What’s New in the Code of Ethics for Nurses?
By Megan Murdock Krischke, contributor
The release of the revised Code of Ethics for Nurses with Interpretive Statements on January 1, 2015, kicks off what the American Nurses Association (ANA) has designated the “Year of Ethics.”
“We want to make a concerted effort to educate our nursing public, and our general public, about nursing ethics and that requires a number of activities and approaches. So we decided to spend 2015 focusing on the topic,” explained ANA president Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.
The Code of Ethics for Nurses (the Code) has been around for 65 years and undergone a number of revisions. After surveying around 2,000 nurses, the ANA concluded that enough changes had occurred in nursing to necessitate another set of revisions.
Changes in technology in the workplace, in how society and nurses view certain types of care and interactions with patients, and in the needs for and threats to patient privacy, among other elements, called for a more contemporary document.
“There are several areas of change that stand out to me,” reflected Cipriano. “When we think about ethics, we try to think very broadly. The starting point is making sure that nurses are acting as advocates for patients, protecting their dignity and worth and that their rights, such as privacy and self-determination, are protected.”
“One of the more obvious developments over the last decade is with end-of-life decisions. There has been a big push for patients to give explicit direction to their family and their health care team about what kinds of life-sustaining measures they want, or more importantly don’t want,” she continued. “There are times when a nurse would be in a position to say, ‘Even though the patient didn’t record their desires, they discussed them with me,’ or ‘I was asked to be a witness to this conversation.’ Ten years ago, more often the family’s wishes were catered to rather than the patient.”
“Many of the ethical issues facing nurses today are similar to those we faced 14 years ago. For example, end of life, euthanasia, forgoing nutrition and hydration, the right to refuse treatment and protecting human dignity have been on my radar for the 32 years that I have been practicing as a nurse,” added Jill Arzouman, MS, RN, ACNS-BC, CMSRN, president, Academy of Medical-Surgical Nurses (AMSN). “But some issues, though maybe not new, have intensified.”
“Technology has advanced and often resources are scarcer,” Arzoumann continued. “I face ethical dilemmas trying to discharge a patient who does not have access to home health nursing after a major surgery, or a patient whose best chance for survival is IV nutrition at home and it is not covered by insurance. The Code should help nurses navigate some of those decisions.”
The nine provisions in the revised nursing code of ethics are concise sentences that are elaborated upon in the interpretive statements that provide additional guidance.
“Even if a nurse has never read the Code, it is likely that he or she has been educated in that way of thinking. The Code provides good guidance and is an amazing resource. The Code provides clarity on nurses’ responsibility to the public and can ensure that nursing practice is ethical at all times,” remarked Cipriano.
Both Cipriano and Arzouman encourage nurses to take the time to read through the code of nursing ethics and to refer back to it when they are in challenging situations.
“Nursing ethics is woven into our daily practice. We need to be the experts on our practice,” encouraged Arzouman. “The Code should not be read and then put back on the shelf--it should be discussed and applied. I envision nurses engaging in conversations about ethical dilemmas and how they would use the Code to guide their decision-making.”
“The AMSN is currently forming a plan to disseminate the information on the Code to our members. It is an important topic and nursing organizations can lead the way by sharing the information via email, social media and their publications,” she added.
“Every nurse must exert leadership around ethical issues. It isn’t okay for someone to perceive a misstep or ambiguity without speaking up. Speaking up immediately is important for making sure you don’t put yourself or your patient at risk,” stated Cipriano “We [at ANA] strongly believe there must be an ethical practice environment.”
“A concern that nearly every nurse will express is, ‘I never feel like I have time to do all for my patients that I wish I could;’ this leads nurses into moral distress,” she continued. “The bottom line is, when you are sizing up your work environment you need to be looking at whether you, your colleagues and leadership have ethical practice all the time and, if not, how to do you make changes that will move the environment in that direction.”
“My advice as a seasoned nurse is for nurses working in the clinical setting to read, dissect, and digest the content. Engage in discussions with colleagues, trusted mentors, and senior nursing administration. Be professional and prepared to address ethical challenges as they arise. The public is counting on us,” Arzouman concluded.
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