Ethical Distress and Advocacy

Ethical distress, often called moral distress, occurs when a nurse recognizes what appears to be the ethically appropriate action but feels unable to carry it out because of hierarchy, policy, inadequate resources, conflicting instructions, or fear of reprisal. The problem is not simply that the nurse dislikes a decision. The nurse is caught between professional obligations and a barrier to acting on them. This distress can affect concentration, communication, empathy, sleep, job satisfaction, and willingness to speak up. Those effects matter clinically: a nurse who becomes silent, distracted, or detached may miss a change in the client’s condition or stop challenging an unsafe practice. Advocacy is the practical response. It converts an ethical concern into a clear assessment of risk, a respectful request for action, escalation when necessary, and protection of the client’s continuity, dignity, and informed choices.