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The importance of moral agency for nurses


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Moral agency, an essential concept in the nursing profession, involves the capacity of an individual to make an ethical decision and take accountability for their actions. As frontline providers of patient care, nurses must understand its significance in promoting welfare, autonomy and dignity among their patients. This article explores the concept of moral agency, its importance for nurses and how it can be fostered and maintained within the profession.

Moral agency: Definition and components

Moral agency is recognizing and responding to ethical dilemmas according to one’s values and principles. It consists of three essential components: awareness, judgment and action.

  • Ethical sensitivity 

Ethical sensitivity is the ability to recognize ethical issues and dilemmas in nursing practice. Nurses with greater ethical awareness are aware of the moral dimensions of their decisions and any potential repercussions for patients, families or colleagues. Fostering ethical sensitivity in nurses is essential so they can identify situations requiring moral judgment and act accordingly.

  • Ethical judgment

Ethical judgment refers to the capacity to make moral decisions based on an intuitive grasp of ethical principles and theories. Ethical judgment is integral to moral agency as it allows nurses to make ethically defensible choices that align with their professional values. Nurses with strong ethical judgment skills can weigh various factors, such as patient autonomy, beneficence, nonmaleficence and justice, to decide the most suitable course of action in complex scenarios.

  • Ethical motivation

Ethical motivation is the inner drive to act according to one’s moral values and beliefs. Nurses must cultivate ethical motivation to prioritize moral concerns over personal interests or extrinsic factors. A strong sense of ethical drive helps nurses overcome any barriers that might hinder them from acting on their moral judgments, allowing them to remain committed to upholding ethical standards.

  • Ethical courage

Ethical courage is the strength to hold onto one’s moral convictions, despite opposition or criticism. Nurses must possess ethical courage to act on these judgments even when doing so may result in negative repercussions such as criticism or conflict with colleagues. Demonstrating ethical courage is an essential component of moral agency, enabling nurses to advocate for their patient’s welfare and uphold the integrity of the nursing profession.

The role of moral agency in nursing

Nursing is an occupation founded on ethical principles such as beneficence, nonmaleficence, autonomy and justice. Moral agency is crucial in helping nurses uphold these ideals and adhere to professional standards while building trust and collaboration among healthcare professionals. Below are some of the ways that moral agency is employed in various nursing roles:

  • Advocate

Nurses advocate for patient’s rights, needs and preferences. They guarantee that patients receive appropriate care with dignity and respect regardless of any values or beliefs which may differ from their own.

  • Collaborator

Nursing moral agency requires that nurses work effectively with colleagues, families and other healthcare providers. By working as a team, nurses can guarantee patients receive comprehensive and coordinated care that addresses their physical, emotional and social needs.

  • Educator

Nurses are responsible for providing patients with accurate information so they can make informed decisions about their healthcare. They should present options, risks, advantages and alternatives in a clear and unbiased way while respecting patients’ autonomy and encouraging shared decision-making.

  • Researcher

Moral agency in nursing requires staying current regarding the latest research and evidence-based practice. Nurses must be open to learning new knowledge and skills and use them to improve patient care and advocate for changes in healthcare policies and practices.

  • Leader

Nurses, as moral agents, must demonstrate leadership by setting an example of ethical behavior, encouraging professionalism and creating a supportive work environment. To fulfill this role effectively, nurses must act bravely, speak out against unethical practices and nurture others’ moral agency.

  • Ethicist

Nurses frequently face ethical dilemmas in their practice, making it essential for them to develop the capacity to analyze and resolve these matters. Ethicists employ theories, frameworks and decision-making tools to address moral dilemmas and guide their decisions.

  • Activist

Nurses’ moral agency extends beyond the clinical setting to advocating for social justice and healthcare reform. Nurses must be ready to raise awareness of health disparities, challenge inequitable policies and work towards creating a more just and equitable healthcare system.

  • Counselor

Nurses serve as moral agents, offering emotional support and guidance to patients and families facing challenging circumstances. To do so, nurses must demonstrate empathy, active listening and compassion and help patients and families manage complex emotions and decision-making processes.

  • Guardian of professional standards

Nurses are responsible for upholding the highest professional standards and must ensure that ethical principles guide their practice. This role involves maintaining competence, abiding by regulatory requirements and upholding nursing’s reputation for integrity.

The importance of moral agency in nursing

Nurses play an essential role in patient care and must uphold the highest standards of ethics and professionalism. Below we explore the role of moral agency in patient-centered care, nursing autonomy, ethical decision-making and moral courage:

Patient-centered care

Moral agency is essential in fostering patient-centered care, the foundation of nursing practice. This approach involves treating patients with respect, dignity and empathy, while acknowledging their individual needs, preferences and values. Nurses, as moral agents, must advocate for their patient’s best interests even when those interests may conflict with institutional policies or other healthcare professionals’ views.

Moral agency allows nurses to listen carefully and understand their patients’ perspectives, then collaborate with them in making healthcare decisions. By acknowledging and addressing patients’ worries and preferences, nurses can deliver care tailored to each individual’s requirements, ultimately leading to improved patient satisfaction and health outcomes. Moral agency also fosters trust and rapport between nurses and their patients by creating an atmosphere where people feel safe discussing sensitive topics while actively participating in their care.

