Ethics as a nursing student...

Hi Ryan,

Thanks for sharing us this news from ANA!

One experience that comes to mind was something that occurred during my first clinical in nursing school. I was working with an elderly patient who told me that his post-op pain seemed to be getting worse. I told my nurse, who was at the time taking care of this patient, but she simply brushed it off and said that this patient "complained of pain all the time" and that this was nothing new. However, as the day went on, the patient continued to voice his concern about his increasing pain. I addressed this issue with my clinical instructor, who then ended up discussing this issue with the charge nurse. Eventually, the patient did get an increased dose of his pain medication and things turned out alright.

However, what really concerned me was that the nurse caring for this patient did not seem interested in listening to the patient's concerns. I completely agree with Adam's statements highlighting the importance of advocacy. As future nurses, it is our duty to advocate for our patients and prevent these unethical experiences from occurring in the future.

Meghan Long
President of the Student Nurses Association of Pennsylvania(SNAP)

Hey Ryan, 

Great questions. Thanks for bringing them up.

1. Ethical practice as a nursing student means doing what is right no matter what. Even having the courage to stand up to an experienced nurse when you see something unethical.

2. I think developing ethical awareness and practice comes from teaching it to our students right off the bat. We practice the accountability just be being ethical people in and out of the hospital, and confronting classmates who are making unethical decisions.

3. One thing our program did was create scenarios in class to get the students used to having to think ethically. The more you think about these situations, the more knowledge you will have and will know how to better address the situations. 

4. Students can use one another, textbooks, research, and even laws to back them up when it comes to facing ethical challenges. 

5. Neglect. If we neglect the fact that unethical practice is happening, then we can not fix the problem. We need to identify problems, hold people accountable, and enforce the teaching of ethics in our lectures. 

Thanks again for all you do Ryan.

Zach Hartley
President - Georgia Baptist Association of Nursing Students

I appreciate everyone jumping in on the conversation... I don't think there's a thing here I disagree with either.  I hope other nursing leaders chime in if they feel so inclined... I'm interested in what you have to say.

Some things that crossed my mind which I haven't heard yet are as follows:

Q2) How can we develop ethical awareness and accountability as nursing students?
    A) Start with ourselves & practice developing personal accountability
        - What are our core values, personally?
        - Are we behaving in ways that resonate with our values & beliefs?
        - Do our values and beliefs align with those of the organizations we belong to?

Q3) What are ways we can develop our competence around ethical decision making?
    A) Build competence through participation.
        - Attend professional events like the ANA Ethics symposium;
        - Seek out mentors;
        - Get involved through shared governance organizations.

Q4) What are tools nursing students can use when facing ethical challenges with supervisors, faculty, or peers?
    A) NSNA Resources
        - Student Bill of Rights & Responsibilities for Students of Nursing
    B) Organizational Resource
        - Grievance policies: Learn about steps we can take when faced with ethical dilemmas. A grievance process is a formal outline on steps a member of an organization can take when they want to formally confront a problem. Decisions on when to move forward and implement a grievance process are best left for another article, but setting this up, and making students aware of it is a powerful way to help advocate for those who may feel disadvantaged or threatened by the system. Students who are familiar with the shared-governance model can provide important insights for organizations or groups of people that want to develop and gain approval for any sort process like this. Luckily for you, members of NSNA have exceptional resources and opportunities to learn how to do just that.

Q5) What are some roadblocks that may prevent our own progress towards ethical practice?
    A) Lack of knowledge
        - Strive to reduce our ignorance around ethical theory.  Here is a good place to start: NSNA Resources, A Blueprint for 21st Century Nursing Ethics, and the ANA Code of Ethics.
    B) Fear
        - Part of developing an “ethical awareness” is to acknowledge the fears that might prevent us from positive action in the face of questionable behavior. I fear having these discussions, because on a thorough review of my life I wouldn’t pass the litmus test for saint hood. Some of the other fears I’ve felt include: Appearing pretentious or snobby, being wrong, conflict, being put under a microscope, becoming a hypocrite.
    C) Personal insecurities, limitations, & defects
        - No one is perfect, and we've all made mistakes... Literature cites fatigue and stress as a major reason we look for shortcuts when we shouldn't, which is a HUGE reason to practice quality self-care.  The important thing here is how we respond in the face of poor decisions.  Did we realize that what we were saying or doing was unwise? How did we respond when the issue was brought to our attention? All is not lost when we stumble during the journey. The important thing is to focus on honesty and making things right.  Ethical behavior and decision making is a practice, not a destination that can ever be perfected.