Nursing as a Profession - Essay Example

Biomedical Ethics 23 November 2009 Introduction Nursing has come a long way since it was first practiced in the battlefields during the previous centuries. It is today a recognized profession that is focused on the care of people to make them recover from their illnesses and maintain good health all throughout their lives. It is also a crucial part of the health care delivery team in which nurses are recognized and given praise for their expertise in various sub-specialties. Nursing as a separate and distinct practice has its own professional code of ethics to guide its members by in carrying out their duties and responsibilities with a high level of quality in nursing care. Trends in nursing today include overlap of their duties with other health care members so it is important for nurses to be aware of the expectations from them. Another new trend is the increase in specialization in such areas as geriatric care and post-operative care. They also include pediatric care, acute or emergency care, long-term care (retirement institutions) and psychiatric care. Just as practice of medicine has grown in complexity due to discovery of new drugs and other forms of treatment, nursing practice has likewise grown in complexity as a response to evolving standards in overall health care delivery. Some people see a need for nurses to be highly specialized so that they can deliver on what the consuming public (patient, health care institutions like hospitals, clinics and health maintenance organizations, insurance companies, business organizations, etc.) have come to expect of them with regards to care. It is this need that has spawned some movement towards differentiated nursing so that a nurses unique skills and competencies can be applied to specific areas of health care. The profession as a whole has responded positively to these new demands by continuing education seminars. Discussion Nursing as a profession is regulated by state and national governments through license and accreditation. This means there are minimum standards imposed on nurses as well as the level of competencies and skills set. Nursing practice with regards to the provision of nursing care has to follow strict protocols or procedures called a nursing plan which is usually made by a doctor or physician. This nursing plan is based on two main factors regarding a patients actual treatment plan which are accepted nursing theories and best practices derived from the nursing research field. Combined, these two make up the long-term recovery plan of a patient on the road to wellness. Nursing combines knowledge from physical sciences, social science and nursing theory. Contrary to popular opinion, nursing does not only involve the treatment of sick individuals and communities but also the maintenance of well-being of those healthy. Nurses as professionals are expected to keep themselves updated of the latest models of care using new knowledge and advancements in technology. This means nurses should be competent to render the type and level of care expected because that is what is being held out by them to the consuming public. Nurses today are under increasing pressure because of this new activist consumerism where patients sometimes demand more from their nurses based on their available knowledge obtained from various sources. It is true that in some situations, the patients seem to know more than what the nurses caring for them knew themselves. As professionals, nurses are bound by ethical considerations and obligations. Ethical conduct of nurses is in the revised Code of Ethics for Nurses with Interpretive Statements and was adopted in July 2001 by the Congress of Nursing Practice (www.nursingworld.org). The code governs the whole conduct of nursing with regards to patient care to include such areas as respect for human dignity, privacy and patients best interests. Sometimes, nurses may also find their own values at variance with nursing goals, creating possible conflicts of interest. This variance can result in differences regarding procedures, personal beliefs, religion, sexual orientation and even political principles. For example, some nurses are opposed to the practice of abortion on a personal level but may be forced to assist during these procedures in certain situations where these operations are allowed by law. Opposition to abortion could be attributed to a nurses religious affiliation such as Catholics who see it as the taking of life. In these situations, what must a nurse do then? This paper attempts to look at the issues involved when a nurse elects not to have an H1N1 vaccination despite knowing he or she may have to work with patients infected with the deadly virus. Jane Doe is within her rights to refuse voluntary vaccination but this can have a profound impact on her effectiveness as a nurse in the ward. If some patient also refused to accept the vaccine, how can she convince that patient when she herself was not vaccinated? In an interesting article, the New York Times reported that the state of New York had made it compulsory including all doctors, nurses and other health care professionals to take seasonal and swine