If there are any ethical issues in nursing, one that is definitely developing is that our roots are disappearing. As trite as 'caring' sounds, it is the cornerstone of our career birth. Too often, now we find ourselves in the position of being little more than waitresses or waiters with medicine [or procedures] and off to the next 'table'. Ethics in nursing isn't about the big issues like ending life support, it's about us as individuals, risking our licenses because of managed care plans that demand staffing ratios at impossible numbers to deliver excellent care. Ethical issues are about corporate executives shaking hands on deals to merge hospitals because they hear "cha-ching" and not because they have ever set foot on 4 East [just an example, not my floor, and never was] to see that the nurses there regularly suck it up because they don't get dinner breaks. Nevermind that it's against the law. If they balk about it, they're not "team players", right?
Ethical issues in nursing remain at the common denominator - the nurse him or herself, because we still haven not risen above nurse-on-nurse bullying. It's a well known, well documented phenomenon, and we need to start to improve our lot in this career by putting a stop to it. Now. There's nothing cute or funny about the expression "Nurses eat their young". If we want to be ethical nurses who bring in a generation of supportive people, we teach them what we know, that we are patient, we welcome them to our work environments. Hospitals are corporations now, mostly for profit, not passion - and if we are divided, they will conquer. That means these ethics conversations will remain academic, Powerpoint meetings that boil down to avoiding lawsuits.
Our nurse managers have the power to lead us in this direction to some extent. They are responsible for creating the atmosphere in which we work, even if they cannot do all staffing we would like. We are the advocates for our patients - our ADON's and DON's should be *our* advocates.
Their will always be personalities that clash at work - and that's ok. We need to make a committment to do our best learning from our enemies. Yes, I am saying, the nurse that you cannot stand - offer to cover his patient care so he can go eat dinner. These are the actions that forge unity in our ranks, which we so urgently need. This is what a nurse of the highest ethical standard does. When you feel good about what you have done, it trickles down to your performance for your patient.
In the meantime, we wait for political changes to makes our jobs safer. Nurses - the core of patient care - are our own worst enemy at times, so why should executives, managed care outfits, or even the government listen to our ethical concerns on an individual level? In what other profession do you see this toe-stepping? Does a school district listen when teachers say that a classroom of XX number of children is not safe or practical? They do! Parents of students demand it because they have some knowledge of that system. Patients, on the other hand, are in the dark about patient safety, hospital profit, even their own medicines!
Do hospitals want us to advocate for our patients? Only to a point. What would the corporate executives say if we encouarged our patients to demand higher staffing ratios because their safety was at risk? We would be fired.
The bottom line is, if doctorate and graduate level nurses want to take on ethics, forget a thesis on end of life care or bioethics. Start where it really counts, where we really need help: the ethical concerns nursing on a daily basis on an individual level. Help us get these issues out of an academic hall and into legislation -uniformly across the country- that actively prevents a hostile work environment and promotes safety, cameraderie, and motivation to stay in nursing.
At heart, nurses are nice people. The nice guys and girls shouldn't finish last.