Lived Experiences of Ethical Dilemmas in Nursing Among Newly Graduated Registered Nurses in the Emergency Department: A Qualitative Study in Shanghai

Abstract Background As a new cohort in the emergency nursing workforce, the professional stability of Newly Graduated Registered Nurses (NGRNs) is crucial to overall nursing quality. However, factors such as the theory-practice gap, deficient communication skills, and insufficient clinical decision-making experience frequently lead this group into ethical dilemmas within emergency settings. This not only generates negative emotions and induces physical and mental dysfunction but also increases nurse turnover rates. This study aimed to explore the lived experiences of NGRNs in the emergency department regarding ethical dilemmas encountered in their nursing practice, aiming to provide new perspectives and a theoretical basis for interventions to reduce such dilemmas. Methods This study employed a phenomenological qualitative approach. Participants were NGRNs working in the emergency departments of three tertiary grade-A hospitals in Shanghai, selected via purposive sampling. Data were collected through face-to-face semi-structured interviews and analyzed using Colaizzi's seven-step method. Results Three main themes and ten sub-themes emerged: Causes of Ethical Dilemmas (sub-themes: Individual medical literacy; Organizational factors; Physician-nurse decision-making conflicts; Futile medical and nursing care); Impacts of Ethical Dilemmas (sub-themes: Intense feelings of guilt; Emotional detachment; Job burnout);Coping with Ethical Dilemmas (sub-themes: Self-coping strategies; Seeking multi-source support; Optimizing the ethical climate). Conclusion This study reveals the cognitive-behavioral patterns and affective characteristics of NGRNs in the emergency department when confronting ethical dilemmas. It highlights the need for nursing managers to focus on the clinical ecology and genuine needs of these nurses. Tailored institutional policies and programs should be developed and refined to reduce the frequency of ethical dilemmas experienced by NGRNs in clinical practice, enhance their capacity to cope with the impact of these dilemmas, and ultimately promote the specialization of emergency nursing and the continuous improvement of service quality.