Luppo Kuillman

Moral reasoning explained by personality traits 57 3 INTRODUCTION Two decades ago, a medical workforce shortage in the Netherlands was predicted. To overcome the imbalance between the demand and supply of medical care, new professions such as nurse practitioners (NPs) and physician assistants (PAs) were introduced. In the Netherlands, both NPs and PAs are trained at a Master’s degree level and are employed in all medical specialties, including general practice (Zwijnenberg & Bours 2012, van den Driesschen & de Roo 2014, van Vught et al. 2014). The NP and PA program last 24 and 30 months respectively and enrolment requires an undergraduate degree in nursing or any paramedical science, besides having at least two years of clinical experience. From a socio-economic viewpoint, the introduction of NPs and PAs to Dutch society appears to contribute to a satisfactorily level of medical task shifting throughout the healthcare system (Laurant et al. 2008, Schuttelaar et al. 2011, Maten-Speksnijder et al. 2014, Timmermans et al. 2016). Both NPs and PAs are entrusted and legally enabled to autonomous practice (Bruijn-Geraets et al. 2014). Moreover, when viewing NPs and PAs as advanced practice providers, an important layer in the fundament of their professionalism, namely ethical understanding (Stern & Papadakis 2006), remains underexposed in the literature to date. In their professional codes of conduct, both health professionals are obligated to ethical standards. To adhere to the professional profile and codes of conduct NP and PA students are trained in presenting moral dilemmas experienced in their own daily medical life to explore the meaning of concepts such as: recognizing ethical implications, reflection on central concepts of professionalism in ethical decision- making and moral consultancy. In discussing personally experienced ethical dilemmas the generic principles of no harm, autonomy, non-maleficence, beneficence, justice, truthfulness and honesty and respect for human rights, if relevant, are employed to foster enhanced levels of moral reasoning. Yet, the NP and PA literature is scarce concerning predictors of moral reasoning as a skill necessary for thorough decision-making in moral dilemmas. This gap in evidence - not only for Dutch NPs and PAs but globally -presents an opportunity to explore ethics as a basic requirement for all healthcare professionals. With continuous changing healthcare environments (e.g., working conditions, contextual stressors, the pressing need for cost containment), the assumption is that ethical conflicts are commonly experienced by all healthcare professionals, regardless of their specialization