Running Head: NURSING CODE of ETHICS

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Running Head: NURSING CODE OF ETHICS

Renee Latoures

Nursing Code of Ethics

San Francisco State University

Introduction

One of the hallmarks of a profession is a tangible and enforceable code of ethics. A profession’s code of ethics helps distinguish it from other vocations and establishes the standards each member of the profession is held accountable to. In the profession of nursing this is the American Nurses Association (ANA) Code of Ethics. Members of the profession subscribe to their code of ethics when joining the profession. In nursing this is the time of licensure. Violation of the code of ethics can be grounds for disciplinary action or revocation of license. The ANA has outlined nine ethical provisions in Guide to the Code of Ethics for Nurses; Interpretation and Application for the nursing profession.

Provision 1:

The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

Provision one states that nurses should always conduct themselves professionally and practice with caring and respect for others thoughts, wishes, and perspectives irregardless of prejudice for individual characteristics such as race, cleanliness, ability to pay, illness, etc. Under this provision lie the tenets of providing all patients with inherent respect for their worth as a person, respecting the rights of all persons, and maintaining a nurse patient relationship that is not affected by the patient’s individualities or health issues. Furthermore, the respect, compassion and caring relationship the nurse is expected to demonstrate in their practice is not reserved only for patients but also for colleagues and all individuals encountered by the nurse.

This is important to nursing because individual prejudice and bias regarding race, religious beliefs, lifestyle, illness, disability, functional status, age, etc. should not affect the care given to any patient. Their worth as a human being should transcend any personal bias or feelings the nurse has. By eliminating such influences from the planning and delivery of care we maintain the patient’s individual autonomy and rights. However, this does not mean that we ignore each individual’s uniqueness, but rather they prevent it from negatively affecting the care they receive.

As a student during my psychiatric clinical rotation I was in charge of facilitating a daily group meeting in a psychiatric treatment facility. Many of the group participants had been homeless, were drug addicts, etc. and some had relapsed to the program multiple times (the veterans) while others were there for the first time. When some of the counselors conducted the group they relied on people who had been there before for input and involved them more since they had “been through this before.” The veterans did have past experience to contribute but when conducting the group I did not look at each of them by these labels but treated them all equal affording each the same opportunity to share, ask questions and participate. They were all worthy of the same amount of care and help I could provide and I divided my care to each as equitably as possible.

Provision 2:

The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.

Provision two states the nurse’s responsibility is first and foremost to his/her patient. It is important to realize that the term “patient” does not only refer to an individual or individuals, but families and communities as well. Patient in this context refers to any recipient of nursing care. Additionally, this commitment to the patient should drive the nurse to include any members of the interdisciplinary team that might benefit the patient’s care.

This is important to nursing because families, other practitioners, institutions, etc. may compete for the nurse’s loyalty or persuasion and the nurse must remember their primary responsibility is to be an advocate to and for their patient not these competing influences. In doing so the nurse prevents other factors or people from influencing their decisions, actions, and care for their patient. It focuses the nurse’s perspective to that of the patient not competing issues.

Recently during my capstone, a patient’s family did not want me to give their family member pain medications indicating that she was only uncomfortable when she moved and she wasn’t moving. When present, the patient deferred such choices to her family. To me, the nurse, the patient was in visible discomfort and trying to stay still was not a reasonable pain management strategy. I also suspected the family did not want pain medication given because it made the patient drowsy and they wanted to visit with her. I told the family I needed to check her surgical site and asked them to step out of the room for a moment. Once they had left I offered the patient pain medication again in private and she said yes and thanked me. This made the patient more comfortable and eliminated her having to go against her family’s wishes in their presence. My priority as a nurse was to my patient and helping control her pain not to her family requesting no pain medication.

Provision 3:

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

Provision three states that the nurse focuses not only on the care given but promotes the rights, safety and protection of health of patients. This provision extends beyond the patient the nurse is caring for more globally covering patient care in general. In provision three, the term “protect” is purposely used to point out how the nurse acts as a gatekeeper for the patient or patient groups. Furthermore, Included in this provision is patient confidentiality, research ethics, and reporting of impaired coworkers who jeopardize patient care.

This is important to nursing because it focuses the nurse’s actions and encounters with the patient specifically. Such principals are used to drive protocols and promote the well being, protection, and autonomy of all patients and improves all patient care.

During a clinical rotation the nurse I worked with and I observed that the nurse we took report from had not given medications on time for any of her patients and had not given some medications all together. Upon discussion with the charge nurse we learned this was not the first time this had happened. We completed an incident report regarding her substandard care not only for the specific patient’s we had but in order to protect future patients the nurse may care for, as this was not an isolated incident.

