NUR 552 Module 6 Critical Reflection Paper: Workplace Application of Ethical Principles Example

Charting What Did Not Happen: Pressure to Document Missed Rounding, the ANA Code and a Path to Moral Resilience

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 552: Dynamics of Professional Nursing I

Instructor Name

Month Day, Year

Charting What Did Not Happen: Pressure to Document Missed Rounding, the ANA Code and a Path to Moral Resilience

Introduction

Ethical issues in nursing are often imagined as dramatic dilemmas about life support or consent. Many are smaller and closer to routine, and they can still wear nurses down. This paper examines one such issue from my telemetry unit: pressure to document care that was not provided. It applies bioethical principles and the American Nurses Association (ANA) Code of Ethics, describes the moral distress the situation caused and recommends a solution that protects patients and strengthens moral resilience.

The Workplace Issue

Our unit requires hourly rounding, documented in the electronic record, to address pain, positioning, toileting and the call light. On a composite night shift, the unit was two nurses short and admitted three patients from the emergency department. Rounding fell behind. As the shift wound down, our charge nurse reminded staff that rounding compliance was audited weekly and said, "Just make sure every hour is charted before you leave." Some nurses filled in the missing hours. I had rounded on my patients every two hours at best, and I left the missed hours blank. The next week, our unit's compliance report showed my patients at 60% while others were near 100%.

Ethical Principles in the Situation

Autonomy. Patients rely on accurate records to receive care that reflects their actual condition and choices. Falsified rounding entries undermine the information that future decisions depend on.

Beneficence. Rounding exists to benefit patients, by preventing falls and pressure injuries and addressing pain. Charting it without doing it creates the appearance of benefit without the substance.

Nonmaleficence. Documenting rounding that did not happen could hide a risk. If a patient fell in an hour charted as "rounded, call light in reach," the record would mislead those investigating the fall and the patient's family.

Justice. The staffing shortage affected all patients, but falsified records hide the shortage from leaders who allocate staff. The patients most harmed are those on understaffed nights, whose needs become invisible in the data.

The ANA Code of Ethics

The Code of Ethics for Nurses is the profession's statement of its ethical obligations (American Nurses Association [ANA], 2025). Three of its themes apply directly. First, nurses are responsible and accountable for their own practice, including documentation, and that accountability does not transfer to a charge nurse who asks for a shortcut. Second, nurses have duties toward themselves as well as toward patients, including maintaining integrity, so doing what one believes is wrong to satisfy an audit is a threat to integrity. Third, nurses help establish and maintain an ethical environment of practice, which means speaking up when a unit norm encourages inaccurate records. Our textbook's chapter on ethical dimensions of nursing describes how organizational pressures shape ethical behavior and why individual nurses still carry responsibility (Friberg & Saewert, 2024).

Moral Distress

Jameton (1984) used the term moral distress for the experience of seeing the ethical course clearly while the institution stands in the way of taking it. That describes what I felt: I knew the right action was to chart accurately, but doing so made me look like the least compliant nurse on the unit and put me at odds with a charge nurse I respect. Over several weeks, the recurring pressure left me frustrated and tempted to give in, which is how moral distress becomes moral residue.

Recommended Solution

Rushton (2016) describes moral resilience as the ability to keep or recover one's integrity when moral adversity strikes, built through self-awareness, clarity about one's values, skill in ethical action and supportive environments. My recommended solution has individual and organizational parts.

For myself: continue to chart accurately, document the reason for any gap, such as "rounding delayed due to admission," and use a short reflection after difficult shifts to notice moral distress early rather than letting it build. Accurate charting is consistent with the Code's emphasis on integrity and accountability.

With the charge nurse: request a private conversation, acknowledge the pressure she faces from the audit and propose that the unit report missed rounding with its reason rather than hiding it.

For the unit: bring the issue to the unit practice council with a concrete policy proposal: allow documentation of "rounding not completed, reason" without penalty, and link rounding compliance reports to staffing data, so leaders see that low compliance tracks short-staffed nights. This turns a hidden ethical problem into a visible staffing problem, which is what the Code's call for an ethical practice environment requires.

Conclusion

Pressure to chart care that did not happen seems minor, but it touches every bioethical principle and several provisions of the Code of Ethics. Accurate documentation protects patients, preserves integrity and gives leaders the information they need. Moral resilience is not simply enduring such pressure; it is acting on one's values while working to change the conditions that create the pressure in the first place.

References

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/

Friberg, E. E., & Saewert, K. J. (Eds.). (2024). Conceptual foundations: The bridge to professional nursing practice (8th ed.). Elsevier.

Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.

Rushton, C. H. (2016). Moral resilience: A capacity for navigating moral distress in critical care. AACN Advanced Critical Care, 27(1), 111-119. https://doi.org/10.4037/aacnacc2016275