Press Release: U.S. Nursing Leaders Issue Blueprint for 21st Century Nursing Ethics

For Immediate Release

Media contacts:
Danielle Kress
Johns Hopkins School of Nursing; (410) 955-2840

Leah Ramsay
Johns Hopkins Berman Institute of Bioethics; (202) 642-9640

U.S. Nursing Leaders Issue Blueprint for 21st Century Nursing Ethics

In the wake of media focus on the trials and bravery of nurses in the context of the Ebola crisis, leaders in the fields of nursing and clinical ethics have released an unprecedented report on the ethical issues facing the profession, as the American Nursing Association prepares to release a revised Code of Ethics in 2015.

The report captures the discussion at the first National Nursing Ethics Summit, held at Johns Hopkins University in August. Fifty leaders in nursing and ethics gathered to discuss a broad range of timely issues and develop guidance. The report, A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit, is available in full online at It covers issues including weighing personal risk with professional responsibilities and moral courage to expose deficiencies in care, among other topics.

An executive summary of the report is available at:

“This blueprint was in development before the Ebola epidemic really hit the media and certainly before the first U.S. infections, which have since reinforced the critical need for our nation’s healthcare culture to more strongly support ethical principles that enable effective ethical nursing practice,” says Cynda Hylton Rushton, PhD, RN, FAAN, the Bunting Professor of Clinical Ethics at the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and lead organizer of the summit.

The report makes both overarching and specific recommendations in four key areas: Clinical Practice, Nursing Education, Nursing Research, and Nursing Policy. Among the specific recommendations are:

  • Clinical Practice: Create tools and guidelines for achieving ethical work environments, evaluate their use in practice, and make the results easily accessible
  • Education: Develop recommendations for preparing faculty to teach ethics effectively
  • Nursing Research: Develop metrics that enable ethics research projects to identify common outcomes, including improvements in the quality of care, clinical outcomes, costs, and impacts on staff and the work environment
  • Policy: Develop measurement criteria and an evaluation component that could be used to assess workplace culture and moral distress

What does this blueprint mean for nurses on the front line?

“It’s our hope this will serve as a blueprint for cultural change that will more fully support nurses in their daily practice and ultimately improve how healthcare is administered – for patients, their families and nurses,” says Rushton. “We want to start a movement within nursing and our healthcare system to address the ethical challenges embedded in all settings where nurses work.”

On the report’s website, nurses and the public can learn more about ethical challenges and proposed solutions, share personal stories, and endorse the vision statement by signing a pledge.

“This is only a beginning,” says Marion Broom, PhD, RN, FAAN, Dean and Vice Chancellor for Nursing Affairs at Duke University and Associate Vice President for Academic Affairs for Nursing at Duke University Health System. “The next phase is to have these national nursing organizations and partners move the conversation and recommendations forward to their respective constituencies and garner feedback and buy-in. Transformative change will come through innovative clinical practice, education, advocacy and policy.”

At the time of publication, the vision statement has been endorsed by the nation’s largest nursing organizations, representing more than 700,000 nurses:

American Academy of Nursing
American Association of Critical-Care Nurses
American Nurses Association
American Association of Colleges of Nursing
American Organization of Nurse Executives
Association of Women’s Health, Obstetric and Neonatal Nurses
The Center for Practical Bioethics
National League for Nursing
National Student Nurses’ Association
Oncology Nursing Society
Sigma Theta Tau International

An updated list, including individual endorsers, is available at:

# # #

Report Summary:

Full document, A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit:

Additional information on nursing ethics developed by the Nursing Ethics Summit:

“What Keeps Nurses Up at Night” (video, 5:30):

Nursing Ethics Summit website:

#NursingEthics Twitter Chats:

Nursing Ethics Blogs




A Vision of Hope For Young Patients Living With Debilitating Chronic Illness

Media Contact: Leah Ramsay 202.642.9640,

November 10, 2014
For Immediate Release

Johns Hopkins Bioethicists Have Vision of Hope For Young Patients Living With Debilitating Chronic Illness
Scholars from the Johns Hopkins Berman Institute of Bioethics launch a curriculum for training diverse healthcare workers to apply palliative care principles to pediatric patients suffering from sickle cell disease and Duchenne muscular dystrophy.

Palliative care is traditionally focused on care for the terminally ill, but scholars at the Johns Hopkins Berman Institute of Bioethics are aiming to change that by bringing the principles and comfort of palliative care to pediatric patients suffering from chronic illness.  A curriculum launching November 10 will guide healthcare workers in integrating the principles and practices of pediatric palliative care into their long-term care regimen.

Titled “Vision of Hope,” the curriculum uses two specific chronic conditions as case studies: sickle cell disease (SCD) and Duchenne muscular dystrophy (DMD). All content is free and publicly available at

“Young people living with chronic diseases routinely confront challenges that benefit greatly from an expanded repertoire of ethically grounded palliative care practices that are holistic, attending to their emotional wellbeing, spiritual developmental and physical needs,” says Cynda Hylton Rushton, PhD, RN, FAAN, co-principal investigator on the project.

The curriculum provides healthcare institutions with evidence-based curricular materials on pediatric palliative care (PPC) concepts, with flexibility for training interdisciplinary healthcare workers, with all levels of PPC knowledge and experience. The various components include video segments, discussion questions, and interactive activities that can be used together or separately. Three formats are suggested for training sessions: in-service, workshop or a two-and-one half-day retreat.

“What makes these palliative care training programs innovative is that they are experiential, interdisciplinary and relational,” explains Gail Geller, ScD, MHS, co-principal investigator on the project. “Relational learning expands the notion of professional competence to encompass the moral realm of human relationships and experience.”

