This, we believe, equips students with the necessary cognitive skills, clinical reasoning, clinical imagination, professional identity, and commitment to the values of the profession that are necessary to function as effective and ethical nurse leaders in situations that are under determined, contingent and changing over time.
The appointment of the Chief Nursing Officer at the beginning of 2014 and a detailed strategic plan for Nursing Education, Training and Practice provide a good foundation in South Africa for strengthening ethics training and enhancing ethical nursing practice.
Other studies have also recommended raising awareness of professionalism and ethical behaviour as a means of strengthening ethical nursing practice (23, 37).
They also stressed that even if the nurses wish to do so, it is not possible to provide adequate ethical nursing care [ 35].
Importantly, the health system deficiencies alluded to by study participants would need to be addressed in order to facilitate ethical nursing practice.
The SANC, established in terms of the Nursing Act (9), is the regulatory body for all categories of nurses (including midwives) and is responsible for setting standards for professional and ethical nursing practice, and nursing education and training throughout South Africa (10).
Specific strategies recommended include CPD that focuses on the four component model, the establishment of nursing ethics groups, nurses' participation in inter-disciplinary ethics rounds, the possible introduction of nursing ethics ward rounds, seeking guidance or support from senior or experienced nursing or medical colleagues, and a wider discourse on ethical nursing practice (5, p. 69).
When deciding on how to handle ethical issues, nurse managers usually rely on three things: their personal skills, the management team or other nurses, or the code of ethics.
Since 1953, however, behaviors that are accepted as ethical in nursing practice are those according to the International Council of Nurses' "ICN Code of Ethics for Nurses", which nowadays becomes the basis for nursing practice standards worldwide.
As we saw in our study, this can lead to a feeling of powerlessness when confronted with an ethical problem nurses cannot "solve" themselves, because they are in close proximity to the patient and his or her family.
However, this paper is not about overall nursing ethics, but about ethical issues that affect nurse managers.
