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Team-Based Care Sheds Light on Nursing Ethics Issues

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Recent transformations in healthcare are prompting another look at medical ethics, particularly as relationships among clinicians change. Team-based patient care models now being adopted throughout our national healthcare system are changing the roles of nurses in relation to physicians and allied health professionals, and thus sparking renewed interest in ethical considerations within the healthcare workplace.


AMN Healthcare ethics specialist Nadine Salmon, MSN, BSN, answers key questions around why it is becoming increasingly important that nurses understand theirevolving role as ethical practitioners within team-based care. She is Clinical Content Manager for, where she is responsible for all clinical aspects of course development.

How have changes in healthcare sparked a renewed interest in ethics for nurses? 

Healthcare reform presents an opportunity for nurses to take on leadership roles as well as strengthen their roles as patient advocates in the changing system. Increased access to care brings with it increased autonomy, leadership and training opportunities, which are opening more doors for nurses. With this additional responsibility comes a need to refocus attention on nursing ethics and remember to best serve the needs of the patient. 

How are nurses reacting to team-based care? Are you seeing any changes with how they manage ethical practices? 

There is a huge focus in nursing right now toward interprofessional collaboration and the importance of team work. As the largest single group of clinical health care professionals in the health system, RNs are educated within a holistic framework, and are fundamental to team-based care. Nurses are also becoming more aware of the importance of ethical behavior in teamwork, and the importance of advocating ethically for patients in the ever-changing healthcare arena. The ethical principles governing nursing will hopefully ensure that nurses continue to deliver compassionate care in all aspects of nurse-patient interaction within the context of team-based care.

In a team-based care setting, is there support for nurses or other clinicians who may have alternate views on ethical situations? 

It is difficult right now for clinicians, and especially for nurses, who may face opposition when dealing with ethical dilemmas while working in teams. However, as more healthcare professionals continue to become trained in team care and communication, this should improve. Traditionally, different healthcare professions have not been formally trained in interprofessional collaboration, but now there is a strong move toward incorporating this into training. In fact, continuing education is already following suit by moving toward a single regulatory body for continuing medical, nursing and pharmacy education under Joint Accreditation. This will promote more interprofessional collaboration and a refreshed focus on ethics training in continuing education.

Is there a difference in nurses’ considerations for ethical practices compared with that of other clinicians? 

Nurses are strong patient advocates, often deliberating between the patient and the physician as well as other members of the health care team, interpreting the patient’s needs to the team and explaining agency policy and other issues to the patient. Nurses’ considerations for ethical practices are also not impacted by any type of incentive or influence. For example, nurses’ own values and personal beliefs may influence individual outlooks, but ultimately, nurses’ actions should always be guided by the Code of Ethics for Nurses, as the clinical framework for ethical analysis and decision-making. Their ethical practices can strengthen interprofessional collaboration, if other professions are assured that the primary agenda of nurses is focused solely on the patient.

How else do enhanced professional relationships and communication skills influence patient care outcomes? 

Interprofessional collaboration and open communication can only strengthen and improve the delivery of safe, consistent and efficient patient care. Healthy relationships increase nurses’ ability to make care decisions based on ethical principles. With effective interprofessional collaboration, communication, cooperation, coordination and teamwork can all be improved, resulting in safer, more effective and ethical delivery of care -- and ultimately better patient outcomes. 

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