Nurses have some of the broadest roles among medical professionals. They work in many aspects of clinical care, advocate for better health in their patients and communities, conduct academic research, educate patients and their families on health conditions and options (and how to cope when an ailment doesn't go as hoped), and serve in numerous other ways on the forefront of health care.
Following that theme of admiring the tremendous contribution of Penn Medicine nurses and nurses nationwide, the News Blog joins the rest of the United States in celebrating Nurses Day on May 6 and Nurses Week, May 6-12.
Nurses Week always ends on Florence Nightingale's birthday to commemorate her influence as a caregiver, social reformer, statistician, and researcher. Many of today's nurses follow in those footsteps by assuming hybrid roles that span these areas, while advancing the field of nursing and continuously finding better ways to care for patients and improve health.
While our hospitals host events for nursing staff throughout the week, the News Blog takes a moment to highlight a unique effort to advance nursing ethics at the Hospital of the University of Pennsylvania (HUP).
The American Nurses Association (ANA) calls 2015 the “Year of Ethics," and updated its own ethical code earlier this year for the first time since 2001. At HUP, a nursing ethics special interest group is picking up steam in its influence on nursing practice and patient care.
Drawing from experience as co-director of HUP's interdisciplinary medical staff ethics committee, Mary K. Walton, MSN, MBE, RN, director of Patient and Family Centered Care and nurse ethicist, launched the interest group in October 2014. The new initiative operates as a forum for nursing staff to discuss ethical issues, provides education about clinical ethics, and helps nurses develop the knowledge and skills to address ethical concerns at the bedside and beyond. This group offers the opportunity to learn about clinical ethics to many more nurses beyond the opportunities provided to the nurses appointed to the hospital ethics committee.
Walton's own passion for the field of nursing ethics began during her clinical experience, and sees a similar sentiment echoed from many of the 75 other nurses who have expressed interest in the group since its start.
The group empowers nurses to make the best possible ethical decisions in patient care and doubles as a valuable professional development opportunity.
Part of that professional development, Walton adds, can be bolstered by pursuing a master's degree in bioethics (MBE) from Penn. Walton's MBE from Penn, coupled with her research and clinical experience, qualifies her to be a resource for staff members every day, helping them express their concerns and structure them in ethical frameworks and support them in engaging stakeholders, and identifying the values at play in each unique situation.
Much of the conversations about nursing ethics have traditionally focused on moral and ethical dilemmas in quandary ethics around end-of-life decisions, but there is increasing recognition of the need to focus on the ethical questions and concerns that arise throughout the continuum of care.
"Ethics is about every day decisions and experiences," says Walton. "It is about how to treat everyone with respect and dignity, and help families and patients understand what is going on."
Walton looked at the idea of "informed consent" as one example, and how to best help the patient understand the complexity of treatment options and connect those options to the patient's goals.
Ethical decision making is not always simple. Beyond ensuring that care is in accord with legal standards and respects the values of patients and families, ethical decision-making needs to factor in organizational values, as well as a clinician’s own personal and professional values, spiritual beliefs, and all the competing priorities in the workplace.
While clinicians might encourage a medical or surgical treatment plan they know is clinically indicated, patients’ values and goals might prompt their rejection of such recommendations. Understanding and respecting the diversity of values about health, the meaning of illness and how one evaluates their own quality of life presents challenges for clinicians. While some patients face difficult decisions in the inpatient setting, the clinical nurses offer a caring supportive presence as well as clinical expertise about the treatment options under consideration.
Walton explained that a subset of nurses see ethics as part of their professional career development, where they may choose to earn a masters or doctorate in ethics and conduct research or pursue academic positions, and others who want to develop their knowledge of nursing ethics to deepen their understanding of the field, enriching their own practice as well as that of their colleagues in the acute care setting. Roles for hospital based nurse ethicists are being developed around the country as more and more hospitals recognize the central role of ethics in clinical care to support both the quality and safety of patient care and a rewarding professional practice environment for nurses.
"Nurses want a deeper understanding of how to sort through complex problems through the lens of ethics," said Walton. "We are pretty comfortable sorting through the lens of law, but it's a separate analysis thinking about what is right from an ethical perspective."
While Walton sees increasing numbers of nurses seeking this understanding, a persistent stigma about ethics too often gets in the way. In some clinical environments, someone raising ethical concerns often comes with a connotation that a member of the care team must have done something unethical, when it's often a complicated situation.
Walton hopes that raising ethical concerns will be viewed as an important aspect of quality care and reflecting thoughtful person-centered practice.
"It comes down to ‘How do we treat everyone with respect and dignity in a complex, high intensity environment so that everyone has a voice?’" said Walton. "We need to make ethics front and center in how we talk about care."
Ethics is as much about care for patients and colleagues as it is about nurses taking time to care for themselves, Walton adds.
"When you have eight or 12 hours over a time span with a patient, and you need to do things that can inflict pain, you strive to help with both physical and emotional suffering -- that places a heavy moral burden on the nurse,” she said.
Recognizing the moral burden of being so close to patient suffering is a reminder for many nurses to make that time for themselves. In fact, the ANA Code of Ethics outlines the responsibilities to promote one’s own health and safety and continuing personal and professional growth.
As part of Nurses Week celebration at HUP, the eight nurses on the HUP Ethics Committee organized self-care kits and will be giving out copies of provision five of the ANA's Code of Ethics that reaffirms that nurses have a duty to self as to others. Interpretative statements in the code include the importance of eating a healthy diet, exercise, sufficient rest, maintaining family and personal relationships and engaging in leisure and recreational activities.
"We're celebrating nurses this week, and our message to them is that you need to take care of yourself so you can care for others," Walton said.