Hospital Social Workers' Perceptions of Ethical Environment

Background & Purpose:  Hospital social workers are working with professions educated and trained in different ethical models, which may affect the hospital Ethical Environment.  Ethical Environment is a perception both communicated to and constructed by employees about the ethical practices of the organization, and affects ethical behavior.  Prior hospital Ethical Environment research with small, non-representative samples of nurses suggests variables related to perceptions of Ethical Environment.  Hospital social work ethics literature indicates similar variables related to actual ethical behavior, but has not considered Ethical Environment.  Utilizing a large, nationwide, representative sample, the purpose of this study was to (1) determine hospital social workers perceptions of Ethical Environment, and (2) explore the relationships between personal, professional, and organizational variables and those perceptions. 

Methods:  Five hundred randomly selected hospitals from a list of all hospitals in the U.S. with 200 beds or more were invited to participate by phone.  A secure, web-based survey link and invitation was emailed to hospital contacts who agreed to participate.  The Ethical Environment Questionnaire (EEQ) measured the dependent variable.  Personal, professional, and organizational variables included demographics, religiosity, job satisfaction, education, ethics training, and information about the employing hospital.  Analyses included t-tests, ANOVA, and multiple regression modeling, with confirmatory testing and effect sizes, and psychometrics for the EEQ instrument. 

Results:  The sample is 973 social workers from 290 hospitals across 40 U.S. States, a 58% hospital response rate, and a minimum 24% social worker response rate.  The sample is primarily female, Caucasian, MSWs, working full-time in non-profit hospitals in centralized social work departments.  The EEQ instrument performed well and provided a mean EEQ score for social workers of 73.2 on a 100-point scale, which is significantly higher than the values from previous EEQ research with nurses.  Greater religiosity predicted higher EEQ scores, but was completely mediated by job satisfaction, the strongest predictor of EEQ scores.  Professional social work education was not found to have a relationship with perceptions of Ethical Environment.  Social workers rated the Ethical Environment of for-profit hospitals with centralized social work departments more favorably.  A regression model of contributing variables explains 29.1% of the variance in perceptions of Ethical Environment, the majority (22%) from job satisfaction.

Conclusion & Implications:  Social workers in the sample rated hospital Ethical Environment positively.  Job satisfaction is the only practically significant predictor of perceptions of Ethical Environment.  Literature indicates that both job satisfaction and Ethical Environment are positively correlated with actual ethical behavior.  The finding of no relationship between ethics education and perceptions of Ethical Environment may suggest a weakness in the connection between education and ethical reasoning and action, consistent with the literature.  More research is needed to find a method of ethics education that will translate into practice behavior, and attending to the influence and construction of Ethical Environment may be helpful.  Finally, organizational resources and structures are indicated as contributing to the favorable perception of the Ethical Environment in hospitals, which suggests the need to support both attention to ethical issues and a centralized social work department.