1). This is a problem that needs to be addressed by adding more training to the budget. The problem is, most hospitals' budgets are already spread too thin. Therefore, hospital administrators need to work harder to find sources to help fund their activities. Complete Honesty

Nurses have more power and responsibility than ever before to ensure that they are making honest reports about their patients. They may be in a rush to get home and not feel like entering all of the proper data into the computer. Or, they may take shortcuts in the use of other technologies. It is a nurse's ethical responsibility, however, to ensure honesty in all that she does. This includes 'blowing the whistle' when she sees that other nurses are not being honest or are misusing technology.

This can be extremely difficult, however, considering that nurses often suffer negative repercussions for 'whistleblowing'. A study conducted by McDonald (2000) found that for the 95 nurses they interviewed "Results indicated that there were severe professional reprisals if the nurse reported misconduct, but there were few professional consequences if the nurse remained silent. Official reprisals included demotion (4%), reprimand (11%), and referral to a psychiatrist (9%). Whistleblowers also reported that they received professional reprisals in the form of threats (16%), rejection by peers (14%), pressure to resign (7%), and being treated as a traitor (14%). Ten per cent reported that they felt their career had been halted." Therefore, it is not surprising that many nurses would rather keep their mouths shut than report misconduct. This is something that needs to be changed in a written policy that encourages full disclosure and punishes silence.

Job Satisfaction and Leadership Practices

Many studies have associated job satisfaction with salary and benefits (e.g. Rutherford et al., 2009; Sabharwal & Corley, 2009) . However, nursing and other caring professions do not generally operate on this principle. For example, Mayfield and Mayfield (2006) report on a study of full time nurses for whom the communications styles of their leaders were more of a motivating factor in job satisfaction and organizational commitment than salary and benefits. Watson (2009) found similar results from her survey of 359 medical imaging staff members. The results indicated that supervisors with a transformational leadership style, and who offer contingent rewards were the most highly motivating factors and the most likely to prevent turnover.

According to Kudo et al. (2006) trouble sleeping, often attributed to nursing shortages, poor scheduling practices and unsympathetic supervisors, is also a factor that affects job satisfaction and the likelihood of turnover. Kudo et al. (2006) conducted a study in which 293 full-time registered nurses, licensed practical nurses, and assistant nurses were given a survey designed to determine why they would consider leaving their jobs, if they were going to make such a decision. Using a multiple linear regression analysis as their data analysis method, the researchers were able to conclude that "Turnover intention may be reduced by the enhancement of trust in the organization, giving appropriate advice to young nurses and registered nurses, and developing measures for addressing sleep disorders" (p. 128).

The extent to which nurses are held accountable by their supervisors also enters into the picture of job satisfaction and organizational commitment. Sorensen et al. (2009) conducted a descriptive correlational study of 299 RNs working in rural settings in the Midwest. Using the Specht and Ramler Accountability Index-Individual Referent and the McCloskey-Mueller Satisfaction Scale (MMSS) the researchers were able to find a significant correlation between accountability and job satisfaction.

The philosophies of organizational leaders can also play a significant role in how motivated, productive and committed to the organization that employees tend to be. Birdi et al. (2008) discuss how "high commitment management" (also known as "high involvement management") fits into the future of strategic human resource management. According to the authors, these types of management strategies are "necessary to promote organizational effectiveness for modern volatile and increasingly competitive economic conditions" (p. 467). High commitment and high involvement management strategies focus on empowering employees to have a say in the decision-making process, but also emphasize training and development programs that boost the value of the organization's human capital. This, in turn, will ideally lead to increased productivity (Birdi et al., 2008). Furthermore, according to Neininger, et al. (2010), the implementation of high-functioning teams also fosters organizational commitment.

While there are many motivating factors that positively affect leadership practices and organizational commitment, many studies have focused on de-motivating factors as well. For example, Bodenheimer, MacGregorand & Stothart (2005) discovered that nurses leaders in chronic care situations often alienate their staff by failing to reward them verbally (or otherwise) for a job well done, and for not always showing the proper respect or trust toward the nurses. This in turn causes nurses to become frustrated, unhappy and unproductive.

