While industries attempt to address the spread of COVID-19, nurses have been working long hours, many times with insufficient personal protective equipment (PPE) and constantly changing state and federal requirements. They are also having to make ethical decisions about patient privacy, informing others of likely exposure, and patient treatment, and as the fight against the virus continues, we are seeing new and changing ethical issues arise.
The Code of Ethics for Nurses is the standard for ethical training and decision making, and is a resource that nurses are taught to know and implement. However, as the day to day operations of hospitals continue to be fraught with unexpected challenges, it is up to the frontline workers to fight for the ethical treatment of patients, families, and even themselves. As the front line personnel most intimately familiar with COVID-19 cases, nurses have a unique perspective on the effects that this pandemic is having on their communities and patients.
Knowing the available ethics resources, standing as an example of ethical conduct, and staying as up to date as possible on regulatory changes, are just the first steps in fighting for quality of care during this turbulent time. As a nurse in the midst of it, you can use the following tools to hold yourself, your colleagues, and your organization accountable.
Know Your Code of Ethics and Related Resources
The first step in being able to fight for strong ethical standards is knowing those standards yourself. Ethical nursing practices are taught using The Code of Ethics for Nurses, and there are now supplemental texts to deepen your understanding of how to apply them. Among them, The Code of Ethics for Nurses with Interpretive Statements, published in 2015, addresses especially difficult ethical situations such as crisis management and pandemics.
Staying up to date with the standardized documentation available will provide you with a framework for addressing new situations in conjunction with the help of your hospital or organization’s ethical resources. Organizational ethical support for nurses is a major necessity that your organization is obligated to provide, and institutions are not allowed to retaliate against nurses who bring concerns about their working conditions to management. These concerns may include unsafe exposure risks, physical safety, and the quality of ethical decision making by other personnel.
While simply knowing your ethical code cannot prepare you for all of the possible decisions you will have to make as a nurse, make sure to utilize the resources you can and bring any concerns to the attention of your organization’s management. By continuing to develop your understanding of ethical standards as they apply to the crises we are experiencing, you are better prepared to argue for both your and your patients’ safety.
Stay Up to Date and be Vocal
By staying as up to date as you can on your hospital’s current regulations, as well as government regulations, you can foster transparent communication between yourself and the organizations you interface with, making sure that you are working with the most recent information available. It is a difficult task as these regulations are changing daily, but keeping an eye on current regulatory requirements is important. This knowledge is the main factor in staying vocal in the workplace.
Addressing the ethical decisions of your colleagues can help save a patient’s life, limit spread to others in the hospital, and evaluate new symptoms of the virus. In the high-tension, high-stress situations that we are seeing right now, nurses are in a position to utilize strong ethical convictions and honesty to uphold their obligation to their patients and themselves. By staying vocal when you see a questionable decision made, bringing the information to management, and holding others accountable, you can be a force in maintaining an ethical workplace.
Part of ensuring the safety and well-being of patients is to ensure that those you work with are not endangering them. This could be simply a matter of fatigue, or of an inexperienced person attempting to complete a new procedure, but either could lead to a patient being injured or worse. Being aware of the ethical practices of those around you as well as their level of experience, is another way to help ensure that high-quality ethical practices are in place.
Stand as an Example
If you are working as a CNA, or in any other advanced position, new employees will look to you as an example of how to conduct themselves. After all, the codes of ethics apply not only to patient care, but to a nurse’s responsibilities to themselves and their team. By setting an active example for your colleagues, you can help create an environment founded on ethics that support the well-being of both patients and nurses.
There are basics of care that all nurses are trained in, including ways to protect a patient’s privacy, but we are experiencing a massive event that has taxed our medical system and its practitioners beyond any in recent history. Organizations are experiencing a lack of resources, personnel are working extremely long hours in high-risk environments, exhaustion is at a high, and newly trained medical professionals are being called on to make difficult decisions. In this environment, holding yourself to high ethical standards can help provide a path for others to follow.
Education, training, understanding, and action are all required to ensure the health and safety of patients, communities, and staff alike. While the mainstays of health and wellness are still important, the environment and stakes that medical professionals are working with have changed drastically. By fighting for ethical practices, you can become a part of the solution, and help ensure that patients, both yours and future ones, get the treatment that they deserve.
As we usher in the 116th Congressional Session beginning January 4, 2019, lawmakers (newcomers and incumbents) will have the opportunity to address a number of legislative and regulatory issues. Immigration reform, access to affordable health care, climate change, and national and global security are among a long list of issues that will be discussed and debated during this new congressional session. And while there are numerous competing demands as with all other legislative sessions, nurses are encouraged to remain abreast of issues that impact health care and the nursing profession.
