Chapter 5: United We Stand

Ethical Advances

A profession or a scientific field can make great advances when the people belonging to that field make it their personal responsibility to work towards targeted improvements (Holm, 2006). These improvements can come from advancing the rules concerning the practice, participating in the education of others, performing administrative and counseling duties and doing active research towards the development of knowledge. The code of ethics for nursing recognizes this as a duty for all nurses even if they are directly engaged in health care delivery (ANA, 2001).

This does raise a question about the role of a nurse who works with patients at their bedsides since it would be rather difficult to expect all nurses to start producing research papers for publication in journals while they are on active duty. In such situations, the code of ethics (2001) provide other means by which the nurse can discharge her duty to the field such as:

• Acting as a mentor and guide for other nurses in the workplace
• Being a part of the various education or research related committees in a health service facility
• Serving as models for integrity

Even participation in civic activities as a nurse improves both the visibility of the field and the respect that the public has for the profession; therefore, such activities can also help in fulfilling the ethical obligations a nurse has to the profession (ANA, 2001).

No one is in a better position to advance the field than the nurses who work as educators and research experts. They are often considered to be mentors for younger nurses who are just venturing into the field, and have the ethical duty to try and enhance the level of commitment for future nurses. Similarly, nurses working as research professionals are in an excellent position to improve the visibility of the field and can support field nursing with their contributions towards increasing the collective knowledge base for nursing (ANA, 2001).

At the same time, there is one area in which all types of nurses can make contributions and that is the creation of standards, ethical guidelines and recommended operational procedures for various situations which nurses can come across (Holm, 2006). For example, nurses on active duty can give first accounts of the situations which they face and make their recommendations for those who are doing research on the topic. Researchers can then consult each other, as well as currently accepted nursing procedures to come with improvements or solutions to a given problem. Finally, educators and nurses working as teachers can convey the message to student nurses, thus completing the cycle of improvements for the field. If all nurses strive for such a cycle of improvements it is very likely that the results would make things better for all concerned individuals.

The development of regulations and standards for nursing practice is also an ethically recommended activity since it allows the field to improve with input from nurses themselves. Of course an expert on the principles of ethics could also compile a code of ethics for nurses by utilizing the commonly accepted ethical rules for various professionals. However, the people who make such standards should be experts in the field as well as expert nurses since they would be more aware of the issues and challenges of modern nursing (Holm, 2006). Any standards or practices which have been developed should be inline with accepted guidelines, and should reflect the level of commitment which the nursing profession has to itself and to society at large (ANA, 2001).

While a nurse could be given a ready made document for ethical guidelines and for acceptable practices in a health care facility, it is also the responsibility of the individual nurse to identify her position as outlined in the code of ethics or the rules which are enforced at the work place. For example, if a nurse works in the children's ward of a hospital she should focus on the ethical requirements which help her balance the wishes of the patient, as opposed to the wishes of the family decision maker. On the other hand, if a nurse is engaged in the administrative side or is working on a research topic, then the ethics concerning collaboration with other nurses become very important.

Likewise, nurses engaged in education and learning have a different set of ethics which have a higher importance than others. For example, a student nurse would give special importance to the ethics of learning and improving her abilities. In all cases, individual nurses have to understand the ethics which are applicable to them in particular and the field in general (ANA, 2001). This ethical requirement is in addition to understanding and appreciating the social values, local guidelines, state regulations and federal laws which are concerned with the nursing field.

Just as every nurse has an ethical obligation to learn about the field and be aware of happenings in the nursing profession, every nurse also has the obligation to help other nurses in learning and understanding their roles as members of the nursing community. It would be unethical to keep information from other nurses, or to not inform them to the best of one's ability, if the nurse knows something important regarding the topic being discussed. The code of ethics acknowledges the fact that knowledge is created and shared amongst teachers and researchers in the fields of humanities and sciences which have a direct effect on nursing. Therefore, the study of these fields is also appreciated as a duty towards the collective (ANA, 2001). On a personal level, studying about humanities and other sciences would only make a professional nurse a more rounded individual; therefore, there is a significant personal benefit for nurses who choose to do so.

For such developments to take place, the culture of the facility where the nurse is working, as well as the resources made available at the facility, have to be of a high quality. If a nurse does not find such resources or such an environment she can always make suggestions and work with the administrative bodies to ensure that such an environment can be created with time and effort. Given the high ethical standards that nurses are supposed to adhere to, such efforts clearly come under the dictates of improving the overall nursing environment where the collective and collaborative efforts of many nurses help in improving the situation of the entire field.

