Kleinman C. S. (2006).
JONA'S healthcare law, ethics and regulation,
8(3), 72–76.
Abstract
There are many factors in today’s healthcare environment which challenge nurses and nursing administration in adhering to ethical values. This article discusses the phenomenon of ethical drift, a gradual erosion of ethical behavior that occurs in individuals below their level of awareness. It is imperative for nurse managers and executives to be aware of the danger that workplace pressures pose in encouraging ethical drift at all levels of nursing, and to take steps to prevent this phenomena from occurring in their facilities.
Here is a summary and some thoughts:
The article explores how well-intentioned nurses and healthcare leaders can gradually erode their own ethical standards without realizing it. Under pressures such as staffing shortages, budget constraints, and competing organizational demands, small justifications for bending the rules accumulate until significant breaches become normalized. Kleinman illustrates this phenomenon through scenarios in which nurse managers unconsciously override physicians’ orders or skew performance appraisals to meet immediate needs, ultimately exposing themselves and their institutions to liability, moral distress, and burnout. She traces ethical drift to broader shifts in moral philosophy—where diverse, and sometimes conflicting, theories of right action make it easier to rationalize incremental deviations—and emphasizes that its insidious nature lies in occurring below conscious awareness until serious harm has already been done.
For psychologists, understanding ethical drift is vital because it mirrors key concepts in social and cognitive psychology, such as moral disengagement, obedience to authority, and the slippery-slope effect of incremental rationalization. Industrial-organizational psychologists can apply these insights to design training, support groups, and leadership practices that reinforce core values and ethical vigilance in high-pressure environments. Clinical psychologists and supervisors working with healthcare professionals must recognize how stress and systemic demands can undermine personal integrity and patient care, integrating strategies like values clarification, reflective practice, and peer feedback into interventions. By bringing psychological theory to bear on the gradual erosion of ethical behavior, psychologists help ensure that individuals and organizations remain aligned with the foundational principles of care and professional integrity.
