Ethical Non-Compliance in Nursing Practice as an Organizational Risk: A Governance-Oriented Analysis of Supervisory Structures

Vollständiger Abstract

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Objective: This study aims to analyse ethical non-compliance in nursing practice through a governance-oriented perspective, focusing on how supervisory structures and organizational arrangements shape ethical conduct within health service organizations. Design: A qualitative, document-based study employing an interpretive content analysis approach. Setting: The study was conducted in a tertiary hospital, examining formal supervisory, governance, and policy documents related to nursing practice. Main outcome measures: Governance-related patterns associated with ethical non-compliance, including supervisory accountability, workload management, credentialing arrangements, and ethical oversight mechanisms. Results: Four interrelated themes were identified. Ethical non-compliance was normalized under sustained workload pressure and operational demands. Supervisory accountability was fragmented across organizational units, resulting in unclear ethical oversight. Gaps between formal credentialing requirements and actual task allocation weakened professional accountability. In addition, ethical standards were often symbolically emphasized but weakly enforced in routine supervisory practice. These governance conditions collectively contributed to the routinization of ethically problematic practices in everyday nursing work. Conclusions: Ethical non-compliance in nursing practice is best understood as a governance-related phenomenon embedded within supervisory structures and organizational routines rather than as an individual moral failure. Addressing this issue requires strengthening supervisory accountability, integrating credentialing and clinical oversight, and embedding ethical evaluation within routine governance processes to prevent the normalization of ethical deviations in healthcare practice.