Honesty and Ethics in Nursing

by Jebra Turner | Oct 14, 2013 | Magazine

The latest Gallup Poll of Honesty/Ethics in Professions says the most trusted profession (for an astounding 13 out of the last 14 years) is—drumroll, please—nursing. When random Americans were asked to “please tell me how you would rate the honesty and ethical standards of people in these different fields,” more than 85% gave nurses “high” or “very high” marks.

This year’s rating is the highest since 1999 when the profession was first included in the poll. The one year nurses didn’t top the list? It was 2001, after the terrorist attacks of 9/11, when firefighters were included for the first and only time and scored higher. Gallup conducts the telephone survey in late November each year.

Health care professions dominated the top five most trusted groups: pharmacists came in next at 75%, medical doctors rated 70% (tied with the oddballs in this cohort—engineers), and dentists earned 62%. The lowest rankings go to car salespeople (8%) and, sadly, members of Congress (10%).

What is it that makes nurses so trustworthy? There are as many theories as respondents. Some say intimacy. After all, we stand naked—both literally and metaphorically—before nurses. But would the ratings be similar for massage therapists, say? Not likely. The Gallup data suggest that women—on the whole and on average—are seen as more trustworthy than men.

So would male nurses earn the same trust ranking as female nurses? Most likely.

But can nurses count on garnering trust automatically? Definitely not.

In the end, trust is personal. Some minority nurses especially feel that they must battle for respect. Here are a few ways to enjoy high regard in this very special profession—one that for many nurses is more of a “calling” than an occupation.

Embrace your role as a caregiver and patient advocate. “One reason for trust is that nurses have what I call the home-court advantage,” says Ramón Lavandero, RN, MA, MSN, FAAN, senior director of the American Association of Critical-Care Nurses. “They’re with patients and their families more than any other professionals. In the hospital, it’s 24/7; even with home care, nurses still have more patient and family contact than anyone else.”

Lavandero says another factor is that above all else, nurses keep their patients’ needs in mind. “They see nurses going to bat for them when there are rules or systems in a health care setting that aren’t effective.” For example, it doesn’t serve end-of-life patients, he says, when hospital regulations don’t allow visits from a lifelong pet.

Turn up the volume with stellar communication skills. “One of the things I learned as a man and a nurse and as a native Puerto Rican is that if I was comfortable in a situation, the patient was comfortable,” says Lavandero. “Ninety-nine percent of my experience was without problem, and that includes the year I worked in a labor and delivery unit.”

Strong communication skills become even more important when there is perceived bias, such as a patient who believes a minority nurse may be less competent or have a substandard education. “That’s when your communication needs to shine,” he says, “perhaps by addressing the unasked question with a comment like ‘Did you know, when I was a student at Columbia University …’” A skilled communicator learns that direct confrontation is only one way to address barriers such as mistrust, he adds.

Nurses must communicate with many parties besides patients, including families, administration, and other health care staff members. It’s not easy to speak to (and on behalf of) multiple constituencies, especially when a nurse isn’t familiar with a patient’s desires, circumstances, or cultural background. “That’s why we need to learn all we can about a patient and have to determine how to be honest without creating or introducing more difficulties,” says Lavandero.

Recognize that ethical issues are a cornerstone of nursing. “Nurses are also trusted because their Code of Ethics is grounded in fairness and respect for all people,” says Cynda Hylton Rushton, RN, PhD, FAAN, the Anne and George L. Bunting professor of clinical ethics at Johns Hopkins University in Baltimore. Ethical training is part of every nursing school curriculum, and a code of ethics guides all nurses as they care for patients, she says. This is not a profession that only pays lip service to a moral ideal.

Some common ethical questions that nurses must consider, according to Rushton, are: “How do we balance what patients or families want with what’s available? (Often there are limits.) Also, how do we balance quality care with safety and efficiency?” One element of quality care is relationships, she says, but the “health care system is relationally depleted” and devalues relationships in favor of efficiency.

Also, our American society and health care system “would like to pretend that death is optional,” she explains. “There is such fear and despair around aging, illness, disability, and death. Sometimes we feel that we’re doing things that are harmful or disrespectful to patients. That’s not what we’re called to do as nurses.” Nurses are often at the center of trying to navigate a broken system that causes them much distress, she adds.

Moral distress is a term Rushton uses to describe when a nurse knows the moral thing to do, but feels powerless to act on it. It’s paramount that nurses become knowledgeable about ethical issues and effective ways to address quandaries, she says.

The future can be brighter, though, if nurses realize the public’s trust in nurses is “sacred” and “hard won.” She implores nurses to “make sure, first of all, that we’re deserving of it. And second of all, uphold that trust.”