Numerous factors, including demographic factors can alter the manner win which leadership practices affect nursing behaviors and attitudes. For example, Carver & Candela (2008) found that generational differences can largely influence job satisfaction, commitment to the organization and turnover. The divided the current nursing profession into four generations: Veterans, Baby Boomers, Generation X and the Millennial Generation, and encouraged leaders to learn to better "relate to the different generations and tap into their individual strengths" because this "can lead to improved nursing work environments." The authors further recommend that nursing leaders pay attention to cultural differences among nurses and adjust their leadership styles in order to ensure the greatest amount of loyalty and the least amount of turnover.
Conclusion

As technology continues to evolve, so do the ethical responsibilities of advanced practice nurses. This paper has discussed five important ethical issues related to modern technology in health care. These are: 1) technological error prevention; 2) responsibilities regarding access to confidential information; 3) responsibility to train new staff members on the system 4) to ensure complete honesty in all reports; and 5) to maintain commitment through the organization through effective leadership. Each of these issues was discussed in terms of its impact on the profession and on the patients, studies that have been done on the subject, and recommendations for solving the problems associated with each issue. Overall, nurses need to be better trained and less overworked, but the nursing shortage and lack of financial resources still continue to limit these options.

References

Birdi, K., Clegg, C.W., Patterson, M.A., Robinson, A., Stride, C.B., Wall, T.D., & Wood, S.J. (2008). The impact of human resource and operational management practices on company productivity: A longitudinal study. Personnel Psychology, 61, 467-501.

Bodenheimer, T., MacGregor, K., and Stothart, N. (2005). Nurses as leaders in chronic care. British Medical Journal, 330(7492), 612-613.

Carver, L. & Candela, L. (2008) Attaining organizational commitment across different generations of nurses. Journal of Nursing Management, 16 (8), 984-991.

Charette, R. (2006, June) EHRs: Electronic Health Records or Exceptional Hidden Risks? Communications of the ACM, 49(6),120.

Ellis, J.R. & Hartley, C.L. (2004), Nursing in Today's World: Trends, Issues & Management, Lippincott Williams & Wilkins.

Estryn-Behar, M., Van der Heijden, B., Oginska, H., Camerino, D., Le Nezet, O., Conway, R, et al. (2007). The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses. Medical Care, 45(10), 939-950.

Hillhouse, J., & Adler, C. (1997). Investigating stress effect patterns in hospital staff nurses: Results of a cluster analysis. Social Science & Medicine, 45 (12), 1781 -- 1788.

Kudo, Y., Satoh, T., Sinji, H., Miki, T., Watanabe, M., Wada, K., Hosoi, K., Hagita, K., Saito, Y., and Aizawa, Y. (2006). Factors associated with turnover intention among nurses in small and medium-sized medical institutions. Environmental Health and Preventive Medicine, 11(3), 128-135.

Krichbaum, K. Diemert, C., Jacox, L., Jones, A., Koenig, P., Mueller, C. & Disch J. (2007). Complexity compression: Nurses under fire. Nursing Forum, 42(2), 86-95

Lavoie-Tremblay, M., Wright, D., Desforges, N., Gelinas, C., Marchionni, C., & Drevniok, U. (2008). Creating a healthy workplace for new-generation nurses. Journal of Nursing Scholarsbip, 40(3), 290-297.

Lawrence, S. (2006) Study: Nurses not trained for IT, eWeek, Retrieved from http://www.eweek.com/c/a/Health-Care-IT/Study-Nurses-Not-Trained-for-IT/

Leiter, M.P., Harvie, P., & Frizell, C. (1998). The correspondence of patient satisfaction and nurse burnout. Social Science & Medicine, 47(12) 1611 -- 1617.

Mayfield, J. & Mayfield, M. (2006) The benefits of leader communication on part- time worker outcomes: A comparison between part-time and full-time employees using motivating language, Journal of Business Strategies, 23(2), 131 -- 154.

McDonald, S. (2000). The professional consequences of whistleblowing by nurses. Journal of Professional Nursing, 16(6), 313-321.

Mintz-Binder, R.D. & Fitzpatrick, J.J. (2009) Exploring social support and job satisfaction among Associate Degree program directors in California, Nursing Education Perspectives, 30(5), 299-304

Neininger, A., Lehmann-Willenbrock, N., Kauffeld, S. & Henschel, A. (2010). Effects of team and organizational commitment - a longitudinal study. Journal of Vocational Behavior. 76, 576-579.

Rutherford, B., Boles, J., Hamwi, G.A., Madupalli, R., and Rutherford, L. (2009). The role of the seven dimensions of job satisfaction in salesperson's attitudes and behaviors. Journal of Business Research, 62(11), 1146-1151.

Sabharwal, M. & Corley, E.A. (2009). Faculty job satisfaction across gender and discipline, The Social…