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Novel ethics champion programs

By: Heather Fitzgerald, MS, RN; Angela Knackstedt, BSN, RN-BC; Karen Trotochaud, MN, MA, RN

Three pediatric hospitals share tips for success.


  • Ethics champion programs can connect nurses with the ethical foundations of nursing practice and promote moral agency in clinical care.
  • Three pediatric hospitals describe how ethics champion programs can create unit-based ethics champions to provide hospital-wide support and education to address moral distress, deepen moral sensitivity, increase ethical competence, and connect colleagues to available ethics resources.

By Heather Fitzgerald, MS, RN; Angela Knackstedt, BSN, RN-BC; Karen Trotochaud, MN, MA, RN

novel ethic champion programRecognizing ethical issues, engaging colleagues in discussion, speaking up despite perceived risk, acting in response to ethical concerns, and addressing moral distress are essential to effective teamwork and patient well-being. However, these skills too often aren’t sufficiently developed in education or clinical settings, leaving nurses ill-prepared in the face of ethical challenges. Studies show that nurses who experience moral distress and feel powerless to act effectively are at risk for moral disengagement, emotional numbing, and distancing from patients. Mitigating moral distress, promoting moral courage, and developing moral resilience are pressing priorities for nurse ethicists, scholars, educators, and leaders.

Ethics champions

An ethics champion program is one way to meaningfully connect nurses with the ethical foundations of nursing practice and to promote moral agency. Children’s Hospital Colorado (Magnet®-recognized), Children’s Mercy Kansas City (Magnet®-recognized), and Children’s Healthcare of Atlanta are three pediatric centers with robust ethics champion programs. Each site has distinct approaches, but all provide supportive, educational, unit-based, hospital-wide forums to address moral distress, deepen moral sensitivity, increase confidence in recognizing and responding to ethical issues, and connect colleagues to available ethics resources.

Ethics champions augment their professional roles by serving as visible and accessible ethics representatives in their respective settings. They attend meetings for ethics education to deepen knowledge and practice in the complex skills necessary for effective communication, ethical decision-making, conflict resolution, and diminishment of moral distress among peers and interdisciplinary colleagues. The champions take these skills back to their settings to help clinical colleagues navigate ethically complex issues and take advantage of hospital ethics resources, such as the ethics committee.

All three programs are grounded in the American Nurses Association’s (ANA’s) Code of Ethics for Nurses with Interpretive Statements, which offers a clear charge to integrate ethics into clinical practice and promote ethical environments.

Provision 4.3 states that “nurses must bring forward difficult issues related to patient care and/or institutional constraints upon ethical practice for discussion and review.” And Provision 6 states, “The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality healthcare.”

Elements of success

Hospital-supported nurse ethicists direct all three programs. Working collaboratively, they conducted a survey across the three settings to describe their respective program aims. (See Champions make an impact.)

novel ethic champion program impact

The nurse ethicists believe that the comments and results of the survey positively reflect the programs and provide feedback of their impact on each ethical environment. The ethicists agree that the following elements are necessary for success when launching an ethics champion program:

  • Approach the hospital ethics committee to confirm support for the program. Ethics champions programs aren’t a replacement for the committee; they’re a mechanism to extend the committee’s reach throughout the organization.
  • When possible, administer a baseline assessment of the organization. For example, a hospital ethical climate or moral distress survey can provide valuable data to guide and measure program interventions.
  • Engage key stakeholders—such as nurse executives, nurse directors, and nurse managers—to assist with member recruitment, share perspectives about organizational needs, and foster ownership. To provide clarity about the scope of the effort, confirm support for staff time to participate and the number of ethics champions approved per unit.
  • Customize your recruitment and engagement approaches to the setting, and consider individuals’ inherent leadership qualities, interest in ethics, and “early adopter” attitude. Consider connecting the ethics champion role to professional advancement within the organization to offer a measurable benefit to program members and the clinical setting.
  • Create an ethics education curriculum based on baseline survey results and cultivated over time in response to emerging organizational needs and current bioethics issues. To keep participants engaged, develop a mix of approaches, including study of ANA’s Code of Ethics for Nurses with Interpretive Statements, literature reviews, case discussions, guest speakers, ethical analysis tools, films, podcasts, blogs, book clubs, and “ripped from the headlines” ethics topics. If possible, offer free continuing-education credit at monthly meetings to provide an additional benefit to participants.
  • Develop education for regularly scheduled ethics champion meetings so that the content can be easily replicated in their respective settings for ethics champion–facilitated, unit-based ethics education and discussion.
  • Promote interdisciplinary inclusion and discussion at these sessions.
  • Include the ethics champions in hospital-wide ethics committee meetings and activities to build relationships and increase awareness of available resources.
  • Match ethics champion program development (through education, consultation, and policy guidance) with the ethics committee to increase participants’ skills, knowledge, and engagement with the committee’s work.
  • Plan an annual program evaluation to elicit feedback and shape program development.
  • Establish a “true north.” For example, incorporating ethical discernment of everyday practice into cognitive action.
  • Above all, provide a safe place for the ethics champions to bring ethical concerns, develop skills for effective ethics conversations, and share skills and abilities with their colleagues to benefit patients and families in their care.

Meet your ethical obligations

Marsha Fowler, in the Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application , 2nd edition, states that “nurses, in all roles, must create a culture of excellence and maintain practice environments that support nurses and others in the fulfillment of their ethical obligations…the Code goes beyond a foundation of support for nurses; it seeks to construct a culture of excellence wherein meeting ethical obligations is an everyday expectation.” These three ethics champion programs aim to do just that and provide an example for other organizations to follow.

Heather Fitzgerald is a clinical nurse ethicist at Children’s Hospital Colorado in Aurora. Angela Knackstedt is a health literacy/bioethics clinical coordinator at Children’s Mercy Kansas City in Missouri. Karen Trotochaud is a nurse ethicist at Children’s Healthcare of Atlanta in Georgia.

Selected references

American Nurses Association. Code of ethics for nurses with interpretive statements. 2015.

Burston AS, Tuckett AG. Moral distress in nursing: Contributing factors, outcomes and interventions. Nurs Ethics. 2013;20(3):312-24.

Campbell SM, Ulrich CM, Grady C. A broader understanding of moral distress. Am J Bioeth. 2016;16(12):2-9.

Hamric AB, Wocial LD. Institutional ethics resources: Creating moral spaces. Hastings Cent Rep. 2016;46(suppl 1):S22-7.

Musto LC, Rodney PA, Vanderheide R. Toward interventions to address moral distress: Navigating structure and agency. Nurs Ethics. 2015;22(1):91-102.

Olson LL. Hospital nurses’ perceptions of the ethical climate of their work setting. Image J Nurs Sch. 1998;30(4):345-9.

Robichaux C. Developing ethical skills: From sensitivity to action. Crit Care Nurse. 2012;32(2):65-72.

Rushton CH, Caldwell M, Kurtz M. Moral distress: A catalyst in building moral resilience. Am J Nurs. 2016;116(7):40-9.

Storch JL, Rodney P, Starzomski R. Toward a Moral Horizon: Nursing Ethics for Leadership and Practice. 2nd ed. Toronto: Pearson Education Canada; 2012.

Varcoe C, Pauly B, Webster G, Storch J. Moral distress: Tensions as springboards for action. HEC Forum. 2012;24(1):51-62.


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