In a candid webinar, two national nursing leaders discussed the evolving American Nurses Association (ANA) Code of Ethics, the underexplored topic of moral distress in nurse leadership, and the critical role of ethical communication and support across healthcare settings. The moderator, Dr. Pam Power, is the director of Innovation, Learning, and Research at Tipton Health.
Speaker Dr. Lucia D. Wocial is from MedStar Health System, located in the Washington, DC area. She is a certified ethics consultant and is an adjunct faculty member at Georgetown University. Her expertise is in ethics and addressing communication challenges that occur in an intensive care unit setting
Drawing on years of clinical, academic, and ethical experience, Wocial highlighted the complexity and urgency of addressing these challenges in an evolving healthcare setting.
A Living, Breathing Code of Ethics
The ANA Code of Ethics is revised every 10 years to reflect the changing realities of healthcare. The most recent revision, released in 2025, was shaped by expert input and public comments. The Code now includes 10 provisions and is digitally searchable, making it more accessible and practical to today’s nurses.
A significant theme in this revision is the emphasis on dignity and respect for all individuals—patients, colleagues, and nurses. Wocial urges readers not to skip the introduction and preface of the Code, which gives context for understanding the provisions. A new focus on global nursing also acknowledges the interconnected nature of the profession worldwide.
COVID-19’s Lasting Impact on Ethics
COVID-19 was a turning point in how the Code of Ethics frames self-preservation and safety. Earlier language suggested nurses owed equal duty to patients and themselves but lacked clarity. The 2025 revision explicitly states that nurses are not required to sacrifice their health or safety to fulfill their professional obligations.
This change reflects hard-won lessons from the pandemic and echoes earlier health crises such as SARS. The message in the Code is that you can be a good nurse without giving 150% of yourself every day. Taking a break, asking for help, and prioritizing well-being are now understood as responsible actions that protect your mental health and physical well-being.
Understanding Moral Distress: A Complex and Growing Concern
Moral distress occurs when nurses know the right thing to do but cannot act because of external factors, which in turn threaten their moral integrity. The updated ANA Code defines it as:
“The experience of (A) believing one knows a correct ethical action to take or professional obligation to meet, and (B) being unable to act due to constraints beyond the individual’s immediate control.”
Moral distress isn’t just emotional. It can lead to physical symptoms, burnout, and career attrition. Nurses may detach from patients or leave the profession entirely. Over time, this builds up, deeply affecting nurses and organizations.
The Hidden Strain on Nurse Leaders
While moral distress is often studied in bedside nurses, it’s increasingly clear that nurse leaders face ethical burdens. Issues like resource allocation, staffing shortages, disciplinary decisions, and culture implementation create ethical tension.
Leaders may feel caught between demands from upper administration and their teams’ needs. Leaders are tasked with protecting staff while enforcing policies and preserving institutional integrity. Yet very few receive training in how to navigate these challenges effectively.
A recurring theme is that communication is the most performed but least practiced skill in healthcare. Ethics isn’t just about decisions. It is about how those decisions are communicated. Leaders must foster spaces where nurses feel safe speaking up, reporting mistakes, or sharing concerns.
Training programs, including those that simulate difficult conversations, are vital. Practicing the “how” helps nurses and leaders appropriately deliver serious messages, whether to patients, colleagues, or subordinates.
Supporting New Nurses and Fostering Connection
With a decline in faculty and preceptor numbers, nurses may enter the profession with more simulated clinical experiences and limited patient exposure. They may lack experience in patient interactions or high-pressure situations, which increases the need for mentorship, connection, and psychological safety to protect patient outcomes and prevent burnout.
Simple gestures, such as greetings, personal interest, and shared storytelling, build trust and connection between staff members. Simulated dialogue, peer mentoring, and ethical debriefs further prepare nurses for challenging situations. Practicing real conversations, even with someone “acting difficult,” builds skill and confidence.
Ethics in Higher Education
Debriefings are among the most effective ways to help teams process moral distress. When led by someone with ethics expertise, debriefs help encourage learning and build a sense of community. Skilled facilitation also ensures the focus of the debrief stays on ethical principles and steers away from placing blame.
Faculty in nursing schools also experience moral distress. Barriers like curricular limitations, accreditation pressures, and lack of faculty cohesion can prevent educators from providing the learning experiences students deserve. For faculty, this disconnect undermines professional identity.
Although progress is slow, the industry is responding. More roles that address nursing ethics are emerging in large organizations and university settings. National organizations are developing resources for faculty ethics training. Still, only 3% of the 27,000 self-reported ethics consultants in the U.S. are certified, revealing a gap in standardized preparation and access.
Final Thoughts: Doing the Right Thing Isn’t Always Easy
Wocial described a difficult ethical decision she faced when deciding to report a colleague’s unsafe practice, despite being warned about potential retribution. It was a challenging but necessary choice, highlighting that doing the right thing is sometimes the hardest path.
The 2025 Code of Ethics recognizes that economic realities and geographic limitations may prevent nurses from leaving unsafe environments. The Code stresses that staying may not be wrong, but nurses must know the risks and protect their well-being.
Whether at the bedside, in leadership, or in education, moral distress is a reality nurses face across every level of the profession. Addressing moral distress requires clear ethical frameworks, empathetic communication, and a workplace culture that values the humanity of every nurse.
As healthcare continues to evolve, nurses must be supported not just in doing the right thing but in having the strength, tools, and community to carry it out. The ANCC Magnet Recognition Program incorporates ethics and ethical decision-making into its framework through required elements related to professional practice, leadership, and patient care outcomes.
When your organization would like support in developing programs that meet Magnet Recognition standards for moral distress and ethical considerations, call Tipton Health. Our staff use strategic solutions and evidence-based approaches to optimize your system functions.