NHS pressures are hindering ethical practice and caring among nurses, report reveals

New research reveals eight in ten nurses face barriers to working in a caring and compassionate manner.

Staff reductions, time pressures and “pen-pushing” are leading to moral disengagement – and compromising professional practice, according to new research published today by the University of Birmingham.

Nurses face major barriers in delivering the dedicated and compassionate care they seek for patients, say researchers at the Jubilee Centre for Character and Virtues.

The study, “Virtuous Nursing Practice,” provides a moral snapshot of the profession at a time of unrivalled pressure on the NHS.

It reveals eight out of ten experienced nurses face serious challenges staying true to their moral character and values due to the demands on their time.

The factors preventing nurses “living out their own character” on the wards include staff shortages, time constraints, bed management and administrative tasks, all of which stop them spending the time with patients they feel is required for good professional care.

Professor Kristján Kristjánsson, University of Birmingham said:

‘Many nurses felt their moral obligations to the patients had to be compromised due to the time constraints and staff shortage.

‘Many nurses said often there have been times when they come away from patients feeling they did not do as much for those patients as their hearts dictated and that the patients did not receive the care they deserved due to low numbers in staffing.’

The research, which surveyed almost 700 nurses and trainees, shows a reliance on duty, or rule-based, moral reasoning.
About 45% of respondents tend to follow the rule book, rather than their own moral compass, when faced with moral dilemmas.

The report recommends:

• Moral role modelling should be placed at the heart of nursing education. This is because in the ‘absence of adequate role modelling, the tendency will be to ‘go by the book’, circumventing individual reflection and responsibility and doing uncritically whatever the rules or standards of practice say;’
• A need for a greater emphasis on ethical theory in the education of nursing students, helping trainees to relate values and virtues to practice;
• A robust approach to character evaluation at interview stage is needed to assess the suitability of candidates for nursing, and to monitor the development of their character throughout the programme.

The researchers also identified several positive findings about the profession:

• Trainee nurses consistently identify moral motivators like care and compassion as the principal reason for joining the profession;
• Both student nurses and established professionals view the job as a vocation;
• Despite significant institutional pressures, nurses feel they can work autonomously and feel supported by colleagues; 
• They also believe it is possible to maintain a level of emotional engagement with patients and their profession, which is encouraging given the motivational role of compassion and care in recruiting the nurses of the future.

Professor Kristjánsson, University of Birmingham added:

‘The experienced nurses stand out among all the experienced professionals we have surveyed in previous studies. They are the only professionals where reliance on their own character compass does not pick up as they gain more experience. This fact probably says a lot about the current state of nursing in the UK.’

• “Virtuous Practice in Nursing” was co-authored by Jinu Varghese, Research Fellow at the University of Birmingham’s Jubilee Centre for Character and Virtues.
• The University of Birmingham is ranked among the world's top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
• The Jubilee Centre for Character and Virtues is a world-leader in rigorous academic research into character education. The Centre was founded in 2012 by Professor James Arthur.
• Based at the University of Birmingham, it has a dedicated team of 30 academics, who specialise in a range of disciplines: philosophy, psychology, education, theology and sociology. 
• The Jubilee Centre operates on the basis that teaching good character, which can be demonstrated through moral virtues such as honesty, self-control, fairness, and respect, is possible and practicable. It is about equipping children and adults with the ability to make the right decisions. 
• The Centre works in partnership with schools and national professional bodies on a range of projects that contribute to a renewal of character and values in individuals and in society.