The Oklahoma Nurse - May 2020

18
The Oklahoma Nurse May, June, July 2020
Trust Your Practice
Reprinted with permission from Tennessee Nurse March 2020
Kate Payne, JD, RN, NC-BC
There should be no surprise that once again, 18 th
year in a row, nurses were rated the highest among
a list of professions for honesty and ethics. (1) 85%
of Americans rated nurses as “very high” or “high.”
I know what the public sees in nurses to repeatedly
give such high ratings; they know they will get an
honest answer, that their nurse will help them and
advocate for them. The nature of nursing requires
that ethical decisions are made and enacted daily if
not moment-to-moment for the benefit of the patient,
their practice, and the broader society. This is also Kate Payne
consistent with the Nursing Code of Ethics. (2)
I am blessed to meet regularly with nurses in my work as an ethics
consultant. I also help facilitate support groups, case debriefs, and unitbased
meetings and huddles. Some of these are regular forums for
conversation, support, information, or problem-solving. Some of these
forums are called for specific and difficult patient care situations as well
as thinking together on next steps. Meetings are usually open to other
team members, including physicians, administrators, pastoral care, childlife
in the pediatric hospital, anyone involved in the care of patients. These
gatherings can be of any size, at any time of the day or night. They are
usually small, and sometimes even just one or two people over coffee or a
meal. These conversations show what is not so visible to the public but what
undergirds their repeated high ratings of nurses in the Gallup poll each year.
Nursing stories are all about comfort, care, and concern for patients,
their families, and other loved ones. They are also about how nurses care
for each other, have each other’s backs, and care for others on the team.
Health care is hard work, and it is not getting easier. Nursing stories are
about perseverance in the face of what often seems impossible. Nurses are
hope mongers, and hope is a morally important quality to nursing practice
(3) and to life. It enables perseverance as well as courage, and it is futureoriented,
the idea that we will continue and that adversity can be overcome.
This is what helps build resilience and teamwork and part of what keeps
nurses coming back every day. Nursing conversations also exemplify other
virtues, including creativity, compassion, trust, charity, affection, openness,
and competence, to name a few. The ethics of nurses are seen in how they
treat people, how they care for each other as well as commit to improving
the larger society. It is also seen in how they educate and mentor the next
generation of nurses (4) and others in the intraprofessional relationships, of
which all nurses are a part.
Nursing is a virtuous profession, and we see this reflected back to us
each year in the Gallup poll (one of many ways). It is a reminder that nursing
work is visible and important to the broader public. It should also be a
reminder to trust your practice. Total strangers trust nurses to take care of
them, to help them heal, to have a good death, to speak the truth, to just
care. Nurses have a unique vantage point because of their proximity to the
patient. They see things other members of the team do not. Sometimes a
blessing and a curse, being with a patient for hours teaches us who they are
and what they need, what works and what doesn’t. Trusting your practice
means taking what you learn from the patient and shaping the environment
of care for the patient, in your unit or department, and organization.
Nurses often find themselves in situations that conflict with their personal
and professional ethics, that go against what is best for the patient.
Sometimes, advocating for a better way requires moral courage. (5) Moral
courage is part of nursing practice. It is defined as the willingness to stand
up for and act according to one’s ethical beliefs, regardless of the perceived
or actual risks. Moral distress occurs when nurses feel powerless to act
after witnessing improper behavior or organizational constraints that make
doing the right thing difficult or impossible. Trust your practice to know
that moral courage is another virtue you can develop and use. Health care
is increasingly complex, as are the ethical dilemmas nurses are faced
with. Addressing such dilemmas is never easy, but is required for nurses
to provide the best possible patient care. Advocating for a patient’s best
interest can pose challenges and risks, but nurses must resolve to uphold
their ethical obligations and trust in your practice, you will find the way, there
will be help.
References
1. Reinhart RJ, Nurses continue to rate highest in honesty, ethics. Gallup.
Available at https://news.gallup.com/poll/274673/nurses-continue-rate-highesthonesty-ethics.aspx
2. American Nurses Association (ANA). Code of Ethics for Nurses with Interpretive
Statements. Silver Springs, MD: Author, 2015.
3. Churchill L. Ethics for Everyone. A Skills-Based Approach. New York: Oxford
University Press, 2020.
4. Curtin L. Mentorship and collegiality. The ethics of professional relationships.
American Nurse Journal. 2020;15(1):60.
5. Lachman V. Doing the right thing: pathways to moral courage. American Nurse
Today. 2012; May 11: available at https://www.myamericannurse.com/doingthe-right-thing-pathways-to-moral-courage/