As nurses, we face the complex and sometimes chaotic forces of contemporary health care, science, and technology-forces that sometimes give rise to ethical issues. Regardless of your position or role, you can’t avoid ethical challenges.I think back to my visit to Guantanamo Bay Naval Base in late 2006, and the many ethical issues encountered by the military nurses providing care to the detainees. Despite their personal feelings, these nurses followed one of the fundamental principles of the ANA Code of Ethics that underlies all nursing practice: respect for the inherent worth, dignity, and human rights of every individual.
I’ve also had many discussions with chief nursing officers who’ve acknowledged the challenge in creating, maintaining, and contributing to practice environments that aid nurses in fulfilling their ethical obligations. I don’t know of any nurse who’s free of ethical challenges. In fact, these challenges seem to be increasing as our healthcare system is failing us. Thus, understanding how nursing’s ethical traditions have evolved to the current Code of Ethics with Interpretive Statements—our Code of Ethics—is invaluable to each of us in our daily practice.
“A Code of Ethics stands as a central and necessary mark of a profession. It functions as a general guide for the profession’s members and as a social contract with the public whom it serves.” So opens a new book just published by the ANA on how to apply the Code. The book is titled (not surprisingly) A Guide to the Code of Ethics for Nurses: Interpretation and Application.
The nursing profession consistently ranks as the most trusted in the country. This trust is the result of nurses putting into practice every day the core values expressed in the Code of Ethics, which has a long and distinguished history. The organization that would become the ANA first discussed a code of ethics in 1896. Since then, each version of the Code has reflected the changing roles of nurses over the decades.
For example, the concept of the patient has changed over the years to include family and community as well as the individual. Another important change to the Code stipulates that a nurse owes the same duties to self as to others. To care for patients properly, healthcare systems and professional organizations must care for nurses properly, and nurses in turn must care for themselves properly.
Other changes to the Code include emphasizing patients’ responsibility in participating in their own care and nurses’ autonomy in practice and their role as patient-advocate. The current Code acknowledges the dignity and worth of everyone the nurse comes in contact with. It also articulates nursing’s growing concern about global health and the conditions that produce disease, illness, and trauma worldwide. Through each version of the Code, service to others has been a constant, fundamental value for individual nurses and for the nursing profession.
ANA’s new book helps nurses understand specific implications of the Code for their practice, with a chapter on each of the Code’s nine provisions. Each chapter explains the history of that provision, the thinking behind it, and how to apply it to nursing practice. Next come case studies that further demonstrate how to apply the provision to practice. I have found this book to be a powerful tool for nursing students and practicing nurses.
I’ve been inspired by many individual nurses and nursing students who’ve used the Code to address practice issues. Each and every one of us in the profession should read the Code frequently and apply it carefully, for it tells us who we are as professionals—where we’ve been, where we are, and where we’re going. I keep my copy with me at all times; it has as many frequent flyer miles as I have. A living document, it changes as the profession changes and yet expresses nursing’s enduring value of service to others.
We should all be proud of the Code as a public expression of that value—and proud to put that value into practice. In fact, it’s the value of service that has made this profession so trusted by the general public.