Perhaps history’s most famous nurse, Florence Nightingale, gave her name to the earliest version of today’s Code of Ethics back in 1893, when a “Nightingale Pledge” was established. In 1926, The American Journal of Nursing published a provisional code, although it wasn’t formally accepted by the American Nursing Association until over 30 years later, in 1960.
Since then, the Code of Ethics has been revised and amended several times, although the underlying principles have remained the same. Nurses are still expected to perform their duties with integrity, and do the best job they can. As most people know, their job is difficult to begin with. A nurse is not only a caregiver; he or she is expected to have a wide range of other assets too, such as tact, patience and the ability to communicate.
If you are a nurse, you may not be tested on the Code and you won’t be expected to commit it to memory, but you will need to be familiar with its basic concepts. You may be required to attend seminars on the principles of the Code and perhaps review actual cases, particularly ones in which a difficult or ethical decision was reached.
Due to the fact that the Code also changes, and is amended to from time to time, nurses need to keep up with any updates as well. Arguably, the duties of a nurse have become even more challenging over recent years, due to such things as cost-conscious hospitals, a shortage of nurses in some areas and more complex medical treatments.
Most of us know what ethics are, as we make ethical decisions in our everyday lives. Ethics is actually a branch of philosophy – the word ethics comes from the Greek word ethos which means habitual usage, custom, conduct and character. Put another way, ethics are the guidelines which guide an individual or group in their everyday behavior.
Nurses perhaps know this more than anyone. Each day, nurses are faced with making life and death decisions, sometimes with no more than a few seconds to decide. Although nurses have the necessary authority and skills required to make independent decisions about a particular patient or situation, they are still responsible to the profession in general.
The first three provisions of the Code are perhaps the most important. They cover such basics as the nurse’s commitment to the patient, respect for human dignity and ensuring the privacy of every patient. Nurses can put these principles into practice every day by doing things such as explaining procedures fully, ensuring privacy and ensuring they have a patient’s full consent.
The Code of Ethics is also closely linked with patients’ rights and a section addresses this often touchy subject. A comprehensive bill of rights is a surprisingly recent concept. A Patients Bill of Rights was not enacted until 1973 by the American Hospital Association and was revised in 1992. By law, a patient must be informed of their rights upon being admitted to a hospital.
The Code of Ethics often conflicts with patients’ rights, for example, a patient may refuse treatment or discharge themselves against the better judgment of the nurse. In this case, a nurse must respect the wishes of the patient even though it may go against some of the principles of the Code of Ethics. The Code states that a nurse may never act to deliberately end a person’s life, although they should attempt to alleviate a patient’s suffering even if this causes death
Frequently, a person may have a set of religious or cultural beliefs which leads them to make decisions about their health that many of us would consider unhealthy or dangerous. The Code also addresses the question of funding for medical research and states that a nurse can choose not to participate in such research if they consider it to be unethical.
To some degree, the Code of Ethics also means that nurses must take responsibility not only for their own actions, but for the actions of other nurses too; the Code states that a nurse must take action if he or she observes others acting in an, “incompetent, unethical, illegal or impaired” manner. A nurse is also expected and encouraged to report such behavior, which is not always an easy thing to do.
Many hospitals actually have ethics committees or even an ethicist on the staff. He or she may be called upon in cases where a life or death decision has to be made, a decision that most of us would care to make. Not surprisingly, often the question of ethics arises in those situations in which it is being considered to cease life support and allow a terminally ill patient to die.