Provision 4:

The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.

Provision four states that the nurse is responsible for their individual actions (their practice) and decisions including the delegation of patient care responsibilities. The two key concepts of this provision are responsibility and accountability. The nurse is responsible for the patient care given and accountable for their own practice.

This is important to nursing practice because it makes nurses accountable for the care they give and responsible for providing appropriate care. This provision provides consistency about the patient care outcomes when the responsibility of a task is transferred to another person by keeping the nurse accountable for the outcome or completion of a task they delegated to an appropriately qualified person.

In my capstone I had competing patient interests. I placed a patient on a bedpan and left the room to give her privacy. I needed to assist another patient at that time so I asked the CNA to take the patient off the bedpan in five minutes. Ten minutes later I had not seen the CNA because she was busy elsewhere so I went to make sure the patient’s bedpan had been removed. I delegated this task to the CNA but I was still responsible for the outcome of ensuring it was completed.

Provision 5:

The nurse owes the same duties to self as to others, including the responsibility to reserve integrity and safety, to maintain competence, and to continue personal and professional growth.

Provision five highlights the profession’s focus on service to those who need care while remembering that the nurse must also focus on self care. Provision five states that nurses have an obligation to take care of themselves and keep themselves safe. This applies both physically, mentally, spiritually, educationally, and so forth. This provision also specifically points out educational and professional growth as a responsibility the nurse owes themselves.

This provision is important to nursing because if nurses only focus on their patients they may neglect themselves and overextend themselves. When their own personal care is neglected the care they give also diminishes. It is a reminder that nurses must take care of themselves in order to be able to take care of others and neglecting to do so puts patient care at risk.

My capstone preceptor works eight hour PM shifts. One shift the nurse manager came and asked if she could stay through the eight hour night shift because they were having staffing problems. My preceptor stated that she was scheduled to work the PM shift the following day. She told the nurse manager that she could work tonight’s night shift for a total of sixteen hours worked at once, but she would need to have the following day’s PM shift off. At first the nurse manager resisted giving her the following day off but my preceptor was adamant she could only work one of the two shifts and left it to the nurse manager to decide which. My preceptor was making sure to take care of herself first, so that she was able to provide the level of care expected of her and did not fold and take both shifts. She has a duty to care for herself and she did so in a difficult situation where they wanted her to work sixteen hours on, eight hours off, then another eight hours on.

Provision 6:

The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

Provision six states that through individual or group action the nurse promotes the professional values of nursing in the healthcare environment. The idea behind this provision is that the environment and its morals directly affects the ethical dilemmas that occur and all nurses are obligated to contribute to the healthcare environment in a way that supports the ethics of the nursing profession.

This is important to nursing because it helps establish a standard for workplace ethics. An ethical work environment both for patients and coworkers is the responsibility of each professional to establish, uphold and maintain. Both through individual and collective action an ethical healthcare environment is created. And once created, reflected in its practice.

On some nursing units I have seen nurses are reluctant to go on a break until they are completely caught up with their work. However, on a busy nursing unit completely catching up before the end of the shift if often very difficult. Where I am precepting, there is a break schedule and the nurse going on break passes along whatever unfinished or in progress work they have to the nurse relieving them. The culture of this floor accepts that when you go on break you will leave work behind to be done by your relief nurse. While a nurse may try to get a specific task done before their break because they are more familiar with say the wound dressing, the relief nurse does not make the nurse feel bad for leaving work behind while on break. This is a more positive unit culture where it is ok to have work undone and each nurse contributes to this by not complaining when someone has work to be done when they go on break. As a result no one hides work that needs to be one or puts it off.

Provision 7:

The nurse participates in the advancement of the profession through contributions to practice, education administration, and knowledge development.

Provision seven states that the nurse is responsible to contribute to the progression and development of the profession and field of nursing. This involves advocacy and policy development, development of standards and practices, and generation and distribution of knowledge.

This provision is important to nursing because it connects individual nurses and their practice with nursing as a whole (the profession) and the social roles and responsibilities of nursing. It helps individuals define a sense of professional obligation that is individualized to their practice.

I have a BS degree in Gerontology. In my clinical practice I bring my unique knowledge of the social, biological, and psychological aspects of aging. I possess an extended understanding of the issues facing this specific population and by sharing this knowledge with my colleagues I am helping further the development of practice of our unit as a whole. I can use my unique knowledge for more than my own practice but share it with others so they may also use it in their practice as well.

Provision 8:

The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.

Provision eight states that the nurse collaborates with other health care personnel and the public to further health needs both locally and globally.