This year promises to be another great year to continue improving our policy acumen and advocating for those issues that are most important to us and the communities we serve.
Moving forward in 2019, newly elected Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois will represent the 14th Congressional District of Illinois beginning January 3, 2019. Rep. Underwood is committed to ensuring that everyone has access to affordable health care. She is currently one of two nurses serving in the U.S. Congress. Other nurses across the country hold elected positions in their state legislatures and government appointed positions or serve on a number of advisory committees or boards.
This session, lawmakers committed to eliminating health disparities will work to enact legislation that will propel us toward achieving health equity, particularly for underserved populations who suffer disproportionality from a number of illnesses and poor social conditions. No doubt the issue of health care reform will remain front and center, especially in light of the recent ruling from a federal Texas judge deciding that the Affordable Care Act is unconstitutional. Because this debate is far from being over, we must remain vigilant in monitoring what is happening with this historic legislation. And just as 2018 was deemed the Year of Advocacy by the American Nurses Association, we must be mindful that advocacy is always in season calling us to lend our voices on behalf of those we serve. Regardless of position or setting, every nurse can seize the opportunity to weigh in on policy issues that are of importance to them.
So, consider how will you stay engaged and informed of federal and local policies or regulations that may influence your practice or even the degree to which health care is available to those you serve. Remaining updated on policy issues is becoming even more essential for today’s health care professional. Our professional and specialty nursing organizations provide key resources and often have a specific policy agenda. Have you explored what your professional organization’s position is on a number of policy issues important to nursing?
Consider attending an actual or virtual lobby day this year. Each year nursing organizations such as the American Association of Colleges of Nursing (AACN), the American Organization of Nurse Executives (AONE), and the American Nurses Association (ANA) convene lobby days in DC but also provide opportunities to participate virtually for those who cannot attend in person. Visit their web sites for more details. Numerous state nursing organizations and other health related organizations across the United States also convene lobby days providing yet another venue to lend your voice to a number of health-related causes. And remember to touch base with the Office of Government Relations within your health care system, university, or college.
Be resolved to visit a legislative official this year to learn more about their health policy agenda and promote the profession as well. Commit to reading the local news for policy hooks as they say, “all politics is local.” Subscribe to the Federal Register to stay informed about opportunities to offer comments on proposed regulations, policies or key reports. The Register also highlights opportunities to apply to serve on national advisory committees. Volunteer to give testimony at hearings and town hall meetings as lawmakers can benefit from hearing directly from nurses on health care matters. Well that should keep us all pretty busy. In the meantime, check out some of the resources listed on the right to help with advancing your engagement in policy advocacy.
Key Resources to Stay Abreast of Health Policy and Legislative Issues
When dealing with patients, there are times in which nurses need to be their advocates. But have you ever thought about if the instance occurred when you had to act as your own advocate? Janetta Olaseni, RN, BA, HN-BC, CHC, administrator and director of nursing at Hands of Compassion Home Care, Inc., had to do just that.
In February 2013, Olaseni says that while performing a monthly breast self-exam, she discovered a painless lump about the size of a bouncy ball in her left breast. Of course, she went to see her gynecologist. But he told her that it was a normal cyst and that since she was young and didn’t have a family history of breast cancer not to worry about it. If it did become painful, he told her, she could have it removed. Despite what her doctor told her, she felt that something was wrong.
“I immediately did not feel good about his diagnosis and started making plans to have it removed,” says Olaseni. As time went on and life got busier, seeing a surgeon became less important.
“In the meantime, the small ‘ball’ had grown and started to hurt and fill with fluid,” says Olaseni. She quickly made an appointment to be seen. Like her gynecologist, though, the surgeon was treating the lump like a normal cyst and would drain the fluid. After three weeks of this, she requested a lumpectomy.
In September, when she woke up in the recovery room, Olanseni’s surgeon told her that she couldn’t remove the entire lump because she would have had to have taken out nearly half her breast. The once 3 cm lump had grown to 8 cm.
When the biopsy came back, Olanseni’s diagnosis was Stage 3b Invasive Ductal Carcinoma.
Today, Olanseni is cancer-free, but who knows what could have happened if she hadn’t insisted on the surgeon listening to her.
“This journey made me so much more compassionate and empathetic towards my patients and their families,” says Olanseni. Ten years ago, she started a home health care company that emphasizes facilitating compassion regarding patient care.
“When you’ve been on the other side with the hospital gown on, having your hair shaved because you do not want chemo to take it out, when you’ve had your porta cath accessed daily, when you’ve had the radiation beam hit close to your vital organs, when you have undergone multiple surgeries, when you’ve gotten therapy and wound care, then you are a true patient advocate,” says Olanseni. “Not only can you say you understand, you really do understand.”
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