From its early beginnings, ethics has been embedded in the profession of nursing. Florence Nightingale and others articulated the ethical foundations of nursing and over the years, the field of bioethics has evolved with an expanded presence in scholarship, research, clinical practice, and education. Early nurse ethicists led pioneering efforts to create the foundation for nurses to contribute to the field of bioethics and to expand the significance and impact of ethics within the nursing profession.
New ethical issues have emerged in contemporary nursing that were not recognized 20-30 years ago when the profession began to take leadership and scholarship in this area seriously. Prominent considerations have emerged such as deeper concerns about the meaning of respect and dignity in an increasingly diverse population, new challenges regarding privacy in the face of unbridled access to information, informed consent in the context of profound gaps in knowledge generation and translation, confusion about how to reconcile differences in goals and preferences at the end of life and an ever growing concern about the impact of moral distress and threats to integrity on the recruitment and sustainability of the nursing workforce. Likewise, new ethical concerns in research such as the access and use of “Big Data” repositories and the implications of randomization schema on at-risk populations are largely unexamined. Cross cutting issues of policies, laws and regulations have a profound impact on how nurses uphold their ethical obligations. Today, there is an urgent need to re-ground the profession in the foundational values that have served the profession while expanding them to meet contemporary challenges.
Reasons for a lack of clarity and focus can be explained in part by insufficient sustained dialogue about nursing’s unique conceptual understandings, values, practices and norms, often not sufficiently grounded in theory and empirical evidence. Despite the centrality of the American Nurses Association Code of Ethics for Nurses, the recent Robert Wood Johnson/Institute of Medicine “Future of Nursing” report, for example, is largely silent on the ethical aspects of nursing practice and contributes to further dilution of ethics as foundational to the nursing profession. Likewise, ethical issues are rarely explicitly highlighted in the strategic agenda of professional organizations and specific strategies to build capacities in moral sensitivity, ethical reasoning, and principled action are absent or are not robust. Now, as always, nurses stand at the interface of the patient, family and the health care system. The role of advocate has never been more important in the face of an ever-changing health system context, diminishing resources and the complexity of information use described above. The absence of ethics, especially nursing ethics, from the research agendas of universities, professional organizations and government funding agencies has forestalled progress in building the evidence to guide interventions to address the gaps in clinical practice, education and policy.
A comprehensive and strategic agenda for nursing ethics in the 21st Century has not been articulated. The time is NOW for the nursing profession to develop a blueprint that more fully integrates ethics in four critical areas:
- Clinical practice
To develop the Nursing Ethics Blueprint for Action, we propose the following:
Invitational Nursing Ethics Summit
The Johns Hopkins University Berman Institute of Bioethics and School of Nursing will convene a 2-day Invitational Summit of 25-30 prominent nurse ethicists, professional nursing organizations leaders and key stakeholders. Together they will define the priorities and components of a call to action and strategic agenda for nursing ethics for the United States.
- Identify and prioritize the current and future ethical issues for nurses practicing in diverse roles, settings, and geography.
- Review the evidence and identify gaps in our knowledge of and responses to prevailing ethical concerns in nursing.
- Develop an actionable strategic plan focusing on clinical practice, education, policy and research to fully align nursing ethics with other priorities of the profession and produce results that are scalable, replicable and cost-effective.
- Identify barriers and facilitators in addressing ethical issues in clinical practice, education, policy and research interventions.
- Develop a research agenda for generating additional evidence to understand, address priority ethical issues and stimulate innovation.
- Disseminate findings with strategic partners through multimedia approaches to individual health care professionals, health care facilities, and health professional education programs and organizations.
- Work collaboratively toward commissioned and peer-reviewed papers that will be submitted to influential journals.
- Establish a network of action oriented change agents who will, over time, champion the implementation of an improved nursing ethics environment.
- Alan Regenberg, Director of Outreach & Research Support, Johns Hopkins Berman Institute of Bioethics
- Christina Godack, Director of Marketing & Communications, Johns Hopkins School of Nursing
- Danielle Kress
- Ryan Sullivan
- Matt Casse
- American Academy of Nursing
- American Association of Critical-Care Nurses
- American Nurses Association
- American Organization of Nurse Executives
- Association of Women’s Health, Obstetric and Neonatal Nurses
- International Care Ethics Observatory
- National Institute of Nursing Research
- National League for Nursing
- Sigma Theta Tau International
- National Council of State Boards of Nursing
- American Association of Colleges of Nursing
- National Student Nurses’ Association
- Oncology Nursing Society
- Hastings Center
- Practical Bioethics
- Katherine Brown-Saltzman
- Anna Catlin
- Barbara Daly
- Patricia Davidson
- Marsha Fowler
- COL Vinette Gordon
- Christine Grady
- Amy Haddad
- Joan Kub
- Joan Liaschenko
- Christine Mitchell
- Douglas Olsen
- Gloria Ramsey
- Colleen Scanlon
- Sarah Shannon
- MC Sullivan
- Anita Tarzian
- Carol Taylor
- Deborah Trautman
- Connie Ulrich
- Mary Walton
- Lucia Wocial
Contact: Meredith Caldwell