Nurses’ Ethical Experiences of Conflict Between Physicians’ Orders and Professional Nursing Judgment in Inpatient Hospital Wards: A Phenomenological Study

Clinical environments are among the settings where professional decision-making is often influenced by structural, organizational, and interprofessional factors. Nurses, as the healthcare team members closest to patients, sometimes encounter situations in which they experience ethical conflicts between following physicians’ orders and exercising their own professional judgment. Although these conflicts form a significant part of nurses’ daily experiences, they are rarely openly expressed and are often overlooked. The present study aims to provide an in-depth understanding of nurses’ ethical experiences when facing conflicts between physicians’ directives and professional nursing judgment in hospital inpatient wards. This study was conducted using a qualitative phenomenological approach to gain a deeper understanding of nurses’ perceptions, emotions, and the underlying meanings in their lived experiences. Fourteen nurses working in inpatient wards of public hospitals participated in the study. Participants were selected through purposive sampling based on criteria such as work experience, prior exposure to ethical conflicts, and willingness to participate. Data were collected through semi-structured, in-depth interviews, allowing participants to freely reflect on their experiences and perspectives. After recording and transcription, the interviews were analyzed using thematic analysis. The data analysis identified four main themes. The first theme highlighted the pressure arising from the hierarchical structure of the healthcare system, where nurses’ positions are considered subordinate to physicians, limiting their ability to express independent professional opinions. The second theme addressed conflicts between nurses’ professional conscience and organizational requirements, forcing nurses in some situations to choose between adhering to ethical principles of care and following formal orders. The third theme focused on the psychological consequences of these conflicts, including feelings of guilt, anxiety, job dissatisfaction, and moral distress. The fourth theme explored coping strategies employed by nurses to adapt to these situations, such as professional silence, internal justification of decisions, seeking informal support from colleagues, or emotionally distancing themselves from stressful situations.