Established in 2020, the Nursing Ethics Program (NursE) is a collaborative program between the Nursing Institute and the Center for Bioethics led by Georgina Morley, PhD, RN and Cristie Cole Horsburgh, JD. Nursing Ethics Program Faculty guide development and operationalization of this innovative and emerging program.
This Nursing Ethics Program aims to:
- Create and sustain a network of nurses with specialist interest in ethics
- Help nurses thrive through the provision of ethics education
- Build nursing ethics scholarship and research; and
- Create safe moral spaces for caregivers to receive moral distress support
Moral Distress Reflective Debriefs (MDRDs) Facilitator Training Applications
We are offering a two-day training in facilitating Moral Distress Reflective Debriefs (MDRDs).
Moral distress is the psychological distress that occurs because of a moral issue and may be experienced by any healthcare worker. Unmitigated moral distress can lead to burnout, and cause healthcare workers to leave their place of work or profession. Facilitated by an Ethicist and social worker/counselor, MDRDs are designed to provide healthcare workers with a safe moral space to share their experiences of moral distress with peers, and the impact of morally distressing patient scenarios on them professionally and personally. Ethicist facilitators work with attendees to critically reflect on the ethical issues and engage in perspective-taking. Second facilitators create an environment for perspective taking by sharing reactions, fostering resiliency, and discussing support mechanism.
In this training, attendees will learn about the process steps of an MDRD from intake to post-debrief, the role of the different co-facilitators, and explore ways to optimize the co-facilitation team to meet the needs of their organizations. They will also reflect on their own facilitation style and learn to:
- Recognize ethical issues and moral distress.
- Encourage sharing of values.
- Encourage perspective-taking.
- Respond to distress.
- Share empowerment strategies.
We encourage attendees to bring a partner with whom they would co-facilitate MDRDs.
Training Course: April 15 - 16.
MDRD Ethicist Facilitator Training Application Deadline: December 1, 2023.
Please submit applications electronically to email@example.com.
CLEIP 2024 Applications
CLEIP three-day intensive weekend will be Friday, April 12 – Sunday, April 14, 2024.
CLEIP is a rigorous learning experience with a three-day preparatory intensive course and a two- or three-week immersion in the Cleveland Clinic Center for Bioethics. Through the three-day intensive course, participants will learn classical methods and emerging approaches in ethics consultation and will practice ethics consultation skills. The one-on-one immersion component of the course will be tailored to the individual participant's learning needs, and participants will have the opportunity to apply their newly acquired knowledge in the clinical setting on an ethics consultation service that conducts more than 750 consultations annually.
The deadline to apply for CLEIP 2024 is December 1, 2023.
Please submit applications electronically to firstname.lastname@example.org.
Nursing Ethics Fellowship
A two-year, full-time training program dedicated to developing leaders in nursing ethics through scholarship and clinical ethics practice. It is our belief that a robust nursing ethics training program prepares nurses to conduct clinical ethics consultation independently, contribute to nursing ethics scholarship and research, and lead a nursing ethics program.
Fellows in this program will have the opportunity to:
- Develop expertise in clinical ethics consultation
- Conduct empirical research or a nursing ethics project
- Develop leadership and programming skills
Our high-volume clinical service (>750 consultations per year) and structured curriculum ensures that professionals who complete the fellowship are prepared for a sustainable career in clinical ethics.
Nursing Ethics Faculty Fellowship
A 12- or 18-month professional development program open only to current Cleveland Clinic nurses with a Masters or Terminal Degree. The Nursing Ethics Faculty Fellowship is a project-based, longitudinal experience focused on developing excellence and leadership in examining and addressing ethical issues through the lens of nursing practice. The Nursing Ethics Faculty Fellow will be expected to design and conduct a nursing ethics project during the fellowship year that examines an area of nursing ethics and enhances the delivery of care in clinical practice. The Faculty Fellow will receive direct mentorship from Georgina Morley, PhD Director of the Nursing Ethics Program, Cristie Cole Horsburgh, JD Associate Director, and will receive additional nursing research mentorship from the Office of Nursing Research and Innovation.
Nursing Ethics Summer Internship
An 8- 10 week internship opportunity open to students currently enrolled in an accredited nursing school program (associate degree/BSN/MN) or a registered nurse studying for a terminal degree (PhD/DNP/JD). Priority will be given to students who can demonstrate previous ethics scholarship experience, familiarity with bioethics scholarship, and/or empirical research methods.
The summer intern will contribute to projects examining ethical issues through the lens of nursing practice and research in nursing ethics. Responsibilities include contributing to research activities, quality improvement projects and assisting in the preparation of research reports, publications and presentations. Opportunities will be provided for shadowing clinical activities such as Nursing Ethics Huddles, Ethics Rounding and Clinical Ethics Consultation.
Georgina is a Nurse Ethicist within the Center for Bioethics and works closely with the Nursing Institute and the Heart, Vascular and Thoracic Institute (HVTI).
Morley received a Bachelor of Arts in Philosophy from King’s College London and went on to train as a nurse, receiving a post graduate diploma in Adult Nursing in 2012 and a Master of Science in Nursing from King’s College London in 2014. She completed her doctoral studies at the University of Bristol Centre for Ethics in Medicine, exploring moral distress as experienced by critical care nurses in the United Kingdom.
Recognized as an international expert on moral distress, Morley has been invited to speak on the topic in the United Kingdom and United States, and she has published peer-reviewed papers and book chapters.
Cristie is a Regional Staff Ethicist in the Center for Bioethics. After completing the Cleveland Fellowship in Advanced Bioethics, she joined the professional staff in the Center of Bioethics at the Cleveland Clinic in 2014.