flu vaccinations (Hartocollis, NYT, p. 1). The New York Civil Liberties Union filed a lawsuit claiming such order violated basic constitutional rights regarding control of their bodies (almost similar arguments in Roe v. Wade) and their choice of medical treatment. The state of New York had cited the greater “societal interest” as a reason for making it mandatory which pits it against human rights advocates who see individual rights suddenly being relegated to the greater interests of society. The opponents see it as a threatening way to use state power over individuals by not respecting their opinions and preferences. The CLU cited as examples the United Nations WHO and even the CDC which did not order mandatory vaccinations. Some nurses have opposed it due to concerns about the safety of the vaccine and also due to cultural, religious, professional or other reasons. A bigger and more therefore more serious implication is the possibility of reprisals such as work termination for a refusal. Another reason why New York State had adopted this aggressive approach to flu vaccinations is the concern for protection not only for the nurses but also those patients whom the nurses are caring for such as aged patients, those with weakened immune systems, patients at risk for pneumonia and those in post-operative care (McNeil Jr. & Zraick, NYT, p. 1). This had been proven in some cases where epidemiologists noted fewer deaths among patients if there are fewer health care people afflicted with the flu (ibid. p. 2). The nurses countered that it does not offer full protection because the virus can mutate quickly. However, above all these arguments, it must be noted that every state today requires all health workers to be vaccinated against measles, mumps, polio, rubella, tuberculosis and hepatitis without so much ruckus. Additionally, it is only New York state so far that required mandatory flu shots, hence the union objections. A state judge had issued a temporary restraining order against compulsory flu shots pending further hearings on the issue (Chan & Hartocollis, NYT, p. 1). Main objections of nursing unions were questions of vaccine safety when it is clearly still experimental and claims of personal preferences couched in a language of civil liberties. The state countered through its health commissioner that as members of the health care team, the nurses primary concern should be the welfare of their patients and not their own opinions or sensibilities. On this regard, there is plenty of proof in medical literature that a high level of vaccination affords protection even to those who have not been vaccinated from so-called “herd protection” concept in epidemiology in which a 90% or above rate of vaccination in a certain population protects the remaining 10% who were not vaccinated due to containment. This objection by nurses clearly is a contest between individual freedom of choice and the greater interests of society and the question to be resolved is which should prevail. State authorities had given November 30 as a deadline for compliance. Nurses working in hospitals are supposed to provide benefits to patients by curing the sick but what if they get sick also? If viewed from this perspective, then the nurses who had objected to the mandatory flu shots are violative of their own code of ethics, to wit: Provision 2.1 which is the primacy of a patients interests and Provision 2.2 which states that nurses must resolve conflicts of interest between their own personal and professional values versus that of the interest of others which they should put patient safety and patient interests above all other considerations. In the first, they had failed in their commitment to the group or community at large while in the second, it arose due to changes in the domains of nursing practice. In this particular instance, it was due to a state commissions health ruling which carries the force of law behind its promulgation. However, conflicts of interest should not be viewed narrowly but rather in a broader context of moral and ethical values held by the nursing profession. Along this line, we need to define first what is moral and what is ethical. In this regard, the two values mentioned have an important bearing on biomedical ethics as it concerns communal responsibilities. Ethics can be considered as the practical applications of moral standards. Ethics can be normative (ideal standard) or non-normative. Morality is the sense of right and wrong which often predates us because these have been handed down from prior generations (Beauchamp & Childress, 3). To be more precise, the nurses who objected including the hypothetical Jane Doe in this case could be guilty of not putting the patients interest first ahead of her own interests and in a broader sense, that of the whole community which she had sworn to serve and protect when she took up nursing as a profession. Regardless of all the previous justification for not taking the flu shot, it remains that by not taking that shot, Jane Doe is exposing herself to the possibility of contracting the virus and in all probability spreading it to the patients she comes into contact with. What if those patients are