Critique of American Nursing Association Code of Ethics

Founded in 1896, the American Nurses Association has consistently strived for excellence in professionalism, provision of care, and medical expertise. Members of the American Nurses Association have been collaborating and evolving professional guidelines since 1901, leading to required registration for nurses, accumulation of valuable resources made available to nurses, and standardized academic requirements for exemplary training (ANA, 2007). Today, nurses are required to register as members of the American Nurses Association in order to practice nursing. With membership in the American Nurses Association comes the requirement of studying and mastering the American Nurses Association Code of Ethics. The American Nurses Association has had a formal and mandated code of ethics since the 1950’s (Orlovsky, 2006).

The American Nurses Association Code of Ethics contains nine provisions describing the moral, ethical, and professional requirements of nurses (ANA, 2001). While all of the provisions are important, there are three provisions that are exceptionally valuable and worthy of further discussion. The primary position of a nurse is to ensure the comfort, healing, and emotional wellbeing of a patient. Provision one of the American Nurses Association Code of Ethics stipulates this ideal well by requiring that, “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (ANA, 2001). Perhaps the most important provision of the Code of Ethics, Provision 1 demands that nurses act with compassion and continuously work to ensure that the patient feels that he or she is maintaining dignity.

Nurses work with and have more contact with patients and their families more than all other medical professionals. Patients may have occasional meetings with primary care physicians, specialist doctors, radiology technicians, surgeons and other medical professionals, but the majority of medical care both in hospital and in home is provided by registered nurses. Additionally, if a patient is in a facility for long-term care, he or she may not see his or her primary care physician more than once per month. This means that a client’s relationship with the nurse is an integral part of the patient’s care and quality of life. Nurses can take measures to maintain dignity in patients' care such as, “maintaining privacy of the body, providing spatial privacy, giving sufficient time, treating patients as a whole person and allowing patients to have autonomy” (Lin & Tsai, 2011). Because many patients suffering from severe or debilitating illnesses often feel as though they have lost their dignity and independence due to needing constant assistance with the most private of matters, nurses can do much to ensure that a patient still feels in control and respectable.

Provision 1 requires that nurses work for the patient with compassion. Unfortunately, because nurses have such a demanding job and are charged with so many responsibilities, it is common for nurses to experience burn out (Jennings, 2008). Burnout is the “chronic stress common in occupations involving numerous direct interactions with people” (Jennings, 2008). Nurses suffering from burnout often experience emotional exhaustion, depersonalization, compassion fatigue, and reduced personal accomplishment (Jennings, 2008). This means that if a nurse is feeling overworked, exhausted, and underappreciated in his or her position of employment, the nurse can experience burnout, which affects the patient for whom the nurse is charged with providing care. However, according to Provision 1, nurses are required to continuously provide compassion and treat patients with dignity. In order to adhere to Provision 1, nurses must undergo continuous self-checks to ensure that their own emotional states are not interfering with their professional responsibilities as mandated by the American Nurses Association Code of Ethics.

In order to avoid burnout, the American Nurses Association Code of Ethics includes Provision 5, which states that, “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth” (ANA, 2001). While many nurses feel a sense of responsibility to care for their patients, it is common for nurses to overlook their own self-care (Jennings, 2008). Therefore, the American Nurses Association Code of Ethics attempts to address this issue and bring attention to the needs of nurses.

A nurse can successfully adhere to Provision 5 of the Code of Ethics by engaging in activities in his or her personal life that bring relaxation and joy. A healthy support system, an enjoyment of life, and a meaningful self-care routine that replenishes one’s energy and compassion is essential for the successful practice of nursing. Also, nurses are responsible for maintaining competence (ANA, 2001), which involves staying up to date on the latest and most effective nursing practices and medical procedures. If a nurse is unable to perform certain tasks, use new equipment, or discuss medical conditions with fluency, he or she is in breach of Provision 5 of the code of ethics. Therefore, regular training and education is required on the part of the nurse to ensure that the nurse is consistently up to date with the rapidly changing world of medicine and medical treatments available to patients.

The third provision that is exceptionally important as part of the American Nurses Association Code of Ethics is Provision 8. Provision 8 states that, “The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs” (ANA, 2001). Provision 8 is crucial to the practice of nurses in that it mandates nurses to be skilled in communication. Nurses are required to collaborate with other medical professionals to ensure that a patient is receiving the utmost quality care. Without such a provision, a nurse or other medical professional may be misinformed or uninformed about a patient’s needs. For example, a nurse who fails to communicate a patient’s allergy to penicillin to a primary care doctor is putting the patient at risk. If a primary care doctor then prescribes penicillin to the patient, the nurse is liable for the patient’s detriment due to failing to communicate valuable information to the remainder of the medical professional staff.

The American Nurses Association Code of Ethics is a thorough and comprehensive document. However, there is one provision within the document that could benefit from revision. Provision 4 states that, “The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care” (ANA, 2001). While the responsibility placed on the nurse by this provision is fair and applicable, the wording of this provision makes it seem that the nurse is alone in the endeavor of providing individual care to a patient. This provision should be reworded to elaborate on the fact that nurses have a host of other qualified medical professionals on whom to depend and with whom to confer. The wording of Provision 4 sounds contradictory to the collaborative qualities expressed in Provision 8. In fact, the wording of Provision 4 places undue pressure on nurses and should be re-worded to emphasize taking initiative, but not full responsibility. A nurse who is fearful of being blamed or of having to take full responsibility should a particular patient’s case go awry may be hesitant to perform at optimum capacity. The emotional burden placed on nurses in Provision 4 is not conducive to a healthy work environment. Instead, a simple clause stating that nurses are in collaboration with and share responsibilities with other medical professionals could alleviate this undue burden.

The American Nurses Association Code of Ethics is an essential tool that ensures the success of the medical profession. Without the Code of Ethics, nurses would lapse into burnout, incompetence, and outdated practices and information. Therefore, the Code of Ethics is absolutely necessary to ensure that nurses are held to the highest possible standards. As professionals who hold the lives of patients in their hands, nurses must be held responsible to a Code of Ethics that demands the very best practices and policies. Thankfully, the American Nurses Association is actively involved in the formation of the legislature and modifies its policies and Code of Ethics according to the latest and most relevant legislation (ANA, 2007). It is with thanks to this professional organization and the Code of Ethics that the United States boasts some of the most effective and impressive medical professionals in the world.

References

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. American Nurses Association. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

American Nurses Association. (2007). Historical review. American Nurses Association. Retrieved from http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/History/BasicHistoricalReview.pdf

Jennings, B. M. (2008). Work stress and burnout among nurses: Role of the work environment and working conditions. Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality.

Lin, Y. P. & Tsai, Y. F. (2011). Maintaining patients’ dignity during clinical care: A qualitative interview study. Journal of Advanced Nursing, 67(2), 340-348.

Orlovsky, C. (2006). The nursing code of ethics tackles tough issues of the past, present, and future. Nurse Zone. AMN Healthcare, Inc. Retrieved from http://www.nursezone.com/nursing-news-events/more-news/The-Nursing-Code-of-Ethics-Tackles-Tough-Issues-of-the-Past-Present-and-Future_28956.aspx