Ethical practice has always been the foundation of high quality nursing care – going way back to the days of Florence Nightingale. The scope of nursing practice has changed drastically since then; it has broadened considerably just in the last two decades. With that in mind, the American Nurses Association (ANA) has designated 2015 as the “Year of Ethics” and has issued a revised code of ethics for nursing. The revisions were made in recognition of how complex nursing has become, and were designed to more clearly explain the nine key provisions of ethical nursing practice. The revised code uses interpretive statements for each provision, to help nurses apply theoretical concepts to everyday practice.
At the end of 2014, for the 13th year in a row, a Gallup poll ranked nurses as the top profession for trustworthiness and ethical standards. A full 80 percent of the people surveyed gave nurses high marks in this regard – and this is 15 percentage points higher than the next ranked profession. Clearly, this is something we can all take pride in!
Complexity in Healthcare Brings New Ethical Challenges
Evolving conditions in healthcare have potentially strengthened the need for a strong ethical framework that all nurses can identify with. Nurses may currently find themselves in possession of greater autonomy and decision making power. Obviously, this applies most directly to advanced practice nurses. However, many hospitals are giving nurses the ability to make autonomous decisions about areas of patient care like when to remove urinary catheters or initiate isolation precautions. Decisions like this come with an ethical imperative to monitor the patient’s status and integrate new information in order to plan a course of action.
The complexity of healthcare today has also resulted in an increased need for interdisciplinary collaboration. By its very nature, collaboration requires a high ethical regard for trust, respect, shared decision making, and open dialogue. As the ANA points out in its revised ethics code, even nurses in non-clinical roles (education, research, administration) collaborate to ensure high-quality, patient centered care – they do so by influencing the standards for nursing practice.
And as healthcare expands its focus on population health management and community-based interventions, nurses are increasingly finding that their mission must include promoting wellness, rather than just treating illness when it occurs. This means nurses now have a relationship with society as a whole, and not just with patients and other providers. The spotlight on relationships and respect for human dignity is what differentiates nursing ethics from the broader field of general medical ethics.
Understanding the Ethical Framework
To be effective, an ethical guideline must clarify what is right and wrong in a specific realm, so it is not just abstract theory. Ethics is a structured examination of questions like Is it ever okay to deceive a patient? And if so, under what circumstances? Most importantly, ethics isn’t about your opinions or intuition. While you may have a strong instinct, for example, that it is unethical to continue chemotherapy in a frail, elderly patient, you must first understand that not all opinions are equally well supported. How well informed are you about this issue? Can you build a strong case for your argument to discontinue chemo, based on solid medical evidence, your knowledge of the patient’s preference, and other key criteria?
An argument built on a foundation of opinions can quickly come tumbling down, which is why we must base nursing ethics on critical thinking – particularly when it comes to challenging existing practices, or evaluating the role of a research study in everyday nursing practice.
By far, the most effective way to expand critical thinking skills is through education. When you acquire a broader view of healthcare, from a systems and policy perspective, you equip yourself to make the most informed decisions possible and to better advocate for your patients.