Critique of the ANA Code of Ethics

Abstract

Nurses are faced with ethical dilemmas every day. The American Nurses Association Code of Ethics provides standards for nurses to react within those ethical dilemmas (American Nurses Association, 2015). This paper discusses why The ANA Code of Ethics is necessary to professional nursing practice. It also discusses Provision 1 of The Code and why it is most important in my own nursing practice. Finally, I explore why it would be beneficial to add a provision or sub-provision that addresses the obligation of staff nurses to foster student nurse education and professional well-being.

Critique of the ANA Code of Ethics

For the past 17 years, nurses have been rated the most honest and ethical profession according to Gallup polls (Brenan, 2018). This recognition is not without compelling reason; nurses everyday are faced with situations that test their compassion, decision-making, and fortitude. Ethical dilemmas that nurses face include providing expensive care for patients who may not be able to afford it, mediating discussions between family members with different ideas regarding end-of-life care, and working on a hospital unit that is not safely staffed with enough nurses. However, nurses do not need to face these ethical dilemmas alone. The American Nurse’s Association (ANA) first created a formal Code of Ethics in the 1950s and has revised it over time to become the document it is today (American Nurses Association, 2015). The purpose of The Code is to provide a guideline of standards that nurses are obligated to follow in their professional lives. Its current iteration consists of nine provisions and includes interpretive statements.

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While the entire ANA Code of Ethics serves as a compass to provide direction to nurses in practice, to me the first provision sets the foundation upon which nursing rests. This paper will discuss why the first provision is the most important to me and will also explore further why The ANA Code of Ethics is a necessary aspect of the nursing profession. I will also discuss what may be missing from The Code in its current form.

Provision 1

The first provision in The ANA Code of Ethics deals with the nurse’s obligation to treat each individual with compassion and respect, regardless of their personal characteristics (American Nurses Association, 2015). There are five sub-provisions within Provision 1 that further detail what compassion and respect involve including the inherent dignity and worth of all humans, regardless of their health status, socioeconomic status, sexual orientation, or race (American Nurses Association, 2015). Sub-provision 1.4 discusses how treating patients with dignity also includes allowing patients to make their own choices regarding their care and lifestyles; nurses must respect those choices even if they do not agree with them. Finally, sub-provision 1.5 extends that respect and compassion towards individuals beyond patients that nurses come into contact with. A nurse has the obligation to treat colleagues and employees with the same kindness that they treat patients.

The reason I believe that this provision is the most important to my nursing practice is because it is easier said than done to treat all patients with compassion and respect regardless of their personal attributes. While most nurses have every intention of entering a nursing career in order to help others, it is difficult for nurses to see their own prejudice towards certain people (Lachman, 2009). It is important, in that case, to be mindful and intentional of being respectful of every individual. Respect for human dignity must go beyond words and actions. Respect should also be present within the attitudes that nurses have when thinking about their patients’ care. Most patients that nurses encounter frequently are not “model patients” that are having health issues due to bad luck. Often, patients will have made choices or participated in behaviors that have had negative impacts on their health, such as smoking or drug use. A nurse who gets to know patients as people and understands that health is only a component of their life experience is one who truly treats their patients with dignity (Bramley & Matiti, 2014; Milton, 2003).

The necessity of the first provision can be seen in an example from the labor and delivery unit where I once worked. A young woman who was about 32-weeks pregnant arrived to be triaged due to cramping and decreased fetal movement. Upon getting an ultrasound, the nurses and obstetrician discovered that the fetus had died in utero. The nurses also discovered that the patient’s urine tested positive for drugs. In this situation, it was difficult for the nurses to avoid placing blame on the patient for the loss of her pregnancy. A couple of nurses on the unit were kind to the patient’s face, but judgmental of her behind her back and reluctant to be assigned to her. One nurse, however, explained to me that we can’t possibly know what this patient was going through and what her home life was like. The nurse not only treated the patient with compassion and respect to her face, but she incorporated that compassion in her attitude regarding the patient and how she planned care. The nurse fully embodied what the first provision truly means. She looked at the patient as a holistic human being and provided compassionate care regardless of the behaviors that led her to seek medical help.

Necessity of a Code of Ethics

Like most things in life, the issues that nurses face are rarely black and white. Often, nurses are placed in a situation in which they must mediate between various individuals with their own priorities and interests (Cohen & Erickson, 2006). Additionally, nurses are humans with their own individual values and belief systems. Nurses may be placed in situations where a patient or colleague’s idea of the best course of action may differ from the nurse’s own morals. For these reasons, The ANA Code of Ethics is necessary to help nurses create a bridge between their individual priorities and the priorities of the nursing profession. The ANA Code of Ethics can provide nurses with the tools to learn how to navigate potential ethical dilemmas.

