How Nurses Can Fight For Strong Ethics Amidst COVID-19

How Nurses Can Fight For Strong Ethics Amidst COVID-19

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.

Honesty and Ethics in Nursing

Honesty and Ethics in Nursing

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.

Caring Nurse

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.”