Moral problems and distress among nurse practitioners in primary care.

PURPOSE: To identify the ethical issues nurse practitioners (NPs) encounter in primary care, examine the types of moral problems that arise related to those issues, and determine the level of distress NPs experience. DATA SOURCE: Self-reported responses to an investigator-designed, anonymous, mailed survey on a convenience sample of 71 NPs practicing in primary care in one midwestern metropolitan area.
CONCLUSIONS: This preliminary descriptive study identified a number and variety of ethical issues NPs encounter in primary care. The issue encountered with the greatest frequency was patient refusal of appropriate treatment. Distress was reported most often over problems of moral dilemma, followed by moral distress, and least often, moral uncertainty and moral outrage. Another type of moral problem, possibly related to conflict between patient autonomy and NP beneficence, occurred almost as often as moral dilemma. Not as many NPs reported encountering ethical issues or being distressed as the literature suggests. The reason for this is unclear but may be related to NPs' sense of moral responsibility or their ability to discern subtle ethical issues in the complex primary care environment. Regardless of moral problem, NPs felt frustrated and powerless. As a result, some changed jobs and contemplated leaving advanced practice. IMPLICATIONS FOR PRACTICE: More research is needed to clearly understand ethical issues and moral problems for NPs in primary care, how NPs identify and manage problems, and the effects on NPs and patients.