Objective: To investigate ethical dilemmas and ethical decision making in nursing administration by Head Nurses in the regional hospitals of southern Thailand.

Design: A qualitative approach involving the "Critical Incident Technique" presented by Flanagan (1954)

Materials and methods: Fifty-three Head Nurses who met the inclusion criteria were purposively recruited from five regional hospitals. Data was collected and analysed by using the Critical Incident Technique.

Result: Among one hundred and eight critical incidents in nursing administration reported by 53 Head Nurses, six themes of ethical dilemmas, and six themes of ethical decision making were identified. The six themes of ethical dilemmas included 1) obligation to manage/improve quality of care for the benefit of patients vs. obligation to the organisation/colleagues, 2) advocating for subordinates/patients vs. maintaining relationships with the health team, 3) a duty to perform Head Nurse’s roles in personnel management vs. follower’s duty to organisation, 4) whether or not to follow policies/commands which result in negative consequences for some patients/nurses, 5) having conflict when acting as a mediator, and 6) whether to choose motivation or justice in job performance evaluation. For ethical decision making by Head Nurses, six themes emerged 1) following higher authority, 2) managing for quality of care, 3) maintaining good relationships and avoiding conflict among colleagues, 4) consulting with others to find solutions, 5) working for the benefit of nurses, and 6) following the policy and regulations of the organisation.

Conclusion: Head Nurses in regional hospitals of southern Thailand encountered a wide range of ethical dilemmas for critical incidents in their daily administrative practice. They made a variety of ethical decisions in order to solve ethical dilemmas. The results of this study reflect the ethical dilemmas and ethical decision making in nursing administration by head nurses which can be used as baseline data and guidelines to improve the ethical decision making skills of Head Nurses.