Heavy Burdens

Ethical Issues Faced by Military Nurses During a War

Deborah J. Kenny, PhD, RN, FAAN; Patricia Watts Kelley, PhD, FNP-BC, GNP-BC, FAANP, FAAN


Online J Issues Nurs. 2020;24(3) 

In This Article

Abstract and Introduction


American nurses have faced hardship and challenges in every war period in the relatively short history of the United States. This study was an in-depth reanalysis of a two-phase larger study of uniformed service nurses caring for service members injured in the conflicts in Iraq and Afghanistan. In this second phase, a qualitative descriptive study, 235 nurses and 67 wounded service members were interviewed in face-to-face discussions about their caring and care experiences. The article offers background information, discussion of the study methods, and presents some of the ethical issues faced by deployed nurses who were caring for the injured service members and injured/ill civilians during conflicts in Iraq and Afghanistan. Study findings revealed six themes that emerged directly from the data, providing a comprehensive picture of the many issues faced by these nurses. The stories of the nurses are used to illustrate many of their ethical dilemmas. We offer discussion with implications and recommendations for training and subsequent post-deployment care of these nurses. This article adds to the growing body of literature in the field of military nursing ethics.


It is no surprise that American nurses have faced hardship and challenges in every war period in the relatively short history of the United States (US). For example, Wood (1972) recounted how nurse volunteers during the civil war not only endured the harsh conditions of the war and cleaned up the unsanitary conditions of the military hospitals, but also fought another war themselves with the male dominated medical profession bent on keeping women away from the battlefield or defining their own profession of nursing. Norman (1999) detailed stories of 77 nurses in World War II who were captured by the Japanese, taken prisoner, and held for three years in a prison encampment in Bataan. In interviewing her aging subjects, she discovered a strength within them that was unmistakable; one that allowed them to survive their dire situation while still caring for other prisoners of war. However, despite this, and the fact that psychologists believed nurses' education and their experiences had somehow left them immune to the ravages of war, Norman (1999) found that "the opposite was true: they felt too much" (p. 242). This was supported in a study that considered a direct correlation between moral sensitivity and moral distress of nurses in two countries (Ohnishi et al., 2018). Ironically, it is the empathy of nurses that will often cause them to suffer secondary traumatic stress (Bride, Radey, & Figley, 2007).

Also in World War II, some 10,000 American nurses were involved with troops in France, Germany, and Sicily, saving lives and making vital contributions to military medicine (Sarnecky, 1999). However, they too suffered in silence, rising to the occasion time and again, even though they themselves were hurting. It has been this way in war after war; nurses have been willing to put their lives in danger for their charges, work as long or hard as necessary to ensure the injured got the best care they could give. In former years, this stress has been dismissed, with some claiming that nurses do not suffer the stressors of those who are fighting (Lucchesi, 2019). This position is changing and the stressors of nurses in wartime scenarios are becoming more recognized.

In virtually every war in every country, we hear of nurses suffering distress and handling ethical issues. Generally, this is only documented through stories told by the nurses, mostly after many years have passed since their experiences in an attempt to not lose the memories of their stories (Agazio & Goodman, 2017; Nightingale, 1859/1992; Norman, 1999; Sarnecky, 1999; Sorokina, 1995). This article will discuss some of the ethical issues experienced by nurses during the wars in Iraq and Afghanistan. Though the stories are vastly different from those of their predecessors because of medical and technological advances, the issues remain nearly the same. We will describe some of the ethical dilemmas faced by nurses in a wartime environment, as they were described to the research team.