JOGNN
EDITORIAL
Nursing, Nurses, and Ethics hen Americans were asked by Gallup interviewers in 2014, Please tell me how you would rate the honesty and ethical standards of people in these different fields – very high, high, average, low or very low, nurses were rated very high/high by 80% of the respondents. For the 13th year in a row, nurses have been regarded as the most honest and ethical professionals. In fact, nurses have topped this Gallup poll as the most honest and ethical professionals since we were included in 1999, except for 2001 when firefighters topped the list in the wake of the 9/11 attacks. Nurses were rated greater than medical doctors, pharmacists, police officers, clergy, and lawyers among others, including members of Congress who were at the bottom of the list.
W
Nancy K. Lowe Editor
Our ethical principles as nurses rest fundamentally on the ongoing work of the American Nurses Association (ANA). This history led me into the wonderfully preserved online archives of the American Journal of Nursing (AJN) from the origin of the journal in 1900. In my journey through these archives and as a total aside, I must tell you that I was struck by the wealth of nursing history and the familiarity of topics preserved in the journal’s pages of so many years ago. I had some difficulty remaining focused on the search that led me into these rich pages of nursing history. With its origins in The Nightingale Pledge of 1893, A Suggested Code for nurses was published in the AJN in 1926 as presented to and discussed by the ANA Biennial Convention attendees in Atlantic City, May 1926. This suggested code was the work of ANA’s Committee on Ethical Standards. Among the key principles of this suggested code was the idea that “the nurse is primarily a citizen” and the obligation of a citizen “is to serve society as well as possible by contributing that for which he is best fitted” (ANA, 1926, p. 600). This social principle was followed by statements about nursing as a profession of service, the need for nurses to safeguard their own health, and the concepts of economic independence and self-realization for individual nurses. A most enlightened statement was that the “the use of the term ‘professional’ implies exalted purpose, sound preparation and conformance to requirements imposed by the state which evidence such preparation” (ANA, 1926, p. 600). As well as the principle of
http://jognn.awhonn.org
state licensure, concepts of professional growth and development were emphasized. Are these ideas not appropriate for the 21st century? Finally, this preamble led into ethical statements in the areas of the relation of the nurse to the patient, to the medical profession, to the allied professions, to other nurses, and to the profession. Although some of the text seems quaint and subservient compared to our current ideas about professional nursing practice, these areas of relationship encompass the majority of our current ethical challenges. There is no evidence that the ANA ever adopted this suggested code. In 1940, A Tentative Code was similarly published in the AJN and emanated from the work of the same ANA Committee on Ethical Standards as presented to the ANA House of Delegates during the Philadelphia convention in the same year. A more fully developed statement, this tentative code described the attributes of nursing as a profession and the core responsibilities of the nurse to protect and promote health, as well as to comfort and assist the sick, injured, and feeble. Using the same framework of ethical statements in relation to others, this proposed code was organized according to the nurse’s responsibilities to the profession and in relation to the patient, the medical profession, to other nurses, to the employer, to the public, and to others. Similar to the earlier suggested code, this tentative code was not formally adopted by the ANA. At its 1950 convention, the ANA House of Delegates finally accepted A Code for Professional Nurses. This code included 17 provisions and was revised three times before it was renamed in 1976 to The Code of Ethics for Nurses with Interpretive Statements. The most recent revision of the code occurred in 2014 with the participation of representatives from all major nursing organizations, including the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), and was published early this year (ANA, 2015). With the release of the new code, ANA declared 2015 the Year of Ethics and selected this theme for National Nursing Week in May. Despite our high regard by the American public and history of ethical codes, we are all aware that nursing practice presents daily ethical challenges during which nurses’ ethical principles and professional values are tested.
C 2015 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
339
EDITORIAL
In response to these realities, the Johns Hopkins School of Nursing and the Johns Hopkins Berman Institute of Bioethics sponsored an ethics summit of 50 nursing leaders in August 2014. From this meeting, a new initiative emerged that is summarized in A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit Executive Summary and is freely available on the web. Contemporary reviews of the literature to support this work in the areas of clinical practice, nursing education, and nursing research are planned for publication through appropriate professional journals.
Editorial
care delivery, policy, research, and education using nursing ethics as guiding frameworks. Ethical practice must be at the forefront of all developments in health care and the very fabric of the cultural climate of all environments in which nurses practice and the public receives health care.
REFERENCES Johns Hopkins School of Nursing and Berman Institute of Bioethics. (2014). A blueprint for 21st century nursing ethics: Report of the National Nursing Summit executive summary. Retrieved from http://bioethicsinstitute.org/nursing-ethics-summit-report/ American Nurses Association. (1926). A suggested code: A code of
Recognizing that nurses face ethical challenges in everyday practice, the need to strengthen the ethical foundation of nursing, the ethical pressures resulting from disparities in human, social, and financial resources in health care, and the pervasive nature of moral distress in nurses’ work, the summit leaders determined that there is a need to improve nurses’ ethical environments. Further, nurses should be in leadership roles to refine existing and emerging models of health
340
JOGNN, 44, 339-340; 2015. DOI: 10.1111/1552-6909.12579
ethics presented for the consideration of the American Nurses’ Association. American Journal of Nursing, 26, 599–601. American Nurses Association. (1940). A tentative code: for the nursing profession. American Journal of Nursing, 40, 977–980. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Gallup. (December 18, 2014). Americans rate nurses highest on honesty, ethical standards. Washington, D.C.: Gallup World Headquarters. Retrieved from www.gallup.com/poll180260/ americans-rate-nurses-highest-honesty-ethical-standards.aspx ?version=print/
http://jognn.awhonn.org
EDITORIAL
Nursing, Nurses, and Ethics hen Americans were asked by Gallup interviewers in 2014, Please tell me how you would rate the honesty and ethical standards of people in these different fields – very high, high, average, low or very low, nurses were rated very high/high by 80% of the respondents. For the 13th year in a row, nurses have been regarded as the most honest and ethical professionals. In fact, nurses have topped this Gallup poll as the most honest and ethical professionals since we were included in 1999, except for 2001 when firefighters topped the list in the wake of the 9/11 attacks. Nurses were rated greater than medical doctors, pharmacists, police officers, clergy, and lawyers among others, including members of Congress who were at the bottom of the list.
