Learning Objectives
By the end of this section, you will be able to:
- Analyze what it means for nursing to be the most trusted profession
- Discuss how ethical nursing care involves advocacy for patient safety
- Apply HIPAA and maintaining confidentiality to the role of the nurse
For nurses to promote integrity in patient care and safety, it is imperative to be knowledgeable about the ANA’s Code of Ethics for Nurses. In addition, nurses must be knowledgeable about the standards of practice for the profession, including relevant federal, state, and local laws and regulations, as well as the employing organization’s policies and procedures. When nurses encounter inappropriate or questionable practices or when incompetent, unethical, illegal, or impaired practices are not corrected, nurses should follow the established process for reporting and handling these matters.
When nurses must responsibly report these kinds of situations, the state nurse’s associations should be available to provide advice and support for their members to navigate the development and evaluation of the reporting process and procedures. Reporting questionable practices will likely carry a substantial risk to the nurse (e.g., the fear of retaliation or threat to job security); however, the professional organization has a responsibility to protect the practice of nurses who choose to report their concerns. It is important to note this risk does not negate the obligation to report threats to patient safety.
The Most Trusted Profession
Not only is the nursing profession accountable to society but nurses have been named the most trusted profession for the twenty-first year in a row (ANA, 2023). This is because nurses are trusted not only by their patients but also because of the high ethical standards that are implemented during the delivery of patient-centered care. According to a Gallup poll, “nurses continue to garner the highest ethics ratings from Americans among a diverse list of professions, a distinction they have held for more than two decades” (Brenan, 2023, para 1). The ANA President also recognized the 4.4 million nurses in the United States and commended them on their role in maintaining the health and safety of their patients (ANA, 2023).
Ethical Care and Safety
The Code of Ethics for Nurses is the foundation of the nursing profession’s promise to provide and advocate for safe, quality care for all patients and communities. Nurses work diligently to preserve patient-centered care and safety while navigating ethical dilemmas. It is of utmost importance that nurses remain alert to situations that present incompetent, unethical, illegal, or impaired practices or actions that could result in harm to a patient. When situations of this nature arise, nurses have a duty to take the appropriate action to resolve such matters. Examples of such situations are listed in Table 5.2.
| Situation | Appropriate Action |
|---|---|
| An incompetent act within the organization that could result in patient harm |
|
| A colleague who is impaired while on duty |
|
| A practice in the health-care delivery system or organization that could compromise a patient’s welfare |
|
| An incompetent, unethical, illegal, or impaired practice that is not corrected |
|
When reporting potentially unethical acts, it is important that factual documentation and accurate data are included in the report. It is the duty of the nurse to protect the patient, the public, and the profession from practices that may result in harm. When responsibly reporting, the professional organizations also have a duty to protect the practice of nurses who choose to report their concerns through formal channels.
Advocacy
Nurses are on the frontline of care delivery and are at the center of patient communication when ethical dilemmas are inevitable. The act of pleading for a cause, idea, or policy, or advocacy, is an ethical obligation of all nurses to ensure their patients are protected from harm. Nurse advocacy is one of the most important responsibilities and is crucial to optimizing patient outcomes by:
- Communicating with providers on the patient’s behalf
- Helping patients navigate the health-care system (e.g., billing, medical care, insurance, assisting with legal issues)
- Mediating obstacles to quality patient care
- Promoting patient safety
- Protecting against social injustice
- Protecting patients’ rights
- Providing patient education
- Providing pertinent information and education to help patients make informed decisions
Patients rely on nurses to be their voice as well as to provide support during their time of need when they are not well and are confronted with uncertainties about their health and care. Nurses shoulder a big responsibility because they are often the first and last point of contact for patients, establishing an integral part of the patient-nurse trust relationship.
Refusing to Provide Care
The ANA Code of Ethics for Nurses indicates that nurses have the same duties to self as to others. This includes preservation of wholeness of character as well as preservation of integrity. There may be times when nurses find themselves in circumstances that exceed their moral limits or that violate their moral standards. When this occurs, nurses should express their concerns to the appropriate authority. Nurses are justified in refusing to participate on moral grounds when a specific decision or action is felt to be morally objectionable, especially when it may result in jeopardy to a patient, family, community, population, or to the nursing practice. Nurses who choose to not to participate on these grounds should do the following:
- Communicate the refusal in time for alternate arrangements to be made for patient care.
- Communicate this decision in a timely, appropriate manner.
- Express refusals in advance.
It is important to note that conscience-based refusals to participate in patient care do not include personal preference, prejudice, bias, convenience, or arbitrariness. Although conscientious objections are based on religions or moral grounds, they may not protect nurses from formal or informal consequences. In fact, refusal to provide care for a patient can be viewed as patient abandonment. Patient abandonment occurs when a health-care professional refuses to treat a patient or is negligent in not being available when a patient needs care. This act is a punishable crime and can result in the loss of the nurse’s license.
Although nurses do have a right to refuse to participate in patient care that conflicts with personal religious beliefs, nurses cannot refuse care on the basis of discrimination or dislike. An example of a religious conflict may be refusing to provide abortion care; a discriminatory conflict may be related to providing care for an incarcerated individual or a patient with a substance use disorder. Although it can be quite challenging to care for certain patients if you have a moral objection, nurses have an obligation, a duty, to provide the same level of care to all patients.
Confidentiality and the Health Insurance Portability and Accountability Act
With the increased use of technology and increased access to information, maintaining patient confidentiality (privacy) in the health-care industry has become a daunting task. The Health Insurance Portability and Accountability Act (HIPAA), which became federal law in 1996, created national standards to protect patient privacy and prohibited health information from being disclosed without patient consent or knowledge in almost all situations. HIPAA has two components: the HIPAA Privacy Rule and the HIPAA Security Rule. These rules are designed to protect an individual’s health information while also enabling the needed flow of the health information to provide quality care. It is important to note that no health information can be shared with an outside provider without the patient’s written consent. Examples of HIPAA violations include speaking a patient’s name while in another patient’s room and leaving chart documents in public view.
Certain information may be disclosed under defined policies, mandates, or protocols. The written guidelines must ensure the patient’s rights, safety, and well-being are protected. This type of information includes for purposes of
- Continuity of care
- Education
- Peer review
- Professional practice evaluation
- Quality improvement
- Risk management
- Third-party payments
Nurses must be vigilant in safeguarding privacy for individuals, families, and communities to maintain the trust developed through the nurse-patient relationship. The expectations are that personal information will not be disclosed without their consent, which is facilitated by nurses and other health-care providers maintaining this level of confidentiality. It is a nurse’s duty to maintain confidentiality of all patient information, including personal and clinical information in the work setting and while off duty. It is especially important that nurses remain diligent when maintaining data security when using electronic communications or working with electronic health records. Additionally, nurses not only advocate for privacy for individual patients, they also participate in creating policy and practices to protect both personal and clinical information throughout entire health-care practices and facilities. It is also important to note that patient information of any kind, including pictures of patients, should not be used on any personal social media sites.
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