Investigating the Relationship Between Nursing Managers’ Ethical Decision‐Making Confidence and the Ethical Behavior of Nurses in Hospitals in Northwestern Iran

Background: Confidence in ethical decision‐making is a critical factor for the success of nurse leaders. This confidence impacts the quality of nurse care and influences the work environment and the morality of health workers as a team. Aims: This study aimed to determine the relationship between the ethical decision‐making confidence of nursing managers and the ethical behavior of nurses. Methods: This study used a cross‐sectional and correlational design. In total, 532 nurses and 178 nursing managers from 12 hospitals affiliated with Ardabil University of Medical Sciences in Northwestern Iran participated in the study. The measuring tools used were Birkholz et al.’s Ethical Decision‐making Scale and Orathai’s Ethical Behavior Scale. Results: The mean values of ethical decision‐making confidence in nurse managers and ethical behavior in nurses were 75.51 ± 7.27 and 130.56 ± 29.16, respectively. Additionally, 62.4% of nursing managers and 74.1% of nurses reported their ability to make ethical decisions and ethical behavior at a high or average level. There was a significant positive relationship between managers’ ethical decision‐making confidence and nurses’ ethical behavior ( r = 0.9, p = 0.001). The regression model indicated that the managers’ ethical decision‐making confidence could predict 81% of nurses’ ethical behavior variance. Furthermore, female nurses and participants in an ethics workshop demonstrated higher ethical decision‐making confidence and behavior ( p < 0.001). Conclusion: The confidence of nursing managers in their ethical decision‐making significantly influences the ethical behavior of nurses on these managers’ respective units. Continuous training in ethical strategies is essential for managers, as decisions in true ethical dilemmas require a team approach. Managers should serve as role models and not make independent decisions when the choices lack clear right and wrong options.