Nursing is different than medicine: ethical difficulties in the process of care in surgical units.

Aim: This paper describes a study of the kinds of ethical difficulties nurses face in the process of care in surgical units.

Background: Nurses face ethically difficult situations in trying to find the most appropriate actions to take for patients. Differences of opinion with doctors about the treatment and care of patients and conflicts between nurses' value systems and those in the organization where they are employed are described as sources of ethical difficulty. Nurses experience moral distress when institutional constraints restrict them from carrying out appropriate moral actions.

Methods: Ten female nurses working in surgical units at one university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and doctors about being in ethically difficult situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The study was conducted during 2004.

Findings: The main ethically difficult care situations described by the nurses concerned being open and honest, trusting patients' complaints, and creating limits to their involvement. Differences in opinion with doctors about the treatments, the absence of doctors in the unit and limited interest in holistic treatment and care resulted in nurses not receiving the medical orders they needed. A heavy workload, lack of time and staffing problems resulted in difficult ethical prioritizations and reduced standards of care. Shared rooms and beds in the corridors made it difficult to preserve patients' rights to privacy and confidentiality.

Conclusion: Interventions and investments are needed to improve the work environment of nurses, especially modifying the job constraints of the work environment. The moral responsibility for upholding the quality of care in surgical services and hospital performance should be more equally distributed between nurses, doctors and hospital managers. Discussions and collaboration between and within healthcare disciplines and managers should be initiated to establish shared moral understanding of the standards of care in hospitals.