Q: When you think about the conference theme “Building Moral Community,” what comes to mind? 

A lot of the work that I have been doing is related to this idea of moral community and the conceptualization of moral distress. One of the barriers I foresee in moral distress is being able to build moral community. I see great potential in building moral community where we can all sit down together and recognize that there are lots of different perspectives. There are lots of different people coming to the table that have their own lived experiences that impact the way they look at specific ethical challenges. There is a real strength in saying nobody here knows for sure what the right thing to do is. But we’re going to sit down together, we’re going to listen to each other, and we’re going to try and figure out what the right thing to do is together. Find some willingness to compromise in order to do what is best for this patient in this situation. The idea of moral compromise and moral community is near and dear to my heart and is threaded into the ways I  approach my scholarship. 

Q: How has your personal journey influenced your approach in building moral communities in healthcare? 

My journey is a little bit different in that I studied philosophy first and then I went into nursing. When I went into nursing, I saw all these ethical issues and thought why aren’t we talking about them? Why aren’t we addressing them? I had been in a classroom context where we sat down and talked about how these things are important, and now here we are actually living this and impacting patients and families, and we’re not talking about it. I think I had a slightly different orientation, but like a lot of nurses, I was really interested in the concept of moral distress because of my own experiences at the bedside.

Q: What relationships have been important to you in building a moral community to support your practice as a nurse and as an ethicist?

Relationships are at the core of what we do. I’ve been blessed with great relationships like my PhD supervisor, Jonathan Ives, who was so crucial and pivotal as I started my career. Then as I moved into my fellowship here at Cleveland Clinic and then my faculty role, it’s my relationships with colleagues in bioethics and all of the nurses that I work with each day. I have always wanted the work I do to primarily appeal to the nurse at the bedside. I spend a lot of time doing ethics rounds and partnering with clinical nurse specialist colleagues. I’m always asking how the work relates back to bedside practice. How does this relate to the nurse who is in the throes of that ethical challenge, and how can we develop the tools to help support them? When I’m doing empirical research, the inspiration and drive is always to find recommendations and implications that can be translated back to the bedside to improve patient care. I’m also looking at nursing leadership and the weight of the decisions they make too. How can we help the bedside nurse understand where nursing leadership is coming from, recognizing that big decisions aren’t just being made without thinking? There’s actually a lot of consideration and thought about the implications of decisions. I think sometimes there can be a real disconnect between nurse leaders and nurses at the bedside.

Q: Part of building the moral community is recognizing that what looks like two ends of the spectrum are a part of the same community. We are ultimately functioning in the same larger community. How do we build an ethical awareness for each other, recognizing that when we work together it is for the betterment of our patients and ourselves?

There were a series of calls during the pandemic where nurse ethicists came together to discuss and share our responses to the pandemic . Cynda Rushton talked about this kind of disconnect, where clinical nurses would say that leaders just don’t hear what they’re saying. Of course, when we hear from nurses, we want to validate their feelings of not being heard. At the same time, as nurse ethicists, we have a unique role because we can also challenge that. Cynda’s response was something like, well how would you know that you’d been heard? That really disrupted a thought process that I had developed and impacted my orientation to bridging relationships from the bedside to boardroom.

Q: Does this tie into what your presentation at the conference will focus on? 

Yes. There is a sense right now that society feels increasingly polarized and we can’t run away from it. We experience it outside of the walls of the hospital, and we’re obviously experiencing the effects of it within the hospital walls as well. I want to talk about how we can engage in moral community within an increasingly polarized healthcare environment. We sometimes want to close off and not hear views that are different or contrary to ours. That scares me, because we could get more and more divided. Now is the time for us to figure out how we can hear and listen to one another. There’s a deep tension in how to navigate some of those spaces that upholds important moral principles but at the same time enables us to meet in the middle and seek compromise where possible. 

Q: If you could give one piece of advice to a new healthcare professional about ethics and building a moral community, what would it be?

Find a form of ethics support or ethics education at your healthcare organization. There may be a range. You might have a clinical ethics committee that’s built of volunteers or you might have a 24/7 ethics consultation service and center for bioethics. I encourage everyone to seek out those resources. Start building your moral muscles early on to develop ethical language, critical thinking and ethical analysis skills. The earlier you develop some of that, the more empowered you’re going to feel when you encounter ethical challenges. I still see scenarios where the healthcare professional is distressed about something and the way the question comes across to the rest of the team is conflict-ridden. It doesn’t always open the space for dialogue. If you can learn how to ask “tell me more” while coming from a position of genuine inquiry, I think those conversations would be more productive. It will help you find people willing to have those difficult discussions and willing to meet in the middle.