When you're a nurse, every shift presents the possibility that an ethical dilemma will emerge. And these dilemmas run the gamut from whether a patient has been invited to participate in their own treatment plan to whether an end-of-life care plan respects a patient's spirituality or personal preferences. Now, there's an award that acknowledges and celebrates nurses who demonstrate solid ethical practice.
What's in the code?
The American Nurses Association's Code of Ethics is more than just a guide for ethical practice and the obligations and duties of nurses. It's akin to a promise that nurses make to every single patient they care for to look out for their best interests. "The Code of Ethics helps nurses by giving them structure as to how to own their accountability and their responsibilities within their nursing practice and help make those decisions based on what would be providing the most optimal care for the patient," Emily Emma, DNP, RN-BC, NEA-BC, the director for Magnet and professional practice at Stony Brook (N.Y.) University Hospital, said in a Nurse.com blog. "Having ethical principles in nursing really guides the nurse to make the best, most moral decision on behalf of themselves as practitioners and for the patients."
The Code of Ethics' provisions counsel nurses to practice with "compassion and respect for the inherent dignity, worth, and unique attributes of every person" and to be advocates for patient rights and safety. The provisions point out that a nurse's "primary commitment is to the patient, whether an individual, family, group, community, or population."
The Code of Ethics also acknowledges that nurses owe "the same duties to self as to others" and should prioritize maintaining an ethical work environment. To non-nurses, this may seem like a tall order. But nurses make this commitment even before they land their first nursing jobs. Yet that commitment is not without its challenges.
Types of challenges to ethics in nursing
Research has shown that many ethical challenges revolve around situations that compromise patient care, safety, and morally distressing end-of-life decisions. Common ethical issues discussed in research and news reports include:
- Safeguarding patients' rights
- Informed consent to treatment
- Shared decision making
- Breaches in patient confidentiality or privacy
- End-of-life decisions
- Organ donation and transplantation
A study on the Sage Journals website characterized ethical dilemmas into three themes:
- Balancing harm and care
- Work overload affecting quality
- Navigating in disagreement
The study's authors wrote, "Moral decisions are based on nurses' ethical awareness and involve a complex process of observing, analyzing, and weighing up the possible consequences of a choice where nurses are driven by the ideal of care and the aim of 'doing good.' For nurses, doing good means considering the patient's well-being, quality of care, and the patient's dignity. In other words, the patient's lifeworld is taken into account." When there is an obstacle to doing good is when the ethical dilemma arises. The "balancing harm and care" theme addresses instances wherein nurses are forced to act against what they consider to be good and appropriate care, which is distressing to nurses, according to the study. The "work overload affecting quality" theme can refer to any scenario in which a nurse feels a patient's care is being compromised by an imbalance between patient care and administrative duties. "Navigating in disagreement" refers to situations in which nurses disagree with physicians on treatment strategies for patients, which can lead to ethical dilemmas. "Not being heard or having their opinions ignored because of their lack of authority induced moral distress among nurses," wrote the study's authors. Given the ethical minefield that nurses have to navigate all too often, it seems fitting that The DAISY Foundation has created an award that applauds and celebrates the commitment to ethics in nursing and their professionalism and bravery in making tough decisions.
The new DAISY Award for Nursing Ethics
The DAISY Award for Nursing Ethics was developed in collaboration with the American Nurses Association's Center for Ethics and Human Rights. "The award will recognize nurse leaders and clinical nurses whose leadership, compassion and clinical practice demonstrate the importance of human values and ethics in nursing," according to the foundation's website. [caption id="attachment_106761" align="alignleft" width="250"]
Bonnie Barnes, FAAN, and Mark Barnes, FAAN, The DAISY Foundation Co-Founders[/caption] Bonnie Barnes, FAAN, Co-Founder of The DAISY Foundation, detailed the foundation's motivation for creating the new award during a NurseDot Podcast episode called "Recognizing Ethics," in which she chatted with host Cara Lunsford, RN, Vice President for Community for Relias and Nurse.com, about the award and the foundation's roots. While reading nominations for the DAISY Awards aimed at individual nurses and teams during the pandemic, Barnes said her team was struck by the decision making that was being honored in the nominations when there were "some really tough calls" that bedside nurses and leaders were having to make. [caption id="attachment_106760" align="alignright" width="250"]
Cara Lunsford, RN[/caption] "The more we read about the advocacy that was going on and the nurses who are taking a stand, the more we thought, how do we shine a light on what nurses do without even thinking about it that is in keeping with their integrity and their ethical values?" Barnes said during the podcast. "Then we learned about the ANA's Code of Ethics." Barnes said the award is a way to embolden nurses as they keep ethics front and center when they provide patient care. "This is a way for nurses to be encouraged to practice to their values and to their integrity. We're here to support that," she said. According to Barnes, it's just as important for organizations to support a nurse's ethical practice and recognize when a nurse "stood up and did the right thing."
"We really hope that this recognition will provide to the leadership of organizations [a way] to demonstrate their support for the role nurses play and their practice," Barnes said.
Barnes' enthusiasm about the official launch of The DAISY Award for Nursing Ethics in January (although information on the award is available now on the foundation's website) was matched by Lunsford's during the podcast. "I am so excited for this award because I think it's a long time coming," said Lunsford. Lunsford said the pandemic shined a light on the difficult decisions nurses are forced to make. "What we have to do [as nurses] is we have to constantly lean back on the nursing Code of Ethics," she said. "We have to go back to the to the time when we were new grads and we just came out of nursing school, and it had been drilled into our minds about the nursing Code of Ethics. And how do we advocate? How do we step up and voice when we know that something's not right?" Lunsford said hospitals and leadership can do more to recognize when their nurses do the right thing and look out for the best interests of the people they're serving. Using The DAISY Award for Nursing Ethics to recognize nurses is the perfect opportunity, she said. "Then we have the opportunity to shine a light on that institution and to say, 'Hey, this institution has some pretty incredible people working for them.'" Barnes said that's one of the goals of the award -- to highlight incredible nurses making tough decisions. Another goal is for nurses to reach the realization that the turmoil they may feel when faced with an ethical decision is because their integrity is being challenged -- and they must do something about that. "Your integrity is everything," Barnes said. "When our integrity is attacked is when we go into this area of moral distress. That's what is making nurses rethink if they're in the right career. We don't ever want them to challenge themselves about that. We want them to have complete security that they are supported and appreciated and valued for their brain power, as well as their compassion." Editor's note: Listen to the full podcast on Spotify. To discuss nursing ethics and emerging issues with other professional nurses, download the Nurse.com app. 
