Testing a Model of Speaking up in Nursing.

Background: Speaking up is using one's voice to alert those in authority of concerns. Failure to speak up leads to moral distress; speaking up leads to moral courage.

Objective: The purpose of this study was to explore the influences of organizational culture, personal culture, and workforce generation on speaking-up behaviors among RNs.

Ethical dilemmas in nursing: An integrative review.

Aims: To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas.

Background: The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them.

Tapping Magnet®'s Culture of Innovation to Improve the Patient Experience.

As incentives grow for healthcare organizations to improve the patient experience, an increasing number choose to add consumers directly into their leadership structures. In this final installment about the value of patient and family advisory councils, the senior director of quality at a large, Magnet®-recognized Texas hospital explains how tapping into a well-established Magnet culture helped the organization adopt innovative approaches that produced positive change. Based on an interview with the author, she notes that seeing basic issues through patients' eyes challenged long-held beliefs and led to improvements in a wide variety of areas.

Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy.

Although speaking up to protect patients is a key ethical and moral mandate for nurses, silence still prevails in many situations. On the basis of concepts of safety culture, generational theory, personal cultural literature, advocacy theory, oppressed group theory, and moral distress theory, the author conducted a literature review and offers a new theoretical framework. The proposed theory identifies primary factors of speaking up: generational, personal culture, and organizational.