Ethical Decision-Making Process of Nursing Managers: A Grounded Theory

Background: Making ethical decisions is significant in health systems committed to ethics. Meanwhile, determining how nursing managers incorporate ethical values in their decision-making processes is crucial in developing ethical decisions and achieving the ethical goals of healthcare organizations. This study aims to explore the ethical decision-making process in nursing managers. Methods: This qualitative study was carried out in Tehran hospitals in 2020. Data was analyzed using the Grounded Theory method according to Strauss and Corbin’s 2015 approach. Twenty-three in-depth semi-structured interviews were conducted with 20 nursing managers and 3 nurses. Purposeful and theoretical sampling continued until theoretical saturation was achieved. Results: Conscientiousness was a core variable in managers’ ethical decision-making processes. Nursing managers working in unreliable organizational environments rely on 4 strategies (client orientation, cross-evaluation, contingency decision-making, and prioritizing individual rights over organizational regulations) to gain the comfort of conscience and overcome the anxiety they experience when consciousness is not met at work. Conclusion: Senior managers should take unmanageable organizational environments seriously as a cause of concern for nursing managers. Creating healthy interpersonal relationships and setting up a creative atmosphere effectively improve the organizational environment. Managers’ sensitivity to teaching ethical and managerial principles and developing a positive attitude towards applying ethics can facilitate managers’ ethical decision-making processes. Also, employing empowered managers in decision-making and giving them sufficient autonomy in describing their responsibilities can effectively reduce their decision-making barriers.