1724University of Birmingham, UK.
Nurs Ethics. 2021 Feb;28(1):82-90. doi: 10.1177/0969733020988316. Epub 2021 Jan 21.
The conduct of nurse managers, and health service managers more widely, has been subject to scrutiny and critique because of high-profile organisational failures in healthcare. This raises concerns about the practice of nursing management and the use of codes of professional and managerial conduct. Some responses to such failures seem to assume that codes of conduct will ensure or at least increase the likelihood that ethical management will be practised. Codes of conduct are general principles and rules of normative standards, including ethical standards, and guides for action of agents Nurse managers seem to stride two roles. Contra some accounts of the roles of a professional (nurse) and that of a manager, it is claimed that there is no intrinsic incompatibility of the roles though there is always the possibility that it could become so and likewise for codes of conduct. Codes of conduct can be used to support nurse managers in making practical decisions an 'outside in' approach with an emphasis on the use of principles and an 'inside out' approach with an emphasis on the agent's character. It is claimed that both approaches are necessary, especially as guides to ethical action. However, neither is sufficient for action because judgement and choice will always be required (principles always underdetermine action) as will a conducive environment that positively influences good judgement by being supportive of the basic principles and values of healthcare institutions. The response to the Covid-19 pandemic has created a unique set of circumstances in which the practical judgement, including ethical judgement, of nurse managers at all levels is being tested. However, the pandemic could be a turning point because staff and institutions (temporarily) freed from managerialism have demonstrated excellent practice supportive of ethical and other practical decision making. Organisations need to learn from this post pandemic.
护士管理者的行为，以及更广泛的卫生服务管理者的行为，因其医疗保健领域的高调组织失败而受到审查和批评。这引发了对护理管理实践和使用专业和管理行为准则的关注。对这些失败的一些反应似乎假设行为准则将确保或至少增加实践道德管理的可能性。行为准则是规范标准的一般原则和规则，包括道德标准，并为行为者提供行动指南。护士管理者似乎跨越了两个角色。与一些关于专业人员（护士）和管理者角色的说法相反，尽管这些角色之间可能存在内在的不兼容性，但也总是有可能变得如此，行为准则也是如此。行为准则可用于支持护士管理者做出实际决策，可以采用强调原则的“由外而内”方法，也可以采用强调行为者特征的“由内而外”方法。有人声称，这两种方法都是必要的，尤其是作为道德行为的指南。然而，这两种方法都不足以采取行动，因为判断和选择总是需要的（原则总是不能决定行动），还需要一个有利的环境，通过支持医疗机构的基本原则和价值观来积极影响良好的判断。应对新冠疫情创造了一套独特的情况，在这种情况下，各级护士管理者的实际判断，包括道德判断，都在经受考验。然而，这场大流行可能是一个转折点，因为员工和机构（暂时）摆脱了管理主义，展现了支持道德和其他实际决策的出色实践。各组织需要从后疫情时代中吸取教训。
