	Legal Aspects	Nursing Ethics
Definition	The state statutes that apply to licensed persons and the situations in patient care that could result in legal action	Set of rules of conduct
Focus	Rules and regulations	Ideal behavior of a group of licensed people
	Obligations under the law	Morality
	Obligations under the law	Higher standards
Applies to	Member of a professional/career group	Member of a nursing group
Participation	Mandatory	Voluntary
Source	Your state’s Nurse Practice Act	NFLPN and NAPNES codes, Florence Nightingale Pledge, PN Pledge

Nursing ethics

According to the Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing & Allied Health, nursing ethics are “the values and ethical principles governing nursing practice, conduct, and relationships.” Nursing ethics deals with the relationship of a nurse to the patient, the patient’s family, associates and fellow nurses, and society at large. Nursing ethics attempts to look for underlying patterns or order in a large number of ethical decisions and practices of nurses, individually or as a group. Codes provide a guideline for what the LPN/LVN ought to do. However, codes do not carry the weight of law. It is interesting to note how many ethical items are actually found in the law, such as your Nurse Practice Act. When ethical items are included in a legal document, it places emphasis on the importance of these items. It also gives the LPN/LVN a source to fall back on to defend the choices in behavior they make in regard to patients and families; it is then a matter of law.

Ethical codes of the national association for practical nurse education and the service and national federation of licensed practical nurses

Ethics that are adopted by nursing groups are in their codes of behavior. Both the National Association for Practical Nurse Education and Service (NAPNES) and the National Federation of Licensed Practical Nurses (NFLPN) have ethical codes for LPN/LVNs (see Appendixes B and C).

Try This

Ethical Issues and Your Nurse Practice Act

Discover how your state includes ethical issues (what you ought to do as an LPN/LVN) in the law, which is your Nurse Practice Act (what you must do as a licensed person).

• Read the ethical codes of the NAPNES and NFLPN.

• Use the NFLPN code as an example.

• Search for the elements of this ethical code in your Nurse Practice Act. Fill out the following worksheet.

• Summarize the ethical elements found in the Nurse Practice Act.

Ethical Area	Is this ethical area addressed in your state’s Nurse Practice Act?	If “yes,” cite section
1. Know the scope of maximum utilization of the LPN/LVN, as specified by the Nurse Practice Act, and the function within this scope.
2. Safeguard the confidential information acquired from any source about the patient.
3. Provide health care to all patients, regardless of race, creed, cultural background, disease, or lifestyle (e.g., single parent, sexual orientation).
4. Refuse to give endorsement to the sale or promotion of commercial products or services.
5. Uphold the highest standards in personal appearance, language, dress, and demeanor.
6. Stay informed about issues affecting the practice of nursing and the delivery of health care, and, where appropriate, participate in government and policy decisions.
7. Accept the responsibility for safe nursing practice by keeping mentally and physically fit and educationally prepared to practice.
8. Accept the responsibility for membership in NFLPN or the LPN/LVN organization of your choice, and participate in its efforts to maintain the established standards of nursing practice and employment policies that lead to quality patient care.

Your personal code of ethics

Practical/vocational nursing students and LPN/LVNs also have personal ethics that provide personal guidelines for living. You ultimately chose what your personal code of ethics would include. Your personal code of ethics will influence your nursing ethics. Sometimes personal ethics conflict with the law (state’s Nurse Practice Act). When this occurs, you have an obligation to follow the law. If you object to a medical procedure on religious or moral grounds, state this objection in writing. Present the statement to the employer before starting employment. The employing agency and you need to be clear in advance about your objection to procedures because of religious or moral reasons. For example, you may be ethically opposed to abortion. Abortion in the United States is permitted under certain circumstances. You may ethically refuse to assist with the abortion procedure (and have stated this in writing at the time of employment), but postprocedure you cannot refuse to give nursing care to the woman involved. In the words of Sister M. Antoinette, former Director of Nursing at Sacred Heart Hospital in Allentown, Pennsylvania, “You may not abandon your patient.” Abandonment is a legal matter, and your license may be at stake. The best strategy is to seek employment in a health agency that does not participate in procedures or nursing care of which you do not ethically approve.

Some nurses have tried to opt out of caring for patients who have an illness that may be related to a lifestyle of which they do not approve. A nurse needs to separate personal ethics from nursing ethics. You are legally expected to care for a patient regardless of his or her lifestyle. For example, when caring for an AIDS patient, use proper technique during care as you would with any patient with an infectious disease. You may not refuse to care for this patient. Ethically and legally this patient must receive the same level of care, with dignity and respect, that other patients do. Nursing is not about giving care selectively to those patients you approve of and refusing care to others you see as less deserving.

Critical Thinking

Personal Values

Write your personal value system regarding health and illness. Be concerned with content, not form. What you write will be an ethical code in progress. You may want to add or subtract statements after you have completed this chapter. It will also be a code you can modify as your experience with patients increases.

Roots of nursing ethics

Years ago, nurses saw themselves as doers, not thinkers. Nurses worked only to serve the physicians’ wishes. Before the nursing process and critical thinking were added to nursing curricula, those in the nursing profession did not see themselves as having something separate to contribute to patient care (in addition to the nurses’ dependent role to physicians). Nursing ethics was primarily a modification of medical ethics and ethics of other professions at that time.

What changed?

Nursing education was initially disease-oriented. Nursing textbooks focused on the disease process, including cause, signs, symptoms, treatment, prognosis, and nursing care related to the treatment. Physicians did the medical assessment and wrote orders for the nurse to carry out. The nurse reported on patient progress, based on physicians’ orders. Nursing assessments did not exist. Additional concerns the patient might have had (e.g., spiritual, cultural, emotional, sexual) were not routinely assessed. Patients were expected to follow physicians’ orders without question. The nurse’s job was to see that the orders were carried out. The early nursing role was limited to the dependent relationship with the physician.

As nursing theories emerged, so did the nursing process and critical thinking, and nursing textbooks began to include these topics. Nurses discovered that in addition to their dependent role to physicians, they had something special to contribute to the patient. Finally, it was understood that the patient was a person, not just a disease. With the help of the nursing process, nurses had a way to identify additional needs that could be responded to through nursing care. Rather than expecting patients to blindly follow orders because “we know what is wrong with you and we can fix it” (benevolent paternalism), patients were encouraged to be an active part in planning and implementing their own nursing care plan (support of patient autonomy).

Changes in nursing did not happen easily. Many nurses were entrenched in their dependent role to physicians, and they believed that nursing was being ruined by the changes that were taking place. Nursing textbooks and curricula, however, both had to change to reflect the nursing process, critical thinking, and a focus on the total patient (not just the physically diseased or injured portion of the patient). Adding the nursing process and critical thinking changed the nursing role and changed nursing philosophy. This in turn influenced a change in nursing ethics.

Ethical principles in this chapter are about application of nursing ethics to nursing decisions and action. You are encouraged to look at both sides of an ethical principle. Recognize that no principle applies in the same way to all patients and their unique situation. No principle is absolute.

Critical thinking (see Chapter 8) plays a major role in sorting out ethical choices and legal responsibilities in regard to the patient. The patient’s knowledge of choices regarding care also affects ethical decision making.