Nursing Ethics in the 21st Century: A Blueprint

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“Until one is committed there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative and creation there is one elementary truth the ignorance of which kills countless ideas and splendid plans:

That the moment one definitely commits oneself, then Providence moves too. All sorts of things occur to help one that would never otherwise have occurred. A whole stream of events issues from the decision, raising in one’s favor all manner of unforeseen incidents and meetings and material assistance which no man could have dreamed would have come his way. I am reminded of one of Goethe’s couplets: ‘Whatever you can do or dream you can; begin it. Boldness has genius, power and magic in it. Begin it now.’”

W.H. Murray, The Scottish Himalayan Expedition

The Blueprint for the Future

Summit participants developed ideas and an initial blueprint for moving nursing ethics issues forward in four key domains:


Each work group was led by two facilitators and group discussion was aimed at refining what participants believed was a “bold idea” that would move the field forward in that domain. Groups discussed how a firm and clear connection between their ideas and foundational nursing commitments was essential to maintain the strength of nursing’s voice. Groups also explicitly discussed barriers and challenges to changing the status quo and how they might be ameliorated. This discussion paved the way for action plans to avoid the pitfalls, giving them a greater chance of successful implementation.

In each domain, key shifts are needed in order to achieve the bold idea, outlined in the tables that follow. Methods to achieve these shifts are outlined in the action plans, with both short and long-term actions suggested. Clearly, these are only the first steps in what should be an ongoing and iterative process, with timeframes, milestones, assessments, and many other touchstones defined and reached along the way.


Several key themes emerge from the reports of the four domain groups:

  • The need for a more intentional and proactive approach to ethical practice
  • Ethical practice is a key feature of accountability and personal responsibility across domains
  • The significance of moral distress in the daily lives of nurses
  • The interplay among nurses’ competence in ethics, the environments where they practice, and the culture that either supports or constrains integrity and ethical behavior
  • The need for inter-disciplinary and cross-organizational efforts and partners and strong dissemination plans
  • The importance of building on existing work, activities, and commitments
  • The value of a diverse set of funders for this work, including pooling funds from multiple sources
  • While changing the culture of health care is a long-term project, changing the work environments for individual nurses can be started now


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