June 11, 2017

By: Jennifer L. Farrell Burns, MJ, BSN, RN-BC

15th time’s a charm!

The December 2016 Gallop Poll announced that once again, nurses were rated the highest for honesty and ethics among professions for the 15th straight year! As we graciously accept this honor (again) and receive congratulatory “likes” on our Facebook posts, let’s discuss the Code of Ethics for Nurses (2015), presented by the American Nurses Association.

The Code of Ethics is the nursing professions’ document that expresses “the values, duties and professional ideals” central to the core of nurses’ behaviors (ANA, 2015, p. viii). The Code began as the “Florence Nightingale Pledge”, written by Lystera Gretter in 1893, and remained the informal standard until 1950 when the “Code for Professional Nurses” was adopted by the ANA Delegates. The Nightingale Pledge by Gretter reads;

“I solemnly pledge myself before God and in the presence of this assembly: To pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my profession. With loyalty will I endeavor to aid the physician in his work and devote myself to the welfare of those committed to my care (Gretter, 1910).”

If we evaluate each line separately, we can easily understand that most of what Gretter was writing about in 1910 still holds true and why nurses continue to be viewed as honest. Let’s compare:

 

Florence Nightingale Pledge (Gretter, 1910) Code of Ethics for Nurses with Interpretive Statements (ANA, 2015)
“To pass my life in purity and     to practice my profession faithfully.” Provision 5: “The nurse owes the same duties to herself as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.” (ANA, 2015, p. 19)

 

Nurses not only have a duty to their patients, they have a duty to themselves. If a nurse is not healthy of mind, body and spirit, he or she will find it difficult to focus and make sound judgments. This not only places patients at risk, but herself or himself as well. Nurses need to be aware of their personal limitations. For example, some people can function very well on six hours of sleep, yet others require a full eight to feel mentally sharp. Caffeine should never be considered the gold standard of wakefulness. Proper diet, sleep, and exercise are vital to sound and safe decisions.

 

Florence Nightingale Pledge (Gretter, 1910) Code of Ethics for Nurses with Interpretive Statements (ANA, 2015)
“I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.” Provision 5.4: “Nurses should model the same health maintenance and health promotion behaviors as they teach and research…” (ANA, 2015, p. 19)

 

The Wyoming Nurse Practice Act states that a licensed nurse must “report unfit or incompetent nursing practice” (WNPA, Title 33, Chapter 21, Section 3(vi)). Essentially, nurses are required by law to report themselves if they becomes unfit mentally or physically. As nurses, we hold ourselves to that higher standard.

 

Florence Nightingale Pledge (Gretter, 1910) Code of Ethics for Nurses with Interpretive Statements (ANA, 2015)
“I will do all in my power          to elevate the standard of my profession…” Provision 5.6: Professional and personal growth reciprocate and interact.”(ANA, 2015, p. 22)

 

Nursing is a science. We lead our practice forward by engaging in evidenced-based research. We no longer do something because it has always been done this way. From nursing interventions and treatments to models of care and management, science leads our decisions. We welcome best practices and new evidence and wince at the recall of all the dementia patients restrained early in our careers. We just didn’t know any better back then. It is exciting to think of what’s ahead for us and what modern nursing research will bring to our care.

 

Florence Nightingale Pledge (Gretter, 1910) Code of Ethics for Nurses with Interpretive Statements (ANA, 2015)
“..will hold in confidence all personal matters committed    to my keeping, and all family affairs coming to my knowledge in the practice of my profession.” Provision 3.1: “The nurse safeguards the patient’s right to privacy…and has a duty to maintain confidentiality (ANA, 2015, p. 9).

 

I recall that even before the enactment of The Health Insurance Portability and Accountability Act of 1998, we nurses attempted to at least speak in “code” in the elevators, while going to lunch. The “heart attack in room 444” and the “stroke in room 449” were meager attempts to disguise our conversations. Society is quickly changing, especially fueled by modern technology devices and their portability. I am pleased ANA has identified that social media is a potential risk to patients and provided a Social Networking Principles Toolkit (www.nursingworld.org/socialnetworkingtoolkit).

 

 

Florence Nightingale Pledge (Gretter, 1910) Code of Ethics for Nurses with Interpretive Statements (ANA, 2015)
“With loyalty will I endeavor…and devote myself  to the welfare of those committed to my care.” Provision 1: “Nurses should affirm and respect patient values and decision-making processes…” (ANA, 2015, p. 3)

 

Loyalty and commitment to our patients is the second provision of our code, ranking a close second behind provision one, practicing with respect and non-bias. Is it any wonder that once again, we are voted the most honest and ethical professionals? If we as nurses strive to treat all our patients with considerations and to maintain the most ethical standards during our daily work, then we truly are committed and deserving of this honor; for the 15th year in a row.

 

 

Code of Ethics for Nurses with Interpretive Statements (ANA, 2015) Provision 1: “Nurses respect the dignity and rights of all human beings regardless…the person’s health status. The worth and uniqueness of a person is not affected by illness, ability, social or economic status, functional status or proximity to death.” (ANA, 2015, p. 1)

 

Jennifer L. Farrell Burns is a practice and education consultant in Cheyenne, Wyoming.

Selected references

American Nurses Association. 2015. Guide to The Code of Ethics for Nurses: Interpretation and Application. Washington DC: Nursebooks.org.

 

American Nurses Association. 2011. Social networking principles toolkit. www.nursingworld.org/socialnetworkingtoolkit

 

Gretter L. Florence Nightingale Pledge: Autograph manuscript dated 1893. Am J Nurs. 1910; 10(4):271.

 

Wyoming Nurse Practice Act. Title 33, Chapter 21, Section 3(vi).

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