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An ethical approach

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By: Ernest J. Grant, PhD, RN, FAAN, President, American Nurses Association

Guidance for navigating complex healthcare dilemmas.

From the joyous celebrations at the sound of a newborn’s first cries to the solemn moment when a patient takes their last breath, registered nurses are there, sharing these experiences with our patients and processing them within ourselves. Our unique role spans the spectrum of life, health, and disease, granting us exceptional privileges and placing special obligations on us. Navigating the delicate and nuanced aspects of providing sometimes lifesaving and often transformative care also requires balancing our responsibilities with our values, ideals, and risks of practice.

This is why ethics in nursing matter and why the American Nurses Association (ANA) Center for Ethics and Human Rights closely monitors events across healthcare. By considering changes in healthcare delivery, finances, and structures through a lens of moral principles and values, the Center anticipates emerging issues and offers guidance to nurses in all practice settings as they wrestle with ethical dilemmas inherent in complex and stressful environments.

As so many of us can attest, the stressors in healthcare have only mounted since March 2020, frequently placing nurses in difficult and trying situations they couldn’t imagine previously. The pandemic also has raised questions about appropriately allocating scarce resources and providing competent and compassionate care to all patients, even in extreme circumstances and when normal systems of support aren’t accessible. More recently, legal and policy decisions have nurses questioning whether their personal values or duty to their patients would conflict with fast-moving laws and regulations. Nurses also have uncertainties about their legal exposure in providing care according to ANA’s Nursing: Scope and Standards of Practice and Code of Ethics for Nurses with Interpretive Statements (nursingworld.org/coe-view-only). In addition, they have heightened concerns about potential legal vulnerabilities arising from any unintentional errors they might make. These pressure cooker stressors have many nurses reconsidering their roles and motivations for practicing.

In this context, the Center updated and the ANA Board of Directors recently approved a revision of the position statement on risk and responsibility in providing nursing care (nursingworld.org/ANARiskinNursing2022). This update, started before the pandemic as part of the Center’s 5-year cycle of reassessing policies, went on to consider the changed practice landscape forged by COVID-19. The revised statement underscores limits to the personal risk of harm nurses can be expected to accept as an ethical duty and describes harm as emotional, psychosocial, physical, moral, and spiritual. Exceptional among healthcare professional ethics positions, the statement also notes that nurses have a duty to take the same care for our own health and safety as we do for others.

This statement (like 18 others that address ethics and human rights), along with the Code of Ethics, isn’t intended to offer black-and-white solutions to the complex challenges nurses face (bit.ly/3RY0ll1). Rather, these dynamic documents provide nurses with a system of decision-making guidance to navigate dilemmas—major or minor—throughout their careers. This framework underscores nurses’ autonomy of choice—two individuals in similar circumstances can arrive at ethically considered yet opposing solutions, both acceptable.

These essential resources, written in practical, approachable language, bolster nurses when dealing with conflicts and issues they alone can’t solve. “Organizational support for the registered nurse,” the position statement notes, “is a non-negotiable necessity.” The Center also receives inquiries from around the world (ethics@ana.org).

I urge all nurses to keep these resources at the ready to help identify their risks and responsibilities and weigh their options in any given situation. We’re highly skilled, knowledgeable professionals performing our utmost best in high-stakes settings. This merits our agency in making well-considered, ethical decisions that meet the moment.

– Ernest J. Grant, PhD, RN, FAAN, President, American Nurses Association

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