RN Execs & Managers ignore 'research mountain', mislead public, & violate code of ethics?

Massachusetts voters will hopefully see a 'nurse staffing act' on the ballot this November (pending a lawsuit from the opposition). A recent informal poll by the Boston Globe shows significant support (65%, ongoing). The powers that be will be coming out of the woodworks along with their deep pockets to scare the public into voting 'no' by lying, distributing alternative facts, and manipulating the truth.

Nursing executives and managers have decided to toss their hat into the ring with these master manipulators. We get it, they're backed into a corner in the same way they are when the union comes to town (see Johns Hopkins). To speak out with their fellow RNs means that they're risking their job, career, and their family's well-being. I see where they're coming from, albeit a place of selfishness.

John Kelly, CNO is the latest in a string of executives and managers to come out in opposition while denying the existence of evidence that staffing affects clinical outcomes. He says, "to date, there is no evidence that staffing ratios have improved quality or outcomes" (Boston Globe).

This has to stop. Nurse's like Mr. Kelly need to hold themselves accountable for what they say in public. He is certainly entitled to his opinion on the matter, but in using their platform as a nurse, he and his peers need to tread carefully, their duty bound to be honest. Maybe he deserves the benefit of the doubt. As a nurse executive he probably doesn't have much free time to comb through the literature. Maybe I'm taking him out of context and he was only referring to what he has observed at his own facility (if that's the case, what exactly is he measuring). But then again, maybe I'm just reading the article and interpreting it as any non-nurse would - that there is no evidence to support safe staffing ratios. The latter is just plan nonsense and a downright lie.

As we move towards November let's hold our nurse leaders accountable for their actions and call them out when they ignore the evidence. Critique it all you want (the rigor, the methods, the sampling, the power), but don't try to deny its existence. Quite frankly, I don't think the evidence narrative is going to determine whether the initiative passes or not, but we aren't going to let you fabricate an alternative truth on the campaign trail. Safe nurse-patient ratios matter and lead to improved clinical outcomes in the most vulnerable of patients.

Let's also remember that they're bound to both the same code of ethics and nurse practice act as we are. Hold them to it.

MA Nurse Practice Act:

(22) Advertising. A nurse licensed by the Board shall not engage in false, deceptive, ormisleading advertising related to the practice of nursing.

(47) Other Prohibited Conduct. A nurse licensed by the Board shall not engage in any otherconduct that fails to conform to accepted standards of nursing practice or in any behavior that islikely to have an adverse effect upon the health, safety, or welfare of the public.

ANA Code of Ethics

2.1 Primacy of the Patient's Interests

The nurse's primary commitment is to the recipients of nursing and healthcareservices-the patient-whether individuals, families, groups, communities, orpopulations. 5.1 Duty to Self and Others

Moral respect accords moral worth and dignity to all human beings regardless of theirpersonal attributes or life situation. Such respect extends to oneself as well: the sameduties that we owe to others we owe to ourselves. Self-regarding duties primarily concernoneself and include promotion of health and safety, preservation of wholeness ofcharacter and integrity, maintenance of competence, and continuation of personal andprofessional growth.

5.4 Preservation of Integrity

Personal integrity is an aspect of wholeness of character; its maintenance is a self regardingduty. Nurses may face threats to their integrity in any healthcare environment.Threats to integrity may include requests to deceive a patient, to withhold information, tofalsify records, to misrepresent research aims, as well as enduring verbal abuse bypatients or coworkers. Expectations that nurses will make decisions or take action inways that are inconsistent with the ideals, values, or ethics of nursing, or that are in directviolation of this Code of Ethics for Nurses, may also occur. Nurses have a right and aduty to act according to their personal and professional values and to accept compromiseonly if reaching a compromise preserves the nurse's moral integrity and does notjeopardize the dignity or well-being of the nurse or others. Integrity-preservingcompromises can be difficult to achieve, but are more likely to be accomplished wherethere is an open forum for moral discourse and a safe environment of mutual respect.

6.1 The environment and moral virtue and value

Virtues are universal, learned, and habituated attributes of moral character thatpredispose persons to meet their moral obligations; that is, to do what is right. There isa presumption and expectation that we will commonly see virtues such as integrity,respect, temperance, and industry in all those whom we encounter. Virtues are what weare to be and make for a morally "good person". There are more particular attributes ofmoral character, not expected of everyone, that are expected of nurses. These includeknowledge, skill, wisdom, patience, compassion, honesty, and courage. These attributesdescribe what the nurse is to be as a morally "good nurse". Furthermore, virtues arenecessary for the affirmation and promotion of the values of human dignity, well-being,respect, health, independence, and other ends that nursing seeks.

6.2 The Environment and Ethical Obligation

Virtues focus on what is good and bad in whom we are to be as moral persons;obligations focus on right and wrong or what we are to do as moral agents. Obligationsare often specified in terms of principles such as beneficence or doing good;nonmaleficence or doing no harm; justice or treating people fairly; reparations, ormaking amends for harm; fidelity, and respect for persons. Nurses, in all roles, mustcreate, maintain, and contribute to practice environments that support nurses and othersin the fulfillment of their ethical obligations. Environmental factors include all thatcontribute to working conditions. These include but are not limited to: clear policiesand procedures that set out professional ethical expectations for nurses; uniformknowledge of The Code of Ethics for Nurses with Interpretive Statements; andassociated ethical position statements.

6.3 Responsibility for the Healthcare Environment

Nurses are responsible for contributing to a moral environment that demands respectfulinteractions among colleagues, mutual peer support, and open identification of difficultissues that includes on-going formation of staff in ethical problem solving. Nurseexecutives have a particular responsibility to assure that employees are treated fairlyand justly, and that nurses are involved in decisions related to their practice andworking conditions. Unsafe or inappropriate activities or practices must not becondoned or be allowed to persist. Nurses should address concerns about the healthcareenvironment through appropriate channels. After repeated efforts to make change,nurses have a duty to resign from healthcare facilities, agencies, or institutions thatdemonstrate sustained patterns of violation of patient's rights, or where nurses arerequired to compromise standards of practice or personal integrity, and where theadministration is unresponsive to nurses' expressions of concern. Followingresignation, efforts to address violations should continue. The needs of patients maynever be used to hold nurses hostage in persistently morally unacceptable workenvironments. Remaining in such an environment, even if from financial necessity,nurses risk becoming complicit in ethically unacceptable practices and may have bothuntoward personal and professional, and potentially legal, consequences.

7.3 Contributions through Nursing and Health Policy Development

Nurses must lead, serve, and mentor on institutional or agency policy committeeswithin the practice setting. Nurses ought to participate in civic activities related tohealthcare through local, regional, state, national, or global initiatives.

9.4 Social Justice in Nursing and Health PolicyThe nursing profession must actively participate in solidarity with the global nursingcommunity and health organizations to represent the collective voice of U.S. nursesaround the globe. Professional nursing organizations must actively engage in the politicalprocess, particularly addressing those legislative concerns that most impact the public'shealth and the profession of nursing. Nurses must promote open and honestcommunication that enables nurses to work in concert, share in scholarship, and advancea nursing agenda for health. Global health, as well as the common good, are ideals thatcan be realized when all nurses unite their efforts and energies.

Taken from the ANA Social Policy statement

"Authority for nursing is based on a social responsibility, which derives froma complex social base and social contract. Nursing's social contract reflects thelong-standing core values and ethics of the profession, which provide groundingfor health care in society.

Should Massachusetts adopt a proposal limiting the number of patients assigned to a nurse at one time? - The Boston Globe