This paper aims to evaluate both the necessity for and benefit of the American Nurses Association (ANA) Code of Ethics for Nurses, specifically in relation to provision 5.2. The focus of this provision is promotion of the nurse’s health and well-being via application of the nurse’s own skills to heal and care (ANA, 2015). The nature of nursing inevitably involves experiencing the full parameter of life and death, and because of the interpersonal intimacy this often cultivates, the nurse is at risk for the development of negative states, such as depression, acute stress, and anxiety (Boyle, 2011; Chipas & Boyle, 2011; Laschinger & Fida, 2014; Lombardo & Eyre, 2011; Perry, Gallagher, Duffeld, Sibbritt, Bichel-Findlay, & Nicholls, 2016; Perry, Lamont, Brurero, Gallagher, & Duffeld, 2015). Additionally, nursing shortages are a common occurrence within American society, and this can result in exhaustion, job dissatisfaction, and feelings of inadequacy (Kravits, McAllister-Black, Grant, & Kirk, 2010). Despite the aim of the nursing profession to promote health and well-being, nurses are more likely to experience certain health disparities, as well as report increased levels of stress and burnout (Chipas & McKenna, 2011; Henry 2014; Kravits et. al., 2010; Laschinger & Fida, 2014). In addition to these insights, suggestions for revisions of the code with supportive evidence will be provided.
Code of Nursing Ethics: Provision 5.2
5.2 Promotion of Personal Health, Safety, and Well-Being
As professionals who assess, intervene, evaluate, protect, promote, advocate, educate, and conduct research for the health and safety of others and society, nurses have a duty to take the same care for their own health and safety. Nurses should model the same health maintenance and health promotion measures that they teach and research, obtain health care when needed, and avoid taking unnecessary risks to health or safety in the course of their professional and personal activities. Fatigue and compassion fatigue affect a nurse’s professional performance and personal life. To mitigate these effects, nurses should eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, engage in adequate leisure and recreational activities, and attend to spiritual or religious needs. These activities and satisfying work must be held in balance to promote and maintain their own health and well-being. Nurses in all roles should seek this balance, and it is the responsibility of nurse leaders to foster this balance within their organizations (ANA, 2015).
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I deemed provision 5.2 from the ANA Code of Ethics for Nurses to be the most important provision to my practice because to have integrity of character and vocation, the nurse must first observe the same goals of healthfulness towards which he or she encourages the patient. An article by Blake, Malik, Mo, & Pisano (2011), ironically titled ”Do as I say, but not as I do”, describes the findings of a cross-sectional survey of over 300 pre-registration nurses, and found that less than 50% met recommendations for exercise levels, less than a quarter consumed adequate fresh produce, almost 20% smoked, and only 60% regularly received adequate sleep. Similarly, a 382-member survey by Perry et. al. (2015) also discovered links to health disparities: 21% of participants admitted to disordered relationships with food, almost three quarters reported sleep disturbances, 18% were smokers, and 92.5% consumed alcoholic beverages with almost 40% having moderate to high risk consumption habits. Yet we cannot simply look at the unhealthy nurse, tell them he or she should be ashamed, and to try a salad and gym membership; the issue is much more multifaceted than the adjustment of hypocritic lifestyle habits.