Through the use of video, the Vision of Hope curriculum provides a means to integrate the voices and experiences of patients and families throughout all aspects of the training, Geller says.  Some of the film components of the Vision of Hope project have won honors as stand alone pieces, including awards from the Houston International Film & Video Festival, Cine, and the International Association of Audio Visual Communicators.

“Living with the pain and other serious medical complications of Sickle Cell Disease becomes even more frustrating and emotionally painful when healthcare providers don’t believe the patient’s reports of their pain experience,” says Carlton Haywood Jr., an investigator on the project who both researches and lives with SCD.  “The Vision of Hope curriculum, and the films in particular, shed light on the impact of these added burdens on patients, and we hope to use these patient voices as tools to enact lasting changes in the quality of the care delivered to people suffering from sickle cell disease.”

“We believe the integration of palliative care into lifelong treatment of chronic conditions will give young patients hope for a life filled with what young Mattie Stepanek called ‘heartsongs’,” Rushton says.  During his short life, Mattie J. T Stepanek lived with a rare form of muscular dystrophy and inspired others as a bestselling author, poet, peace advocate, and MDA Goodwill Ambassador. His insights regarding living each day with muscular dystrophy and planning for an uncertain future were foundational to the Vision of Hope project, Rushton explains. Stepanek defined heartsongs as “gifts that reflect each person’s unique reason for being,” distinct from their health and suffering.

The Vision of Hope Project is supported by a grant (1 RC1NR011710-01) from the National Institutes of Health National Institute of Nursing Research and the Stavros Niarchos Foundation. One of the films in the curriculum, On the Edge, received additional support from the Slomo and Cindy Silvian Foundation.

NEWS ADVISORY: A Clinician’s Guide to Managing Moral Distress

September 12, 2013

To: Reporters, editors, broadcasters and producers

Johns Hopkins nurse-bioethicist discloses rising concerns about the toll of “moral distress” among nurses and physicians caring for seriously and terminally ill people in the era of health care reform.

As health care reform takes shape in the U.S., vast amounts of attention have been given to the fact that more and more people with pre-existing illnesses will have access to professional care to relieve their physical and emotional suffering. Far less public attention has been given to the nurses and physicians who provide that care, and the authors of a recent study say there is evidence that many already experience serious “moral distress” that may interfere with their own health and their efforts on behalf of seriously ill and dying patients.

“Studies and case histories suggest that clinicians may experience feelings such as empathy, tenderness, sadness, remorse, shame or anger in response to perceived conflicts in values, interpersonal disagreements and institutional constraints,” says Cynda Rushton, PhD, RN, FAAN, a nurse ethicist specializing in palliative and end-of-life care. Rushton is the Anne and George L. Bunting Professor of Clinical Ethics, a joint faculty position at Johns Hopkins’ School of Nursing and Berman Institute of Bioethics.

In a pair of articles published in the Journal of Palliative Medicine, Rushton and her colleagues explain how a clinician’s physical and emotional experience of moral distress can be detrimental to the patient and themselves, and how by learning to stabilize their own nervous system and emotional reaction, they can respond in a more principled, compassionate manner.  The authors propose a framework for “creating a healthy work environment supporting clinicians to practice with integrity” and reducing the toll on caregivers and patients alike.

“Conflicts of conscience are common among clinicians, particularly involving the care of patients at the end of life,” they write. For example, “some… may have concluded it was unconscionable to participate in [care] that caused disproportionate suffering and pursue goals perceived as unattainable.”

The authors add, “Clinicians struggling to address the dissonance between what they are doing and their professional roles often express this conflict as a lament of ‘why are we doing this?’ Coupled with an experience of injustice on behalf of the patient and/or broader society, this conflict can lead to unhealthy emotional arousal and moral distress. Acting against informed moral judgment creates a conflict of conscience by abandoning, consciously or unconsciously, convictions, ethical values or norms, and/or personal integrity.”

Interview Opportunity:
Rushton is available to discuss the proposed framework, which, the team writes, “offers a promising approach to designing interventions that help clinicians mitigate the detrimental consequences of unregulated moral distress and to build the resilience necessary to sustain themselves in clinical service.”

“Like their patients,” the team adds, “clinicians suffer as they attempt to fulfill their ethical obligations and maintain their integrity as individuals and professionals,” and there are “instances when the balance of benefit and burden that patients must tolerate to live longer becomes untenable.”

Rushton also can put the issue in the context of an aging population, a health care system confronted with serious change and cost issues, and ever-increasing attention to end-of-life decision-making and the limits of life-sustaining treatments.

# # #

Media Contact:
Leah Ramsay

Rushton Delivers Inaugural Ethical Issues in Nursing Lecture

Cynda Hylton Rushton, PhD, RN, FAAN
, the Anne and George L. Bunting Professor of Clinical Ethics and a Professor of Nursing and Pediatrics, delivered the inaugural Gerry Lewis-Jenkins Ethical Issues in Nursing Lecture at the University of Colorado.

Dr. Rushton, an internationally recognized expert in ethics and palliative & end-of-life care, delivered a well-received talk entitled “Transforming Moral Distress into Resilience”. 

 Dr. Rushton is a core faculty member at the Johns Hopkins Berman Institute of Bioethics, and is a professor of nursing with a joint appointment in the Johns Hopkins School of Medicine’s Department of Pediatrics.

This lecture coincides with National Nurses Week, celebrated annually from May 6th through May 12th.  May 12th is the birthday of Florence Nightingale, widely regarded as the founder of modern nursing.

Ms Lewis-Jenkins serves as executive Vice-President of COPIC, the leading medical liability carrier in Colorado.  She entered into the healthcare field as a registered nurse and this endowed lecture provides an outlet to continue her commitment to ethics and nursing education & practices.  The event was cosponsored by the Center for Bioethics and Humanities and the College of Nursing at the University of Colorado, along with COPIC.