There is a need to develop evidence-based support at the organizational and individual level to support nurses' ethical competence. Barriers for multiprofessional cooperation in ethical issues should be recognized and addressed as part of the development of organizational ethical practices. Research should pay more attention to the conceptual, theoretical and practical perspectives of ethical competence.

Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses' ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.

These findings should assist nurse leaders to implement effective support practices to strengthen nurses' ethical competence, ethical safety, and work satisfaction.