical lens inventory is to stimulate ethical self-reflection and provide a decision model for future ethical situations. The ethical lens inventory has also been used in ethics education as a tool for both professional curriculums and continued educational context.
Host: So, this is really important for self-development and self-awareness because you said they identify their ethical lens, right? So they really learn something about themselves and then they're able to translate that to the teams they lead, is that right?
Stuart: That's absolutely right, you're spot on. We ask all of the nurse managers at our facility to participate in the program. All of them agreed to do so. Before an inpatient discussion or lecture, each nurse manager was sent this inventory to take privately and complete the assessment. As part of the assessment, participants were also provided with a pretest to assess their comfortability in identifying ethical issues, frequency and assessing ethics resources within the system, and also asked to identify their ethical lens before even taking the inventory. Whether they could identify their blind spots and moral decision making is really what we were looking for. Over 50% of the participants also attended a two-hour didactic session that provided an overview of the ethical lens inventory results, the components to ethical leadership, moral decision making, and potential blind spots. Following that didactic though participants were giving a post-evaluation to determine levels of comfortability in identifying and addressing mall issues.
Host: Stuart, this sounds like a great program and really important as well. So let me ask you this, after these nurse leaders go through this self-assessment so far, what have been the results?
Stuart: Interestingly enough, we found that the majority of nurse leaders did not correctly identify the ethical perspective or their ethical biases. Interestingly, because we often think we know how we approach problems, but when we were tested and measured on how we do it, we find that what we thought to be true may not actually be. It's also extremely important because the lens by which we look at the world and address our moral issues impacts how the features we will see as morally silent and what biases we may have in resolving them. The report is comfortability and identifying ethical dilemmas rose in our research from 3.71 to 4.0 while the reported comfortability and addressing ethical dilemmas dropped from 3.82 to 3.54. While statistical significance cannot be analyzed given the small sample size and also given the variation in the data, the exploratory nature of this study intended to highlight potential trends. And what is particularly interesting is that from our perspective, once we made nurse leaders aware of their lens and biases, their comfortability in addressing issues went down. We think this is due to an overconfidence that generally all of us have in addressing moral matters. We also completed qualitative interviews with the participants, due to the novelty of the study's educational intervention, we collected and analyzed qualitative data using a grounded theory approach. During interviews, we were looking for potential factors that contribute to the participant's ethical approaches and the perceived impact for the study. Three themes emerged from those interviews. One, theory and language for reflection, organizational support, and parallel methods of ethical development. The one that really set out for us with theory and language for reflection.
Host: I love how deep you're going into all of this. You also mentioned the virtual conference. Can you tell us about your session at the virtual conference? What will people walk away with and will they have the tools to implement this on their own?
Stuart: Yeah, so the session at the 2020 AONL virtual conference, will certainly be very thought-provoking and hopefully ignite a spirit of inquiry among the participants to want to learn more about ethics in nursing leadership. Specifically, the participant can expect to lead the session with the ability to recognize the key components of moral decision making and how it relates to ethical leadership development. And secondly, he, or she will have a keen understanding of how the ethical lens inventory contributes to the nurse leader's moral awareness of his or her leadership style. Lastly, there'll be thought-provoking questions that will certainly cause the nurse leader to want to look deep within and take a self-introspective inventory, how they approach ethical dilemmas during the day to day operations of nursing leadership. You also ask, will, people walk away with the tools to implement this at their own hospitals. Absolutely. Any nurse leader can use the ethical lens inventory. It's a product that one can purchase, but it's also important to note that there are other ethical lens and leadership assessments that can be used for free. The point in all of this for us is that nurse leaders began to develop their ethical muscles. I would encourage the nurse leaders to find a tool to begin the conversation, tap into epics resources, to help them implement it and watch their nurse leaders flourish at a higher level of ethical decision making. After all, our goal is to help develop nurse leaders to the point that his or her judgment on ethics has come to be trusted by a specific community and of utmost importance is expressed in some way that makes it possible for others to mimic or represent that judgment.
Host: This is going to be a great session. Developing nurse leaders, moral muscle through ethical self-assessment. Stuart, thank you so much for your time and talking to us about this today, thank you again.
Stuart: Thank you so much, I appreciate it.
Host: That Stuart downs. And for more information, please visit AONL.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.