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When a nurse encounters an ethical dilemma, the conflict between various parties or principles could cause moral distress, and eventually that distress could impair the nurse’s ability to care for patients (Cohen & Erickson, 2006). One ethical dilemma the nurse may be involved in is the care of a patient who has a terminal illness. The patient may be insistent upon continuing to do everything possible to treat their illness, regardless of how the treatments may impact their quality of life and serve only to prolong suffering. The attending physician, however, may feel that it is time to discontinue aggressive treatments and value the patient’s quality of life over the length. In this case, the nurse practitioner or staff nurse can depend on the ethical principles of the nursing profession and utilize The ANA Code of Ethics. Provisions within The Code can assist in making decisions with the patient about how to continue their care, communicating with the patient’s family and other healthcare providers, and keeps the patient’s best interests at heart (American Nurses Association, 2015). Without The ANA Code of Ethics, this scenario could turn into a morally distressing situation in which the nurse feels pulled in different directions by people with opposing opinions.

Changes to The Code

There are many mentions of showing respect for colleagues and students within various provisions of The ANA Code of Ethics (American Nurses Association, 2015). Sub-provision 1.5 discusses the obligation of nurses to create an environment and culture of respect within healthcare and touches on the unacceptability of bullying or harassment within the workplace. Additionally, sub-provision 7.2 discusses the responsibility of nurse educators to ensure that their student nurses possess the required knowledge and skills upon graduation. In spite of these mentions of respect for student nurses and the obligation of nurse educators, there is still a reputation for an occasional culture of incivility among staff nurses charged with helping to educate student nurses during clinical rotations (Courtney-Pratt, 2017). Because of this continued problem for nursing students, I believe that more could be said within The ANA Code of Ethics to prevent poor behavior toward nursing students and to promote the responsibility of all nurses to assist in educating future nurses.

While workplace bullying is not an uncommon occurrence for nurses, despite it contradicting Provision 1 of The Code, the bullying that occurs towards student nurses has potentially different impacts because of the power imbalance between staff nurses and students (Courtney-Pratt, 2017). Because of this power imbalance, student nurses may find it difficult or detrimental to their future to discuss these conflicts with staff nurse managers or school administration (Epstein & Carlin, 2012). When students fear retribution, the incivility can continue and interfere with the student’s ability to learn while in a clinical situation. It can also create an unsafe environment for patients, as the student nurses may become too nervous to think clearly and may be afraid to report mistakes.

A provision or sub-provision that would be dedicated to fostering student nurse abilities and attitudes could have an impact on the nursing community’s cycle of “nurses eating their young.” It would show that the ANA acknowledges this as a problem and is committed to eliminating vertical bullying between staff nurses and nursing students. An addition to The Code that more explicitly underlines staff nurse obligation to foster student and new nurses could change the culture of nursing education and send a message that the ANA is dedicated to the future of the profession.

Conclusion

People that choose to go into the nursing profession are often inherently compassionate and respectful people that are dedicated to following their own moral compass. However, there are occasionally ethical dilemmas within nursing that one’s individual moral compass cannot solve alone. In those situations, it is imperative for nurses to have a professional standard to which they can refer. The ANA Code of Ethics provides that professional ethical standard and it is essential to the nursing profession. Within The Code, I find that Provision 1 is the most important to my nursing practice. The provision requires that nurses look beyond individual components of a patient and treats the patient as a whole human being worthy of dignity and respect. I also believe that an addition to The Code is necessary so that it can be used to solve problems that student nurses encounter. An additional provision or sub-provision that holds staff nurses accountable for how they treat and teach student nurses can help to eliminate a cycle of bullying within the nursing profession.

References

• American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive Statements. Retrieved from https://www.nursingworld.org/coe-view-only.
• Bramley, L., & Matiti, M. (2014). How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses. Journal of clinical nursing, 23(19-20), 2790-2799.
• Brenan, M. (2018). Nurses again outpace other professions for honesty, ethics. Gallup. Retrieved fromhttps://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx.
• Cohen, J. S., & Erickson, J. M. (2006). Ethical dilemmas and moral distress in oncology nursing practice. Clinical journal of oncology nursing, 10(6).
• Courtney‐Pratt, H., Pich, J., Levett‐Jones, T., & Moxey, A. (2018). “I was yelled at, intimidated and treated unfairly”: Nursing students’ experiences of being bullied in clinical and academic settings. Journal of clinical nursing, 27(5-6), e903-e912.
• Epstein, I., & Carlin, K. (2012). Ethical concerns in the student/preceptor relationship: A need for change. Nurse education today, 32(8), 897-902.
• Lachman, V. D. (2009). Practical use of the nursing code of ethics: part I. MedSurg Nursing, 18(1), 55-57.
• Milton, C. L. (2003). The American Nurses Association Code of Ethics: A reflection on the ethics of respect and human dignity with nurse as expert. Nursing Science Quarterly, 16(4), 301-304.