Speaking Up About Ethical Issues

Article Categories: Legal and Ethics & Nurse On the Job

A co-worker takes extra smoking breaks. The resident orders unnecessary lab tests for a dying patient. The new--and cheaper--supplies are terrible quality. A family is concerned that their loved one is not getting adequate pain relief. You suspect an aide is not following proper handwashing technique.

These are common situations for any RN. You probably have a few more examples. Ethics and nursing cannot be separated. To reinforce this, the American Nurses Association (ANA) has declared 2015 The Year of Ethics to help address the daily issues that nurses encounter. An updated “Code of Ethics for Nurses with Interpretive Statements” was published early in 2015 to match traditional standards with current practices.

How do you know when to speak up about the ethical issues that you encounter? Remembering Provision 2 of the Code of Ethics “The nurse's primary commitment is to the patient, whether an individual, family, group, or community,” here are some guidelines:

1. Decide what’s at stake. Medicine is one of the few areas where risk really can result in life-or-death. Or harm to the patient. Are patients missing care because of your co-worker’s absence? Is the dying patient suffering from extra needle sticks? Are the new supplies compromising excellent outcomes? Be clear about the issue before continuing.

2. Know yourself first. Besides adhering to the professional code, you have your own personal sense of ethics that guide your actions. Cynda H. Rushton, PhD, RN, FAAN, Professor of Clinical Ethics at the Berman Institute of Bioethics/School of Nursing at Johns Hopkins University explains: “Knowing who you are and what you stand for personally and professionally provides a foundation to speak up and speak out about issues that support or compromise your values. Without this clarity, your responses may be reactive, unreflective and potentially damaging to you and to others.”

3. Talk to the person. It’s tempting to want to go straight to a supervisor to report your observations. But switch perspectives: Wouldn’t you want to have a chance to explain yourself? Sometimes our perceptions are inaccurate. Ask questions, don’t accuse. It doesn’t mean you won’t pursue action, it means being fair and honest. Of course, if the situation is grave, you may need to proceed immediately.

4. Consider the consequences. James Detert, PhD, Professor at Samuel Johnson Graduate School of Business at Cornell University, says, “Even minor issues can have serious consequences. Only each of us individually can decide which issues we’re willing to lay it on the line for.” Provision 3 of the Code of Ethics clearly states, “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” With this in mind, Detert recommends keeping a record of conversations related to the issue and not taking action alone, in order to protect yourself from possible retaliation.

One more note: You decided to become a nurse because you wanted to make a difference, to help those in need, to be part of something bigger than yourself. The first Provision of the Code of Ethics is a powerful reminder: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”

Carol Taylor, PhD, RN, a Nursing Professor at Georgetown University, sums it up nicely: “Taken seriously, this means that each of us must practice with zero tolerance for disrespect, for our patients, their family members, our colleagues and ourselves.”