Collaboration and Cooperation

One nurse working on her own can help towards curing the ailments affecting several different patients. If all the nurses in the world are united, it is logical to assume that they can help do a lot more when and if they work in unison. It is for this reason that the code of ethics suggests that nurses should cooperate with each other when it comes to promoting community welfare, along with countrywide or international efforts to improve health.

Undoubtedly, there are quite a few issues on the global level which one person can not handle, but it would require the strength of the collective to change situations and create an atmosphere where these issues can be tackled (UN, 1998). In the particular case of nurses, as defined by the ANA code of ethics (2001) these problems include:

• Decreasing world health standards
• Increasing world hunger and poverty
• Environmental pollution
• Accessibility of health care services
• Human rights issues

Even things like public smoking and substance abuse can become problems for a society which has to deal with the negative effects of these social issues. Nurses have the responsibility to take on these problems on a collective basis since many of the problems mentioned above can only be handled with legislative change, governmental influence and social intervention. Clearly, the best way to make sure that positive changes can come into force is the use of collective action along with individual support for the solutions to the problems.

It is rather difficult to understand why nurses should be focused on these issues on a collective basis but the code of ethics explains this focus by making the nurse a part of the community she serves (ANA, 2001). A nurse is expected to know what is good for health and what is bad, at the same time, the ethics and morals which are integrated into the person of the nurse show her that those who are suffering should be helped. Therefore, when nurses take collective action, they should seek out what would be better for society rather than looking at the betterment of the individual.

Such collective actions may not necessarily come from working with the nursing community alone. For example, Nurse Edna volunteers for a local church which addresses community issues such as poverty, shelters for the homeless and children on the street. In her capacity as a nurse, she provides medical assistance when she can and this action, as well as her work as a volunteer, certainly fulfills the ethical requirement of working for the community. Similarly, a nurse may choose to work with any organization that deals with social issues and tries to improve society through fields other than nursing.

The Responsibility of Official Organizations

The last provision of the code of ethics brings the entire debate on nursing ethics to a close by coming back on to the role of the professional organizations that control and define the rules which are meant to be followed by nurses. Just as individual nurses are told to seek out the ethics concerning their profession, the ethical nursing organization is told to seek out nurses and inform them regarding their ethical obligations (ANA, 2001).

Additionally, ethics forbid the organization for making their ethical rules the final word on nursing ethics since the door for debate, discussion and change is always open. In fact, professional organizations are supposed to encourage debate and discussion which leads to improvement and further development of the field (ANA, 2001). Moreover, the professional bodies also have a duty towards the public since the public needs to be informed about the position and the status of nursing in a positive light which is reflective of their high value and position in society (Caputo, 2006).

While individual nurses are monitored by their superiors and have performance reviews by groups of their colleagues, the professional agencies are supposed to monitor themselves and the members of the organization. Promotion of the code of ethics and the associated rules and regulations is very important for such an organization since there are few ways in which a breach of ethics can be handled within such a setup. Constant improvements and developments of the ethical code as well as other guidelines for the nursing profession are also an obligation for any such organization (ANA, 2001).

The connection between any such social organization and society at large can not be denied; that is why nursing organizations have an ethical responsibility to work towards social reform. The nursing field does not exist in a vacuum, nor does it exist solely for the benefit of nursing; therefore, nursing organizations also work with social causes and might even be called up to take a role in politics (Caputo, 2006). This is because political activities are one of the most effective ways in which change can be brought into a system that exists with governments and ruling political parties controlling the health services.

Therefore, whenever an issue of importance comes up which deals with the political, social or economic condition of the general nursing community, the organization which governs professional nursing is ethically bound to present the opinions of the nursing community in a manner which best fits the ethical guidelines and professional regulations for nurses. At the same time, such bodies are supposed to continually monitor important issues which can shape the future of nursing and society at large in relation to the delivery of health services. At times, nursing organizations may even be called upon to speak up on broader issues which go beyond the scope of health care services delivery and reimbursement methods (ANA, 2001).

These issues are very much the same points on which individual nurses can be called to speak on and point out ways in which problems in society can be solved. For example, the violation of individual rights, the concern for the homeless population, the rising violence in society and the negative image associated with illnesses such as mental disorders, AIDS and other diseases are all social problems which need to be solved with collective means. The ANA code of ethics (2001) makes this a particular responsibility of the nursing organizations and a general responsibility for all professionals attached to the nursing field.