Cole-Horsburgh aims to address ethics needs at the local and enterprise level. This comprises clinical ethics consultation, training in ethics consultation, education of healthcare professionals, institutional policy development and innovative ethics programming, including preventive ethics initiatives.
Most recently, she focuses on developing responses to moral distress experienced by healthcare professionals and broadening impact of ethics programming by increasing opportunities to engage in ethics activities and tying such engagement to professional development.
She received her Juris Doctorate from the University of Arizona’s James E. Rogers College of Law in 2008 and a Bachelor of Arts in Biology and Society with a concentration in Law and Society from Cornell University in 2003.
Nancy Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN
Associate Chief Nursing Officer, Nursing Research and Innovation
Esther Bernhofer, PhD, RN, PMGT-BC
Associate Professor , Frances Payne Bolton School of Nursing, Case Western Reserve University
Rosemary Field, CNS, MS, APRN, AOCNS
Clinical Nurse Specialist, Marymount Hospital
Julie Gorecki, MBA, BSN, RN, NEA-BC
Associate Chief Nursing Officer, Akron General
Myra King, CNS, DNP, APRN, ACNS-BC, CCRN-CSC
APRN/PA Coordinator, Clinical Nurse Specialist, Main Campus
Dianna Copley, DNP, APRN, ACCNS-AG, CCRN
Clinical Nurse Specialist, Surgical Intensive Care Unit, Main Campus
Natalie Weigand APRN CNP
Female Pelvic Medicine & Reconstructive Surgery & Transgender Surgery Program
Research & Scholarly Work
Moral Distress Research
Helping caregivers overcome moral distress
Moral distress is the psychological distress experienced in relation to an ethically challenging situation or event. Although it was first observed within nursing, caregivers across all disciplines — including physicians, respiratory therapists, social workers and chaplains — experience moral distress.
Signs and symptoms of moral distress might be feelings of frustration, anger, powerlessness or questioning whether you are doing the right thing concerning patient care.
If left unaddressed, moral distress can cause caregivers to withdraw from patient care, consider leaving their place of work or their profession altogether. Learn more about moral distress from our COVID-19 curbside consult article.
Morley G, Bradbury-Jones C, Ives J. The moral distress model: An empirically informed guide for moral distress interventions. J Clin Nurs. 2022 May;31(9-10):1309-1326. doi: 10.1111/jocn.15988. Epub 2021 Aug 22.
Morley G, Sankary LR, Horsburgh CC. Mitigating Moral Distress through Ethics Consultation. Am J Bioeth. 2022 Apr;22(4):61-63. doi: 10.1080/15265161.2022.2044555.
Morley G, Field R, Horsburgh CC, Burchill C. Interventions to mitigate moral distress: A systematic review of the literature. Int J Nurs Stud. 2021 Sep;121:103984. doi: 10.1016/j.ijnurstu.2021.103984.
Morley G, Sese D, Rajendram P, Horsburgh CC. Addressing caregiver moral distress during the COVID-19 pandemic. Cleve Clin J Med. 2020 Jun 9. doi: 10.3949/ccjm.87a.ccc047. Epub ahead of print.
Morley G, Bradbury-Jones C, Ives J. What is 'moral distress' in nursing? A feminist empirical bioethics study. Nurs Ethics. 2020 Aug;27(5):1297-1314. doi: 10.1177/0969733019874492
Moral Distress Reflective Debriefs
Moral Distress Reflective Debriefs can be requested for caregivers or teams who have experienced a particularly ethically difficult situation that may be related to patient care or organizational issues. A Moral Distress Reflective Debrief is facilitated by a clinical ethicist and licensed social worker or chaplain who will come to the unit to provide caregivers with a safe moral space to talk about and reflect on the moral event(s) that have caused them to experience moral and psychological distress. Read more about Moral Distress Reflective Debriefs.
To request more information about how to facilitate a Moral Distress Reflective Debrief or to access any of our Moral Distress Resources, email Georgina Morley at email@example.com, Sundus Riaz at firstname.lastname@example.org or Cristie Cole Horsburgh at email@example.com.
Morley G, Horsburgh CC. Reflective Debriefs as a Response to Moral Distress: Two Case Study Examples. HEC Forum. 2021 Jan 26. doi: 10.1007/s10730-021-09441-z. Epub ahead of print.
Morley G, Shashidhara S. Debriefing as a Response to Moral Distress. J Clin Ethics. 2020 Fall;31(3):283-289. PMID: 32960811.
Nursing, Ethical Challenges and the COVID-19 Pandemic
The COVID-19 pandemic has exacerbated a number of ethical challenges for nurses. The following is recent scholarship in this area conducted by faculty of the Nursing Ethics Program:
Morley G, Copley DJ, Field R, Zelinsky M, Albert NM. RESPONDER: A qualitative study of ethical issues faced by critical care nurses during the COVID-19 pandemic. J Nurs Manag. 2022 Sep 5:10.1111/jonm.13792. doi: 10.1111/jonm.13792. Epub ahead of print.
Copley DJ, Morley G. Virtual Visitation and Microethical Decision-making in the Intensive Care Unit During COVID-19. AACN Adv Crit Care. 2021 Dec 15;32(4):473-481. doi: 10.4037/aacnacc2021283.
Morley G, Grady C, McCarthy J, Ulrich CM. Covid-19: Ethical Challenges for Nurses. Hastings Cent Rep. 2020 May;50(3):35-39. doi: 10.1002/hast.1110.