Running head: NURSING STUDENTS: INFORMED STRANGERS OF MORAL 1

AGENCY

Nursing Students: Informed Strangers of Moral Agency

Nancy A. Lilienthal

Southwestern Oregon Community College

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Nursing Students: Informed Strangers of Moral Agency

Moral agency is the responsibility of moral agents. “A moral agent is a person who has

the ability to discern right from wrong and to be held accountable for his or her own actions.”

(McCombs School of Business, University of Texas, n.d.) As a moral agent, it is your

responsibility to not cause unjustified harm. Generally speaking a moral agent must have full

cognitive ability. A mentally handicapped person or a child, for example, could not be

considered a moral agent. As a nurse, or in this case a nursing student, it takes on a deeper role

involving ethical decisions and potentially dilemmas. This is a summary of a research article

from 2017 regarding nursing students and their perceived role in unethical situations they

witnessed or were bystanders to during clinicals. (Engel, Salfi, Micsinszki, & Bodnar, 2017)

Informed Strangers

The term ‘informed strangers’ is used because as nursing students in clinicals we are

often an addition to the patient care and not the sole providing nursing staff. Because we are a

weekly visitor instead of part of the regular “culture” (Engel, Salfi, Micsinszki, & Bodnar, 2017)

we have less investment as we haven’t had the opportunity to form the relationships the regular

staff has. In addition to the irregularity of our presence, students are in the unique situation of

being an outsider looking in and our perspective is more of an objective one which also relates to

‘stranger’ as an identifying characteristic of a student’s possible perceived role. The terms used

to identify an ‘informed stranger’ in the article were “informed observer” and “witness to care”.

(Engel, Salfi, Micsinszki, & Bodnar, 2017)

Good Employee, Poor Nurse.

Who has been in a situation where you’ve witnessed the intentional failure to follow

correct policy or procedure in order to get tasks finished and what was your action/reaction?
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(Posed as a question for discussion). The problem behind a ‘good employee/bad nurse’ is “the

focus on self within the context of organization and work relationships.” (Engel, Salfi,

Micsinszki, & Bodnar, 2017). Some examples are; staffing shortage can result in cancelling

scheduled tasks (like bathing patients), the overwhelming # of tasks results in decrease in patient

safety (use of PPE and/or proper hand hygiene), and/or the manner in which tasks are completed

in order to get them done to prevent conflict with shift replacement staff (rushed sterile technique

poorly performed or completely disregarded). (Engel, Salfi, Micsinszki, & Bodnar, 2017)

Damaged Care.

Who can give an example of when a patient was brushed off and/or labeled as dramatic,

or attention seeking, etc.? What was the situation? (Posed as a question for discussion).

Damaged care is described as the “potential or actual harm done to a patient as a result of nursing

actions or neglect.” (Engel, Salfi, Micsinszki, & Bodnar, 2017). Some examples are; neglect to

offer a deceased patient last rights (bathing, proper respectful handling), patients with

psychological needs given a lower priority under other patients, neglect of basic patient rights

(using restroom in a timely manner), disregard for the patient’s right to choice (deceiving a

patient so they’ll take a sedative to make the shift easier for the nurse), and/or threatening a

patient or family to manipulate them into agreement with care- they have the right to REFUSE.

(Engel, Salfi, Micsinszki, & Bodnar, 2017)

Negotiating the Gap.

Can I get an example of where someone has felt like you’ve been in the hot-seat on

witnessing something you knew was unethical? How did you handle it? (Posed as a question for

discussion). When we as students learn to negotiate the gap, we start as the ‘informed strangers’.

Our concerns may be that our voices may not be welcome or acknowledged because the unit
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isn’t a place we are frequently a part of and we may feel like we are viewed as a visitor because

we are not an actual member of the staff. These concerns may be a perception of the student’s,

the perception of the staff, or both. Negotiating the gap is how we “react to ethics and care

witnessed and make sense of it.” (Engel, Salfi, Micsinszki, & Bodnar, 2017) An example is the

response of the student who chooses to be silent due to confusion, discomfort, or disappointment

in their mentor when they fail to uphold ethical standards in their actions or behaviors. The

course content we as students are exposed to is designed to drill the ethical knowledge into us

and we are more predisposed to have awareness of ethical issues. Being a student who is put in

these situations also gives us the opportunity to figure out where we stand on those issues and be

more prepared to be a moral agent in the future as RNs. Another example of how a student might

negotiate the gap is by taking a stance for what they feel is their professional responsibility.

They take action and are bold in addressing the matter without hesitation. Finally, the last

example given is that of a student who is in the middle ground between ‘student’ and ‘practicing

nurse’ with how they negotiate the gap. They are said to be “growing a backbone” (Engel, Salfi,

Micsinszki, & Bodnar, 2017) and learning to find their voice. An important aspect to this part of

transition is for the student to have a source they feel comfortable reaching out to whether it be

the charge nurse or their clinical instructor or another source, they need to have someone to use

their skills of being a moral agent on in order to continue to grow because they are between

being silent and being bold. They need that safety net in between that will reduce the potential

of fear for retribution of staff at the clinical site. (Engel, Salfi, Micsinszki, & Bodnar, 2017)

Potential Issues and Conclusion.

If the student fails to transition in their moral agency they may develop a deep fear of

retribution and begin to justify their avoidance in their duties as a moral agent. (Engel, Salfi,
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Micsinszki, & Bodnar, 2017) We, however, have the opportunity of foresight to know that this

is something that is a universal part of development amongst nursing students. Some are

naturals, and some must find their inner strength to be good proactive moral agents. We need to

take what we’ve witnessed in the matter of poor moral agency or unethical practice and use it to

grow from. The main learning point from this is the need to realize the necessity of finding your

voice as a moral agent. To be a good nurse, you have to.

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References

Engel, J., Salfi, J., Micsinszki, S., & Bodnar, A. (2017, July 26). Informed Strangers: Witnessing

and Responding to Unethical Care as Student Nurses. SAGE Publications, 4, 1-9.

McCombs School of Business, University of Texas. (n.d.). Moral Agency. Retrieved from Ethics

Unwrapped: http://ethicsunwrapped.utexas.edu/glossary/moral-agent