Nurse managers (NMs) lead the biggest personnel group in health care—nurses. They have various responsibilities in clarifying an organization’s values to their staff and overseeing and supporting continuous upholding of ethical standards and nurses’ ethical competence.

The purpose of the study was to investigate the frequency and difficulty of the ethical problems NMs encounter in their work and to determine the background factors correlating with the problems.

Cross-sectional survey design was used. Ethical problems were approached by five categories related to patients, nursing staff, other professional groups, the organization, and the NMs themselves. The data collected with questionnaires from NMs in ward, middle, and strategic management (n = 214) in Finland from November 2014 to May 2015 were statistically analyzed.

The most frequently encountered ethical problems were related to nursing staff and organization: About half of NMs encountered those problems at least weekly. The most difficult ethical problems were related to the organization—the mean value of the sum score being significantly higher compared to the four other sum scores (p < .0001). When combining information on the frequency and difficulty of the encountered ethical problems, organization-related problems were the most significant. The more positively NMs assessed their work-related background factors, the fewer ethical problems they encountered and the easier they considered them.

Awareness of the frequency and difficulty of ethical problems in nursing, especially those related to organization, needs to be increased in health care organizations to find solutions for dealing with them.

Strengthening resources for ethics, like ethics experts and multiprofessional committees, may be helpful. Ethical consideration and discussion of prioritization should be routinely used in administrative decision-making. Ethics education and instructions for repetitive situations could increase NMs’ ability to manage with ethical problems. Support mechanisms are needed for situations where difficult value clashes appear.