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The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

The study is qualitative descriptive, in which researchers stay close to the data. The data were collected in the format of unstructured written reflections. Inductive conventional latent qualitative content analysis was applied to the data.

The issues of head nurses’ management of decision making in ethical dilemmas relate to the following aspects: taking risks in deviating from the formalities, balancing power and humaneness, maintaining the professional hierarchy, managing resistance to change, managing with limited options, and experiencing the decline of nurse’s professional and/or human dignity.

Reflections in written form were preferred to semi-structured interviews and the researchers were unable to contact the participants directly and to ask additional questions. All the reflections were produced in a language other than English.

The issues of head nurses’ management of decision making in ethical dilemmas reveal the gap between societal expectations and the opportunities to improve nursing leadership in health care organizations.

The issues of head nurses’ decision making when managing ethical dilemmas are related to contexts that reflect the attitudes of society and health care system toward nursing management.

The study adds to the understanding of issues of the management of decision making in ethical dilemmas. It is an ongoing systematic process that encourages head nurses to learn from practice and manage the quality of care by empowering themselves and nurses to take responsibility for leadership.

The study aims to explore the experiences of nursing personnel in private health care organizations in Lithuania, in terms of their work motivation and satisfaction, promotion and quitting the job, interpersonal interaction at work and to identify areas for sustainable improvement to the health care services they provide.

The research problem includes the following questions. What is the attitude of nursing personnel to the existing elements of motivation in private health care organizations? What organizational tools should be developed in order to improve the motivation of nursing personnel? The sample consists of 237 registered nurses practitioners and 30 nurses' managers working in private health care sector. Methods: data selection: questioning survey; data analysis: descriptive statistics, correlation and factor analysis (using SPSS for Windows 12.0). The research instrument involves 99 closed‐ended items divided into 11 evaluation blocks; Cronbach α of every part ranges from 0.68 to 0.85.

Results showed no statistical differences among nurse practitioners and executives of what motivates them in private health care organization as workplace and illuminated factors that decrease and increase motivation among nurses. Motivation decreases, when nurses are not empowered not autonomous in activity; nurses' competencies (specific professional and general) are not applied in full value, e.g. managerial, educational, social‐psychological, clinical/expertise; decisions are not made collectively; in organization does not exist mechanism of information‐sharing; meetings of personnel are not prepared methodically. Motivation increases when the nurses collaborate with physicians by parity; nursing profession is respected and recognized as autonomous and valued by themselves and other health care specialists; the interpersonal communication is effective and conflicts are solved constructively.

A major weakness is that the characteristics of the present sample may limit the generalizability of the results. The major implication is that the paper supports the prediction for characteristics of motivation among health care workers in private health care organizations with perspective of nursing personnel.

The paper examines in a private health care sector the factors that increase and/or decrease the motivation of nursing personnel.