Creating an Ethical Culture on Nursing Units and in Hospitals (Podcast)

For bedside nurses, conflicts can arise when treatment plans, family wishes or institutional pressures seem misaligned with patients' expressed preferences. These moments — ranging from end-of-life decisions to everyday clinical choices — can create moral distress when nurses feel unable to act in accordance with their professional and ethical judgment.

"Ethical care requires honoring patients' values — even when they differ from clinicians’ own perspectives," says Julie Gorecki, MBA, BSN, RN, NEA-BC, Vice President and Chief Nursing Officer at Cleveland Clinic Fairview Hospital. "But by addressing moral concerns early and encouraging peer and institutional support, organizations can strengthen their nursing teams and prioritize patient advocacy."

In the latest episode of Nurse Essentials, Gorecki reflects on the ethical uncertainty nurses frequently face — moments when teams question whether care decisions truly align with patient wishes, family values and professional standards. The conversation highlights questions of capacity and surrogate decision-makers, workplace violence and the constant “micro-ethics” of rapid bedside choices.

Click the podcast player above to listen to the episode now, or read on for a short, edited excerpt. Check out more Nurse Essentials episodes at my.clevelandclinic.org/podcasts/nurse-essentials or wherever you get your podcasts.

Podcast excerpt

Podcast host Carol Pehotsky, DNP, RN, NEA-BC: How does one ensure that ethics education gets integrated into the fabric of the hospital culture?

Gorecki: There are usually a few people on every unit who have an interest in it. I think [an important] question is: Is ethics your jam? And if it is your jam, there are so many resources out there – so many ways to learn more about it.

[Start by] taking a look at your organization’s code of ethics…and reach out to your hospital’s clinical ethicists or ethics committee. They can answer questions and help you bring information to your unit.

The next piece is to build alliances with folks who [include ethics] in their thought processes. Palliative care is a particularly good resource.

Especially when it comes to end-of-life care, they do an excellent job in talking to patients and can be a bridge between families and physicians who may not be listening, or nurses who may be uncomfortable with withdrawing a certain treatment like a ventilator or a vasopressor drip.

It’s about using the resources that you have – and I think nurses are perfect at that. They always think about who they can call to get the right [guidance].

Spiritual care can also come in and help the family through the process. If we're planning to have a difficult conversation with a patient's family, it can be helpful to meet with the physician and spiritual care before meeting with the family, so everybody is on the same page. You want to be prepared.

If you have the opportunity at your hospital, invite ethicists to the table to help facilitate. They can help address concerns on both the clinical side and the family’s side…and can bring values into the conversation. The values of the family might be very different from the values of the care team – and that's usually where conflict arises.