Two common terms I encountered during my literature review were “compassion fatigue” and “burnout”. First coined by C. Joinson in 1992, the term “compassion fatigue” is typified by discontent, aversion to one’s workplace, persistent exhaustion, depression, and increase in physical illness (Potter, Deshields, Divanbeigi, Berger, Cipriano, Norris, & Olsen, 2010). Compassion fatigue occurs when a nurse continues to give energy and emotional output into his or her profession, yet does not have a nurturing environment to replenish his or her stores while away from the workplace. On the other hand, Henry (2011) defines “burnout” in terms of the psychoemotional effects of chronic exposure to stressors, involving fatigue, hopelessness, lack of confidence, pessimism, and lack of empathy. A study performed by Aiken, Clarke, and Sloane involving over 10,000 nurses revealed that approximately 54% of American nurses reported burnout during their career (Kravits et. al., 2010). The effects of compassion fatigue and provider burnout not only have the propensity to negatively affect patient care, but wear on the nurse to the point of despair. In a 2011 evaluation of 7,537 Certified Registered Nurse Anesthetists and Student Registered Nurse Anesthetists, Chipas and McKenna discovered that almost one third had made efforts to consult a counselor or other form of psychotherapist, and that almost one fifth were on prescription anxiolytics. Laschinger and Fida (2014) reported that upwards of 60% of newly graduated nurses experienced burnout which was often correlated with feelings of depression and being overwhelmed at work. It is from these negative psychoemotional experiences that the physical manifestations of unhealth stem. In nursing, there is a fine line between serving our patients out of genuineness and serving our patients out of resentful obligation. The nurse is not entirely to blame for a transition from the former to the latter; after all, we have been taught how to care for others, not ourselves. When we forsake self-care, it becomes a challenge to extend the care we need to give ourselves to another, often without thanks. Only when we care for ourselves with the same kindness are we able to continue to do so for others. As Boyle so eloquently points out, “While many nurses perceive their work as a calling, few anticipate the emotional implications and sequelae that come from their close interpersonal relationships with patients and families” (2011). Engaging empathy, selflessly caring for those who cannot reciprocate, showing kindness to those who have been forsaken by even their family: these actions do not come without emotional toll. Yet to continue to serve in genuineness, we cannot forsake these actions so fundamental to our vocation.
Despite the overwhelming occurrence of compassion fatigue and burnout among American nurses, there is a notable amount of research providing suggestions to identify and prevent these phenomenon. These include adequate support systems, appropriate work-life balance, mindfulness, working out, religious or spiritual activities, and time for oneself (Chipas & McKenna, 2011). Additional steps the nurse can take are engaging in therapy, joining a support group, or seeking help from an employing assistance program (Henry, 2014). Although it may seem petty and selfish to prioritize these activities, every life deserves health and happiness, especially one dedicated towards promoting the health and happiness of others.
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The ANA Code of Ethics for Nurses is an essential document that provides a standard of character and practice among nurses, outlining the foundations of the nursing profession and validating the purpose of our vocation. My experience within the world of nursing speaks to the Code not being utilized to its greatest potential for the augmentation and admonition of the nursing profession. The Code of Ethics for Nursing creates an even playing ground for all those under the umbrella of nursing: it allows those without a voice to find leverage, both patients and nurses alike. For example, lack of support from nursing management, as well as from fellow nurses, can create a caustic work environment that is an all-too-common occurrence in the nursing world. The Code of Ethics calls these leading nurses to a standard of behavior that is supportive of their fellow nurses; specifically, provision 6.3 dictates the necessity of a “morally good environment” to promote the wellbeing of the nurse and prevent discontent and/or anxiety (ANA, 2015). The Code goes on to say that nurse educators hold a responsibility to care for the learning and professional growth of those in their care, discussed in provision 7.3. I have witnessed nurses being undermined by management simply because they are disliked by a senior nurse, young nurses criticized because they use newer terminology that the senior nurse is unfamiliar with, ambitious nurses with dreams of going back to school discouraged and actively hindered by management from obtaining additional credentials necessary to pursue their desired degree, and female nurses sexually harassed by male employees who confided in their nurse manager with the hopes of protection and advocacy, yet who went by the wayside because their perpetrator held power. Personally, I have been the victim of more than one of the above examples. Reading the Code gives me hope that if I am ever in a similar situation, I now am prepared to better advocate for myself; even more encouraging is the hope that I can provide this advocacy for one of my fellow nurses in the future should they incur such injustices.
