Wednesday June 19th 2019

Ethics: Integrity, courage and leadership

Pamela Cipriano

Words are powerful. They reflect our thoughts and feelings, and can ignite passion, advocacy and action. Such was the case at the American Nurses Association’s Ethics Symposium in June. From staff nurses to scholars, powerful, evocative words shaped discussions about the Code of Ethics for Nurses with Interpretive Statements and how it guides all aspects of our practice and commitment to society.

Participants stretched their minds to:

THINK about the challenges individuals and communities face: social injustice, disparities, bias and defending health care as a human right. Even your zip code may define how long you live.

FEEL the gut-wrenching, darker side of human behavior: plagiarism, dishonesty, cheating, bias and apathy, that exists — and we are not immune. Recall the internal conflicts inherent in our duty to protect one’s right to self-determination when family members or clinical team members disagree about care.

EXPERIENCE the moral distress of being denied adequate staffing, rationing care, or having an unhealthy work environment that smothers our energy and optimism. These unresolved, everyday crises create moral residue that robs our souls of their vitality and resilience.

ACT to invoke solutions that infuse the provisions of the Code into our daily work. We courageously use our voices to speak out and express our actions that uphold the Code through story-telling, case studies, poetry and public advocacy. We demonstrate leadership by creating better policies and ethical practice environments and by supporting nurses to advocate for patients and themselves.

It’s no secret we face many issues that test our moral integrity and create ethical inflection points. There are big policy issues, like how we spend money as a nation to allocate health care or what we tolerate in our work environments, knowing that safe and empowering environments promote better care that translates into better patient outcomes. Then there are those that are unnerving, such as knowingly providing unequal care or taking shortcuts that jeopardize safety.

At the symposium, participants explored the application of ethics to address day-to-day and often difficult clinical situations; techniques to teach ethics; ways to support ethics in practice; and strategies for nurse leaders to support ethical practice at the organizational level, as well as to create supportive public policy. And although the Code calls on our responsibility to establish, maintain and improve ethical practice environments to support safe, quality care, honest conversations revealed the intimidation some newer nurses encounter when they speak up about their work environments.

Just as patients suffer from physical and emotional stress, so do nurses. For example, when asked, “What keeps you up at night?” on our Facebook page last year, nurses resoundingly responded about the high levels of stress experienced daily. Similarly, more than half of the 7,000+ respondents to ANA’s Health Risk Appraisal report high levels of stress on a routine basis.

What’s likely causing this stress? Everything from feeling stretched and unable to deliver necessary care, to having our integrity threatened by unethical practices and behaviors of others, to internalizing the suffering of individuals in our care, to the interminable effects of oppressive work environments characterized by poor staffing and disregard for professional practice.

ANA’s ongoing efforts to reinforce safe staffing as the lynchpin to safe, ethical and high quality care is a moral imperative for our patients’ and nurses’ well-being. As nurses optimize the health and well-being of those in our care, we must not neglect ourselves. Whether it is developing the courage to address ethically challenging issues, healing from moral distress and residue, or demonstrating leadership and advocacy to address conditions that affect the health of our nation, our patients are counting on us.

I was inspired by the maturity of the dialogue and optimism at the symposium. Conversations about acting ethically were sprinkled with embracing courage and hope — courage needed by us all to be advocates, to do the right thing and face down fear, and hope reflecting the desire that our moral compass will influence ethical practice throughout all health care settings. Our emphasis on the “Year of Ethics” will undoubtedly pay off with increased awareness and assimilation of the Code as a non-negotiable tenet of our practice.

— Pamela F. Cipriano

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