those with vulnerable immune systems and they die as a result of contracting the virus from her? Who is liable for this tragedy? Jane Doe can unknowingly spread the virus before it can be diagnosed with certainty that she is infected. Jane Doe is presently assigned at the hospitals ward and in all probability will come into contact with H1N1 patients. However, her assignment could change and she could also be transferred to other departments where the other patients there do not have H1N1 and this is where she could cause some fatalities. She will also negatively affect those working with her such as other hospital staff if they get the flu from her and become absent from work. Where then is her conscience when instead of making people well, she ends up making people sick? The dilemma facing Jane Doe only comes about if in any eventuality she get sick and then infects others she had contact with. Otherwise, if she is the only one who gets sick, then we can say it is her personal problem. But being a nurse, she has duties and responsibilities to those who rely on her for their care and in this regard, she cannot let them down by letting her personal preferences interfere with that sacred duty. Another factor that gives rise to the moral dilemma will be when the institution she works for would require mandatory vaccinations. In that event, she would have to either subsume personal interests to the greater societal interest as elaborated earlier regarding the state of New Yorks requirement for all its approximately 500,000 health care workers and volunteers to get the necessary H1N1 flu shots or opt out. It is simply a matter of urgency that everyone cooperate when an epidemic is at hand. The case of Jane Doe is quite unique and probably unprecedented because the issue is about her and not that of her patients. The nursing profession had been put on the spot several times in the past but these were mostly due to the patients side such as non-compliance and the other big issues in the practice of medicine like euthanasia, abortion, organ transplants and brain death (ibid. p. 8). Perhaps for the guidance of all practicing nurses, various state nursing unions and even the national umbrella nursing organization should put up a uniform stand regarding the flu shots so all members will be informed on best action to take when it comes to the decision time whether to accept mandatory flu shots or not and avoid all the confusion. In all honesty, Jane Doe herself must re-examine her own personal values in view of her decision to refuse flu vaccination. While it is true that public policy formulation is often embroiled in controversies and compromise, social disagreements must not detract her from a primary duty of caring for her patients. How can she then serve her patients if she got downed with the flu because she did not get herself vaccinated when it was available to her? People in the nursing profession must have strong moral character for them to be able to carry out their public mandate. As what the two authors mentioned, what often counts the most for nurses is not a consistent application of ethics but strength of character when they are confronted with difficult situations such as conflicts of interest. Nurses can exhibit their moral strength by exhibiting compassion, patience and responsiveness when caring for their patients. Impersonal care sometimes worsens a patients condition while showing sensitivity improves a patient in ways not explainable entirely by medical science yet. They say emotions can kill people; conversely emotions can also help people to heal (Siegel, 100). Nurses to be effective must show they are sincere when dealing with patients. It means their language, feelings and expressions show real concern and not just for cosmetic purposes to humor a client in distress (ibid. 26). However, real sincerity does not mean they should get affected emotionally and psychologically because this is a real danger when working under a stressful condition where nurses become attached to their patients. These situations usually are found among nurses who care for terminally-ill patients and when these patients die, they sometimes subconsciously blame themselves for failing to save these patients. Not only nurses can be affected by these emotional attachments but also other health care professionals like doctors and psychiatrists but nurses are very vulnerable because they work in close proximity in caring for these patients on a daily basis. In this connection, their degree of professionalism can help protect them from these hazards of the job, so to speak. Nurses as members of the health care delivery team are likewise subject to the maxim of non-maleficence. This means decisions taken by Jane Doe with regards to the flu vaccine should take this into account with her refusal. She needs to ask herself whether she may have unwittingly exposed others to the virus and if her actions are consistent with this principle in health care. Most philosophical books dealing with ethics and morals emphasize this virtue above that of beneficence because of the potential harm that can be perpetrated by those in the medical professions (ibid. 