Just like other healthcare professionals, nurses need to practice according to a complex web of federal and state statutes – while they make decisions in an ethically responsible manner. Due to rapid advances in medical practices and technologies, nurses and other healthcare professionals often face the challenge making decisions where lawmakers and the court have not established laws for new procedures and practices. As a result, nurses need to exercise caution in their decision-making to reduce their risk of legal liability. Additionally, nurses also need to consider the ethical implications of their decisions to ensure their actions are in the interest of their patient and do not cause harm. At first glance, it might seem that making these decisions should be straightforward, but many situations are not clear-cut and there are times when what seems legal is not ethical or vice versa.
The ANA Code of Ethics: The Essential Guide for Ethical Decision-Making
The American Nurses Association compiles and publishes the accepted guidelines for ethical nursing practice in the United States. The ANA Code of Ethics is a living document that changes as the profession advances. The ANA also publishes separate ethics guides for different specialties and controversial areas, such as the ethics involved in end of life decision making.
The Core Ethical Principles of Nursing
Even when laws and medical practices change, the fundamental ethical principles of the nursing profession stand firm. The foundation of nursing ethics centers on the basic elements of nursing care. The basic elements of caring related to the nursing profession include the following:
- Attentiveness: Nurses are ethically obligated to attend not only to their patients, but also to the needs of their colleagues, employer, and community.
- Responsibility: Most nurses make decisions on a daily basis that have a direct impact on people’s lives. As such, they have an obligation to consider all possible consequences of their actions as they pertain to their patient’s health and well-being.
- Competence: The practice of nursing requires a high degree of knowledge and numerous complex skills. Since medicine constantly evolves, nurses have an obligation to stay up to date on the latest developments and best practice of their profession.
- Patient Responsiveness: As part of a multi-disciplinary treatment team, nurses are typically the professionals that have the most amount of regular contact with the patient. Nurses have the ethical responsibility to monitor the patient’s responses to treatment and intervention and to communicate the information to other professionals on the treatment team. Additionally, nurses have the obligation to address the patient’s concerns about treatment.
Fundamental Questions to Guide Ethical Decision-Making for Nurses
While nurses can often rely upon their employers to provide guidance concerning legal issues, they find they need to deal with ethical decisions somewhat independently. The ethical dilemmas nurses typically have no clear-cut answers that fit with every situation with all patients. Adding to this challenge is that nurses often have to resolve ethical quandaries quickly to make decisions that significantly affect the lives of their patients and their families.
When faced with an ethical dilemma, some of the questions nurses need to ask as part of their decision-making process include the following:
Does the decision respect the autonomy of the patient?
One of the challenges nurses encounter is that they find their beliefs differ from those of their patients, especially when it deals with pro-life versus pro-choice issues and end of life issues. Nursing professionals are obligated to respect the decisions made by their patients, even if the choice the patient makes differs from what the nurse would make in a similar situation. For example, if a patient has elected to have a do not resuscitate order in his or her chart, the nurse needs to respect the patient’s wishes, even if it is contrary to his or her personal beliefs.
Does the decision benefit the patient?
Nurses also need to put their personal belief system aside and consider whether the decisions they make are compassionate and involve positive actions to help their patients. For example, often hospitals limit ICU visitors to family members, but the policy does not address situations where a patient has a same sex partner who is essentially the patient’s spouse. Even if the nurse morally objects to homosexual relationships, he or she needs to put this belief aside and consider whether the patient will benefit from having his or her partner in the room. In some cases, this support will help the patient, in other cases, such as when there is significant conflict in the relationship; the contact might do more harm than good.
Does the decision demonstrate fidelity to the patient?
Nurses are ethically mandated to be loyal, fair, and truthful with their patients. Additionally, they also act as advocates for their patients. While this mandate appears at first glance to be straightforward, families often request that nurses withhold information from their patient because of their concern that knowledge of particular aspects of the patient’s condition might have a negative impact on their recovery.
Is the decision just?
Ethical decisions related to justice often involve allocation of scare resources. An example of an ethical dilemma that nurses faced involving resource allocation occurred in the aftermath of Hurricane Katrina when hospital staff have limited access to medication and lifesaving equipment. Doctors and nurses faced the ethical challenge of choosing which patients would receive treatment and which patients they would merely make comfortable.
The Top Legal and Ethical Issues Facing Nurses
Nurses, along with other healthcare professionals, practice in an environment that is rapidly evolving due to technology, advances in medical science, and pressure to contain costs. Due to the changing healthcare landscape, nurses have to make decisions where the legal implications of their judgments are uncertain and experts differ in their opinions as to what constitutes an ethical decision in a particular situation.
The most common legal and ethical challenges facing the nursing profession include:
- The appropriate use of social media in relationship to their workplace’
- Balancing the need to provide care for patients with pressure to be more efficient in the use of time and resources
- Dealing with conflict in the workplace
- Coping with staffing shortages
When nurses face these dilemmas in their workplace, they need to consult with their supervisors and colleagues. If they work in a hospital setting, the institution’s ethics committee may offer newsletters and in-service training that provide guidance about dealing with certain situations. In all cases, nurses need to follow the core ethical principles of the nursing profession.
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