In a profession continually ranked above all others for honesty and ethics, ongoing discussions about delivering quality care with strong integrity and principles is essential.
For 17 consecutive years, nurses have been named the most honest and ethical profession in Gallup polls, most recently earning the title in December 2018. But even with the confidence of patients and the public, maintaining the nursing code of ethics standards is an ever-evolving process. Advances in medicine, technology, end-of-life care, health insurance and other issues are transforming the way healthcare is delivered, making ethics an important consideration.
Social media nursing ethics to consider
For many nurses, social media serves as a tool to make healthcare more efficient while improving collaboration and communication among peers worldwide. This can have a great impact as nurses connect and exchange information, ideas and best practices. It can also bring to question patient privacy. The ANA offers principles for social networking related to the nursing code of ethics that remind nurses:
- Not to transmit or post any identifiable patient information.
- To be aware that patients, colleagues, organizations and employers may view postings.
- To report any content that could harm a patient's privacy, rights or welfare.
"Nurses need to be aware of the professional reputation they're creating for themselves and how they're using online tools," Robert Fraser, MN, RN, a primary care nurse, author and digital health strategist from Toronto, told HealthLeaders Media in an August 2018 article. "Social media does provide new opportunities and new ways of approaching how we communicate, but nurses need to reflect on their professional identity and their professional expectations within the workplace."
Two CNAs at a Glenview, Ill., nursing home were recently fired after posting a video to SnapChat of a 91-year-old dementia patient being teased over not wanting to wear a gown, according to WGN. The woman's family is suing the nursing home.
"This was a sick game the two CNAs decided to play for their own enjoyment," attorney John Perconti, who is representing the woman's family in the lawsuit, told the TV station. "By filing this lawsuit and pursuing this lawsuit, we will prevent this from happening to other individuals in this facility, as well as other facilities."
With constant access to smartphones in the workplace, inappropriate communication such as a text or post that might seem innocent or even personal and unrelated to the job could be cause for discipline. Legal expert Nancy Brent, MS, JD, RN, highlighted the issue of texting at work in her blog post, "Is Texting at Work Acceptable for Nurses?" "Because you are a licensed professional, you have an obligation to be 'professional' at all times, whether or not you are practicing nursing," Brent wrote. "Thus, being convicted of a DUI or shoplifting, or texting your husband's ex-wife while at work and stoking an ongoing feud, may result in you being professionally disciplined for unprofessional conduct."
Nursing code of ethics issues surrounding EHRs
Although the advent of electronic health records (EHRs) has provided many benefits, experts have found some ethical dilemmas surrounding their use -- particularly when it comes to patient safety, according to a January 2018 study published in the Online Journal of Issues in Nursing.
"Evidence is mounting that EHRs are resulting in unintended consequences with patient safety implications," the study authors wrote. "Clinical teams confront usability challenges that can present ethical issues requiring ethical decision-making models to support clinicians in appropriate action on behalf of safe, effective clinical care."
Researchers found although there is a 95% saturation rate of EHR in healthcare settings, more education, support from nurse leaders and patient interaction is needed. "For care characterized by 'screen-driven information gathering,' the patient's story of his/her illness may be lost to the goal of generating standard data points that, in turn, trigger algorithms and practice recommendations," the study stated. "This computational capacity may establish EHR information as authoritative, potentially displacing work processes critical to nurse-patient interaction."
Nursing ethics in end-of-life care
Today patients have a voice with nurses and physicians about their end-of-life treatment more than ever before. But even with these strides, nursing code of ethics issues surrounding end-of-life care continue to exist. Both patients and healthcare providers associate more procedures, chemotherapy and intensive care with better care, Haider Warraich, MD, a cardiologist at Duke University Medical Center in Durham, N.C., wrote in a recent Vox article. Warraich cites studies that show patients with cancer and heart disease receiving palliative care, which focuses on quality of life versus quantity, can live longer.
"While the goal of palliative care is to help people with a serious illness live as well as possible -- physically, emotionally and spiritually -- rather than as long as possible, some people receiving palliative care might also live longer since they avoid the complications associated with procedures, medications and hospitalization," Warraich wrote.
Rapidly increasing technological advances that save lives, such as pacemakers and mechanical pumps placed in the heart, can create a dilemma when terminally ill patients want the devices disconnected, according to Warraich. "Many patients with terminal illnesses who want to deactivate these devices find resistance from the health system, since some continue to equate deactivating them with euthanasia," Warraich wrote. "We need to continue to make sure that even as technological advances blossom, patients remain at the center and physicians continue to honor their wishes."
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