W
Nancy K. Lowe Editor
Our ethical principles as nurses rest fundamentally on the ongoing work of the American Nurses Association (ANA). This history led me into the wonderfully preserved online archives of the American Journal of Nursing (AJN) from the origin of the journal in 1900. In my journey through these archives and as a total aside, I must tell you that I was struck by the wealth of nursing history and the familiarity of topics preserved in the journal’s pages of so many years ago. I had some difficulty remaining focused on the search that led me into these rich pages of nursing history. With its origins in The Nightingale Pledge of 1893, A Suggested Code for nurses was published in the AJN in 1926 as presented to and discussed by the ANA Biennial Convention attendees in Atlantic City, May 1926. This suggested code was the work of ANA’s Committee on Ethical Standards. Among the key principles of this suggested code was the idea that “the nurse is primarily a citizen” and the obligation of a citizen “is to serve society as well as possible by contributing that for which he is best fitted” (ANA, 1926, p. 600). This social principle was followed by statements about nursing as a profession of service, the need for nurses to safeguard their own health, and the concepts of economic independence and self-realization for individual nurses. A most enlightened statement was that the “the use of the term ‘professional’ implies exalted purpose, sound preparation and conformance to requirements imposed by the state which evidence such preparation” (ANA, 1926, p. 600). As well as the principle of
http://jognn.awhonn.org
state licensure, concepts of professional growth and development were emphasized. Are these ideas not appropriate for the 21st century? Finally, this preamble led into ethical statements in the areas of the relation of the nurse to the patient, to the medical profession, to the allied professions, to other nurses, and to the profession. Although some of the text seems quaint and subservient compared to our current ideas about professional nursing practice, these areas of relationship encompass the majority of our current ethical challenges. There is no evidence that the ANA ever adopted this suggested code. In 1940, A Tentative Code was similarly published in the AJN and emanated from the work of the same ANA Committee on Ethical Standards as presented to the ANA House of Delegates during the Philadelphia convention in the same year. A more fully developed statement, this tentative code described the attributes of nursing as a profession and the core responsibilities of the nurse to protect and promote health, as well as to comfort and assist the sick, injured, and feeble. Using the same framework of ethical statements in relation to others, this proposed code was organized according to the nurse’s responsibilities to the profession and in relation to the patient, the medical profession, to other nurses, to the employer, to the public, and to others. Similar to the earlier suggested code, this tentative code was not formally adopted by the ANA. At its 1950 convention, the ANA House of Delegates finally accepted A Code for Professional Nurses. This code included 17 provisions and was revised three times before it was renamed in 1976 to The Code of Ethics for Nurses with Interpretive Statements. The most recent revision of the code occurred in 2014 with the participation of representatives from all major nursing organizations, including the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), and was published early this year (ANA, 2015). With the release of the new code, ANA declared 2015 the Year of Ethics and selected this theme for National Nursing Week in May. Despite our high regard by the American public and history of ethical codes, we are all aware that nursing practice presents daily ethical challenges during which nurses’ ethical principles and professional values are tested.
C 2015 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
339
EDITORIAL
In response to these realities, the Johns Hopkins School of Nursing and the Johns Hopkins Berman Institute of Bioethics sponsored an ethics summit of 50 nursing leaders in August 2014. From this meeting, a new initiative emerged that is summarized in A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit Executive Summary and is freely available on the web. Contemporary reviews of the literature to support this work in the areas of clinical practice, nursing education, and nursing research are planned for publication through appropriate professional journals.
Editorial
care delivery, policy, research, and education using nursing ethics as guiding frameworks. Ethical practice must be at the forefront of all developments in health care and the very fabric of the cultural climate of all environments in which nurses practice and the public receives health care.
REFERENCES Johns Hopkins School of Nursing and Berman Institute of Bioethics. (2014). A blueprint for 21st century nursing ethics: Report of the National Nursing Summit executive summary. Retrieved from http://bioethicsinstitute.org/nursing-ethics-summit-report/ American Nurses Association. (1926). A suggested code: A code of
Recognizing that nurses face ethical challenges in everyday practice, the need to strengthen the ethical foundation of nursing, the ethical pressures resulting from disparities in human, social, and financial resources in health care, and the pervasive nature of moral distress in nurses’ work, the summit leaders determined that there is a need to improve nurses’ ethical environments. Further, nurses should be in leadership roles to refine existing and emerging models of health
340
JOGNN, 44, 339-340; 2015. DOI: 10.1111/1552-6909.12579
ethics presented for the consideration of the American Nurses’ Association. American Journal of Nursing, 26, 599–601. American Nurses Association. (1940). A tentative code: for the nursing profession. American Journal of Nursing, 40, 977–980. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Gallup. (December 18, 2014). Americans rate nurses highest on honesty, ethical standards. Washington, D.C.: Gallup World Headquarters. Retrieved from www.gallup.com/poll180260/ americans-rate-nurses-highest-honesty-ethical-standards.aspx ?version=print/
http://jognn.awhonn.org
