Issues up close

For many nurses today, the workplace may feel like uncharted territory. New technologies, bold advances in health care, and a growing urgency to collaborate and innovate are changing the way nurses manage care and interact with their patients, their colleagues, and each other.

This unsettled landscape is rife with new ethical dilemmas, and nurses need information and support to navigate them. The American Nurses Association (ANA) has a resource that will help—the newly revised Code of Ethics for Nurses with Interpretive Statements (The Code), released in January 2015.

ANA has been the steward of nursing’s Code since 1950, ensuring that nurses have guidance for making ethical decisions on a vast range of issues, from bullying in the workplace to end-of-life care. But as the times change, so do the issues, and the Code has kept pace by publishing revisions in 1968, 1976, 1985, and 2001.

“Since 2001, there have been massive changes in the delivery of care, emerging diseases, and roles for nurses,” says Marge Hegge, EdD, MS, RN, FAAN, who chaired the 15-member steering committee charged with updating the 2001 Code. “It was time for another revision.”

Hegge is passionate about the field of ethics. She attended the Kennedy School for Ethics at Georgetown University and is a professor of nursing at South Dakota State University, teaching ethics and developing an ethics curriculum at the doctoral level. She says that nurses and other readers will see several important changes in the 2015 revision.

For example, “We addressed conscientious objection more clearly than ever before,” Hegge says. When a particular action exceeds moral limits or violates moral standards, the nurse is justified in refusing to participate on moral grounds. “Whistle blowing is another emphasis in this Code. It’s been in the Code before,” she adds, “but now it’s specified as a responsibility.” RNs should report incompetent, unethical, illegal, or impaired practice that is not corrected and continues to jeopardize patient well-being and safety.

Additionally, Hegge states, there are significant revisions in the last several provisions that address a wider global vision and call for a unified voice from nurses to address poverty, contaminated water, lack of sanitation, climate destabilization, and other issues that affect the public’s health.

Most importantly, Hegge says, the 2015 Code takes into account the changing face of the nursing profession. “The nursing workforce today is more diverse than ever before. So we were very careful to ensure it is inclusive of all nurses regardless of their religious or cultural background.”

Timothy Godfrey, SJ, DNP, RN, PHCNS-BC, an assistant professor of ethics at the University of San Francisco and another member of the steering committee, finds many of the changes in the revised Code are not immediately obvious to the reader. “This was really a revision, not a rewriting,” he says. “The intent was not to start all over. It was to build on what we had because some of it is core and not changing.”

One of the important things that Godfrey hopes readers will see reflected in the revised Code is the sense of personal authority that nursing has adopted and nurses have grown into more deeply. “There’s been a change in how we view ourselves,” he says. “We have grown. We have developed. And we are claiming that sense of personal identity and authority, which is a greater understanding of who we are and what we are about.”

Margaret Ngai, BSN, RN, staff nurse at Cascadia Behavioral Healthcare in Portland, Oregon and a steering committee member, says the reference to social media is another change in the Code.

“When the Code of Ethics was last revised in 2001,’’ she observes, “personal access to technology wasn’t nearly as pervasive in our culture as it is today. While we try to keep the Code timeless and don’t reference any specific communication platforms, we did include social media in the provision regarding protection of patient rights, including confidentiality and privacy.” The revision acknowledges rapidly evolving communications and the need for nurses to maintain vigilance regarding postings, images, and recordings that may jeopardize patient rights and erode nursing trust.

Steering committee member Lori Lioce, DNP, FNP-BC, CHSE, FAANP, executive director of the Learning and Technology Center at the Uni­-versity of Alabama, Huntsville, says the 2015 Code includes many different views and is more holistic and probably more visionary than previous versions.

“The 2001 Code seemed to be geared more for staff nurses. Today, nursing is a much broader profession and the 2015 Code reflects that,’’ she says. “It is more collaborative and relevant for all levels of nursing, including those with graduate and terminal degrees, such as advanced practice registered nurses or others who are doctors of nursing practice.”

Godfrey agrees, stating, “There is an acknowledgement in the Code that nursing practice covers a lot of specialties. In other words, whether we are educators, administrators, or policy folks who may not be doing bedside nursing or direct patient care, we are all doing nursing practice.”

While great efforts were made to ensure the revised document is inclusive for all nurses, that same spirit of inclusion defined the process that brought the Code to life.

The revision of the Code of Ethics for Nurses was informed by more than 7,800 responses from 2,780 nurses with diverse educational backgrounds, roles, and practice settings who responded to an online survey asking whether or not revising the Code was warranted. These comments helped shape the revised draft of the Code, which was posted online for comment. Again, nurses across the country responded in force. More than 1,500 additional responses were received, closely reviewed by the steering committee, and incorporated into the final draft where needed.

“The responses were very helpful,” says Godfrey. “They gave us a good snapshot of the diversity of legal issues, practice issues, and cultural issues that nurses have to negotiate to provide the level of care that is needed. I think the Code reflects that.”

Now that the Code is published, the next goal is to ensure that nurses are able to apply it to their practice. To that end, ANA has designated 2015 the “Year of Ethics” and planned a range of activities, including live webinars, updates to nursing ethics information on NursingWorld.org, a continuing education module, an ethics symposium to be held June 4-5 in Baltimore, and the publication of a new Guide to the Code of Ethics.

With other nursing leaders, ANA participated in a national nursing ethics summit held in August 2014 at the Johns Hopkins University. Using ANA’s Code as a guide for how nurses carry out their ethical obligations, the summit’s vision to change the nation’s health­care culture to more strongly support basic ethical values and more effectively enable nurses’ ethical practice was endorsed by the ANA Board of Directors in November. The summit resulted in a Blueprint for 21st Century Nursing Ethics to strengthen ethics in the profession (available at www.bioethicsinstitute.org/nursing-ethics-summit-report).

To read the 2015 Code and for more information, go to www.NursingWorld.org/ethics. To order copies, visit www.NursesBooks.org. For a summary of revisions to the Code, visit www.AmericanNurseToday.com/?p=19473.

Mary Davis is a professional writer.

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