The Code of Ethics for Nurses has origins dating back to 1893 (ANA, 2015). There are very few discrepancies to address that another has not in the past 126 years. Nearing the end of the Code of Ethics for Nurses in provision 8.4, the issue of human rights is addressed. Certain groups are named, specifically those with limited resources, at age extremes, female, and lastly, “socially stigmatized groups” (ANA, 2015). There is no mention of homosexual, transsexual, transgender, or otherwise queer people groups and the magnanimous need for recognition of the unique health disparities specific to these individuals, such as lack of healthcare, preconceptions among providers, and lack of knowledge regarding their lifestyle, beliefs, and identity (Sirota, 2013). Additionally, other socioeconomic factors plague queer individuals, such as higher rates of homelessness among young adults, less effort towards tertiary health measures, and higher occurrence of suicide among queer teens at rates up to three times their hetero counterparts (Lim, Brown, & Jones, 2013). Although it is possible that the ANA intended to cover these with the umbrella of “socially stigmatized groups”, to do so would both be minimizing to the diversity of such individuals, as well as unintentionally accepting of the inequalities and misunderstandings these members of our society experience. The health needs of these different groups of people vary greatly: a homosexual male is probably at greater risk for certain sexually transmitted diseases, a transgender individual undergoing gender reassignment surgery may incur unique challenges related to their assumed identity postoperatively, and the patient using non-cisgender pronouns may feel misunderstood or even disrespected by staff, and their healing environment may suffer from it. Although the issue of sexual identity and orientation may not be an easy topic for the ANA to incorporate into their Code of Ethics, if our job as nurses is to accept and care for each patient with attention to their unique differences and daily struggles, then we must do so in wholeness of person, incorporating aspects of their physical, mental, emotional, psychological, spiritual, and sexual health.
Provision 5.2 of the ANA Code of Ethics for Nurses focuses on
- American Nurses Association (2015). Code of ethics for nurses with interpretive statements [PDF file]. Retrieved from https://www.nursingworld.org/coe-view-only.
- Blake, H., Malik, S., Mo, P. K., & Pisano, C. (2011). ‘Do as I say, but not as I do’: Are next generation nurses role models for health?. Perspectives in Public Health, 131(5), 231-239.
- Boyle, D. A. (2011). Countering compassion fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16(1).
- Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. AANA journal, 79(2).
- Henry, B. J. (2014). Nursing Burnout Interventions. Clinical Journal of Oncology Nursing, 18(2).
- Kravits, K., McAllister-Black, R., Grant, M., & Kirk, C. (2010). Self-care strategies for nurses: A psycho-educational intervention for stress reduction and the prevention of burnout. Applied Nursing Research, 23(3), 130-138.
- Laschinger, H. K. S., & Fida, R. (2014). New nurses burnout and workplace wellbeing: The influence of authentic leadership and psychological capital. Burnout Research, 1(1), 19-28.
- Lim, F. A., Brown, D. V., & Jones, H. (2013). Lesbian, gay, bisexual, and transgender health: fundamentals for nursing education. Journal of Nursing Education.
- Lombardo, B., & Eyre, C. (2011). Compassion fatigue: A nurse’s primer. OJIN: The Online Journal of Issues in Nursing, 16(1), 3.
- Perry, L., Gallagher, R., Duffield, C., Sibbritt, D., Bichel‐Findlay, J., & Nicholls, R. (2016). Does nurses’ health affect their intention to remain in their current position?. Journal of nursing management, 24(8), 1088-1097.
- Perry, L., Lamont, S., Brunero, S., Gallagher, R., & Duffield, C. (2015). The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC nursing, 14(1), 15.
- Potter, P., Deshields, T., Divanbeigi, J., Berger, J., Cipriano, D., Norris, L., & Olsen, S. (2010). Compassion Fatigue and Burnout. Clinical journal of oncology nursing, 14(5).
- Sirota, T. (2013). Attitudes among nurse educators toward homosexuality. Journal of Nursing Education, 52(4), 219-227.
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