113). This is because health care professionals such as nurses are people in positions of trust; people had put their complete faith in them (nurses) that they will do no harm in the performance of their duties and obligations. This forms the basis of the patient relationship, a trusting nature reposed by the sick person in the person caring for him or her. This has been emphasized to serve as an injunction for those planning to commit acts contrary to preserving life and that includes all nurses. This way, medical professionals are forewarned of the consequences if they violate this principle. People put their lives and welfare into the hands of those caring for them and this trust must be held inviolate in all instances. This principle may seem abstract to some but nurses may be encountering it in their hospital routines such as deciding on the distinction between killing (active) and letting patients die (passive) by withholding certain life-sustaining treatments. In majority of cases, these situations happen with terminally-ill patients and those who are seriously ill or were severely injured. It is not an easy decision to make but nurses who are properly trained can negotiate these ethical minefields with ease. This principle is applicable in most patient cases where there is an outstanding “do not resuscitate order” by the attending doctor. Other ethical issues that Jane Doe must determine for herself is when she will be sent to other departments where the patients could be incompetent and cannot give their informed consent or act appropriately even if told that she, Jane Doe, did not have herself vaccinated. A major corollary to non-maleficence is beneficence which are both recognized as overriding principles even in utilitarian theory. This simply means nothing is more paramount than life itself and the nursing profession must endeavor to use all its knowledge and skills to preserve life in all situations in whatever setting. The priority of non-maleficence over that of beneficence is perhaps an indictment of human nature. It implicitly states that people can do evil when given the right opportunity and circumstances hence in conflicts between the two principles, the former takes precedence over the latter principle of beneficence (ibid. 114). On the philosophical level, beneficence means preventing evil or harm. This jives with the nursing code of ethics (Provision 3.6) in which it is applied in practice such as preventing a colleague who has an impaired judgment to continue working as a nurse. The conscientious nurse will help that colleague regain optimal job performance but at the same time is giving protection to a patient handled or cared for by that colleague. The principle of beneficence is applicable not only to the nurse like Jane Doe but to others who work with her. Conclusion Nursing as a profession is widely recognized as an important part of health care teams. This distinction is well deserved due to the promulgation of a code of ethics by which nurses are to live by based on their standards of competence and excellence. In the provision of care, nurses today have greatly expanded roles to encompass new duties and responsibilities which they must continually update themselves. Nursing practice is also becoming more complex in response to the growing complexity of the field of medicine of which they are a part. Nurses are confronted daily with some ethical questions in the performance of their duties. For these and the accompanying conflicts of interest, they must prepare themselves by resolving these issues with the best interests of the patient as a primary guiding objective. To this end, nurses must take active positive steps to help others such as in social work today. Works Cited Beauchamp, Tom L. & Childress, James F. Principles of Biomedical Ethics. New York, NY: Oxford University Press US, 2008. Print. Chan, Sewell & Hartocollis, Anemona (October 16, 2009). “Judge Halts Mandatory Flu Vaccines for Health Care Workers.” The New York Times. Web. Accessed: November 23, 2009 from http://cityroom.blogs.nytimes.com/2009/10/16/judge-halts-mandatory-flu-vaccines-for-health-care-workers/?scp=1-b&sq=voluntary+vaccination%2C+nurses&st=nyt Hartocollis, Anemona (October 14, 2009). “Mandatory Flu Vaccination for N.Y. Health Workers is Criticized.” The New York Times. Web. Accessed: November 23, 2009 from http://query.nytimes.com/gst/fullpage.html?res=9B03E5D6103CF937A25753C1A96F9C8B63&scp=1&sq=voluntary+vaccination%2C+nurses%2C+H1N1+virus&st=nyt McNeil, Donald G. Jr. & Zraick, Karen (September 21, 2009). “New York Health Care Workers Resist Flu Vaccine Rule.” The New York Times. Web. Accessed: November 23, 2009 from http://query.nytimes.com/gst/fullpage.html?res=9B03EED9163AF932A1575AC0A96F9C8B63&scp=3&sq=voluntary+vaccination%2C+nurses&st=nyt Siegel, Bernie S. Peace, Love and Healing: Body-Mind Communication and the Path to Self-healing: An Exploration. New York, NY: Harper & Row, 1989. Print. Http://www.nursingworld.org. (2005). “Code of Ethics for Nurses with Interpretive Statements.” The American Nurses Association. Web. Accessed: November 23, 2009 from http://nursingworld.org/ethics/code/protected_nwcoe813.htm Read More