Nursing autonomy

Nursing autonomy refers to a nurse’s autonomy in making decisions that are in the best interests of their patients, using professional knowledge and judgment. Nursing autonomy is closely connected to moral agency. In today’s often hierarchical healthcare environment, moral agency gives nurses the power to advocate for patient care that aligns with their professional values and ethical principles.

By exercising moral agency, nurses are free to oppose decisions or practices they believe are not in their patient’s best interests, even when this might put them at odds with other healthcare professionals or their employer. This sense of autonomy contributes to professional satisfaction and helps prevent burnout by encouraging nurses to feel that they are upholding ethical obligations and providing top-quality care.

Ethical decision-making

Nurses frequently encounter the requirement to make ethical decisions in their practice. These often involve competing values, such as respecting patient autonomy while ensuring safety or balancing individual patients’ needs with efficient resource allocation. Moral agency is essential in helping nurses navigate these dilemmas and make decisions that align with their ethical principles.

By engaging in ethical decision-making, nurses can consider all relevant facts, assess potential outcomes of different courses of action and ultimately select the option that best upholds their professional values and responsibilities. Moral agency also allows nurses to reflect on their decisions, learn from mistakes and constantly refine their ethical judgment — leading to personal and professional growth.

Moral courage

Moral courage is the courage to act upon one’s moral convictions, even in the face of potential negative repercussions. In nursing, moral courage often involves standing up for one’s ethical beliefs and advocating for patient care that adheres to professional values. Moral agency forms the basis of moral courage as it equips nurses with the ability to recognize ethical dilemmas and make principled decisions based on these convictions.

Nurses may face situations where they must demonstrate moral courage, such as reporting unethical practices, challenging discriminatory policies or advocating for changes to patient care that face resistance from colleagues or administrators. By exercising moral agency and courage, nurses can create a culture of ethics and accountability within their organizations, ultimately improving patient safety and quality care.

Challenges in exercising moral agency

Nursing is an honorable profession that demands high ethical and moral responsibility standards. Nurses work closely with patients, often making difficult decisions that affect their wellbeing. Because of this, nurses may face both institutional and personal challenges when exercising moral agency.

Nurses will have many roles and responsibilities that accompany their profession; they must learn how to balance their level of care and attachment for patients, whilst also considering the at-times restrictive institutional policies. 

One example of where nurses may face challenges is through levels of honesty with their patient. Every patient has a right to their medical information, but it can be tempting to protect them from the knowledge of how sick they are. Furthermore, honesty vs. withholding information can be prevalent if a family member enquires about a patient’s condition, but you are not always at liberty to disclose this information without the patient’s consent. 

Another example where a nurse may face a challenge is the distinction between science and spirituality. Healthcare is a science-based practice and can therefore have implications for those who favor spirituality as a belief system for why certain things happen. A nurse should always respect the patient’s beliefs, and must simultaneously stick to their institutional policies, making it a complex balance to manage. 

Nurses are not always physically able to do what is right for their patients, whether due to their personal situation, or due to institutional limitations. It is important to stay on top of training that equips nurses with the skills needed to provide moral agency.

Cultivating moral agency in nursing education and practice

Cultivating moral agency as a nurse requires continual education, reflection and mentoring throughout their career. Here are some strategies that nurses can use to cultivate and maintain their moral agency:

  • Education and training

TWU online MSN FNP programs make ethics and moral reasoning a core element of their curriculums. In addition to the online instruction provided through this Texas Woman’s University program, students will be exposed to real-life ethical dilemmas through case studies, simulations and clinical experiences. This exposure allows them to hone their moral decision-making abilities and become better equipped to identify and address ethical dilemmas.

  • Reflective practice

Reflective practice is critically examining one’s thoughts, actions and experiences to better understand their ethical implications. Nurses can engage in reflective practice through journaling, group discussions or mentorship, as well as seeking feedback from peers and supervisors.

  • Mentorship and role models

Nurses can benefit significantly from the guidance and support of experienced mentors who demonstrate moral agency in their own practice. By observing and learning from these exemplary professionals, nurses can develop their own moral agency and deepen their commitment to ethical practice. These role models offer invaluable insights, advice and encouragement as nurses navigate the complex ethical landscape of healthcare.

  • Continuing education

Ongoing professional development is essential for nurses to sustain and enhance their moral agency. Attending workshops, conferences and seminars on ethics and moral decision-making can give nurses a more profound understanding of ethical principles, keep them abreast of emerging ethical issues in healthcare and reinforce their dedication to upholding moral agency. Nurses should be encouraged to pursue these educational experiences throughout their careers.

  • Engaging in ethical discussions

Nurses should actively participate in conversations about ethical matters within their workplace and professional organizations. Doing so can help them hone their moral reasoning skills, stay abreast of current ethical debates and contribute to the creation of ethical guidelines and policies relevant to their field.


Moral agency is of paramount importance for nurses, as it underpins their capacity to navigate the intricate ethical landscape of healthcare and uphold the highest standards of professional practice. By understanding moral agency, recognizing its components, understanding potential obstacles that may impede its exercise and taking measures to enhance it, nurses can ensure they remain accountable and responsive to patient needs, colleagues’ needs and those of the healthcare system at large. By doing so, they contribute towards furthering the advancement and improvement of the nursing profession while providing ethical, compassionate care centered around patients’ preferences.