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According to Davis (1997), an ethical dilemma can be defined as a condition that calls for an occurrence of a conflict between two moral alternatives. Nursing ethics can be defined as a branch of applied ethics which addresses the activities carried out within the domain of nursing (Davis, Fowler & Aroskar, 2009). In the nursing profession the stated goals are irrefutably ethical such as to provide care hence preventing complications, to protect the sick individuals from harm, and to maintain a favorable environment that is psychologically healing for families and patients. Nurses experience nursing staffing issues that possibly bring about moral distress (Davis, 1997). The condition of moral distress is very common especially when the number of staff is inadequate, unqualified trained staff, and the organizational procedures and policies that make it hard for nurses to fulfill the needs of patients as well as those for their families.

When the nurses experience these conditions, they have to be very careful with their responsibilities and roles to fulfill the needs of patients and the corresponding families, and they should balance this with the involved legal and ethical ramifications that may infringe their own beliefs, feelings, and viewpoints. The nurses can realize the imbalance in the number of patients to the number of nurses available to provide health care. This nurse-to-patient ratio is very unsafe and brings about a dilemma, a condition of moral distress for the nurses. The safety of patients is a vital and essential of quality health care. In spite of the fact that nurses are instructed to do no harm, they are put in conditions that appear to be unfavorable for themselves and even the patients. When nurses experience these dilemmas patient quality care, safety, and positive results as nurses' objectives are extremely challenged. The patient outcomes depend on the organizational environment under which nursing practice takes place as well as the levels of nurse staffing (Dossey & Keegan, 2009).

A nurse will be accused of abandonment if he or she leaves in this instance. The nurse can even be followed with prompt disciplinary action and accusations of insubordination. If the nurse stays back, he or she will experience an overwhelming load of patients that will leave the patient to receive inadequate care because of the disproportional nurse-to-patient ratio.  It has been apparent through research that, a large number of registered nurses results in better outcomes of patients (Porche, 2004). Apart from staff nurses, many other parties in the field of health care are faced with this ethical standstill.  For instance, the healthcare's business side is involved in making decisions concerning the allotment of resources to fulfill the needs of patients, including appropriate technology and staffing levels. Ultimately, it is a responsibility of everyone to ensure that patients are safe as far as their health is concerned.  

In healthcare, all stakeholders have the responsibility to ensure that patients do not experience any harm. The stakeholders include individual nurses, patients, administrators, nursing educators, and physicians, researchers, governments including regulators and legislative bodies, accrediting agencies and professional associations (Porche, 2004).  The Institute of Medicine (IOM) suggested six aims to enhance amelioration of the healthcare system. These aims include: following scientific knowledge strictly while offering services to all individuals who could benefit; avoiding injuring patients from the care meant to help them; avoiding wastage of resources such as equipment, energy, ideas, and supplies; offering care that is responsive to and respective of patient needs, values, and preferences, and making sure that all clinical decisions are guided by the patient values; and offering equal care to every individuals irrespective of gender, socioeconomic status, and geographical location (Naylor, 2002).

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