Many of the elements of this provision are found in previous versions of the Code of Ethics, as will be shown shortly. However, the inclusion of a provision directed toward the profession through its associations, rather than toward the individual nurse, is dramatically new. The provisions of all previous Codes have been directed toward individual nurses, most often the nurse at the bedside. In the later revisions, some attention was given to nurse researchers, and then, in the most recent Codes, to nurse educators as well. The 2001 Code expands to include all nurses in all nursing positions, as well as the profession itself. This shift in the Code reflects the ongoing shift in U.S. nursing practice, much as earlier Codes reflected their time. For instance, earliest modern nursing, after the Civil War, took place in the home as “private duty nursing,” in which nurses were hired by the family. Private duty nursing dominated nursing practice until World War II, after which the majority of nursing shifted from the home to the hospital and nurses became employees of the hospital, known as “general duty” nursing. Prior to this shift, hospitals were largely staffed by students. Even into the 1970s, there was a remnant of private duty nursing, often called “specialing,” within hospitals. Private duty nursing within the hospital context rapidly disappears after the late 1960s with the advent of the centralization of illness care, the inception of intensive care units, and the subsequent specialization and subspecialization within nursing.

The effect that the location of nursing in the home had upon codes of ethics was that they were written for a nurse who did not receive direct supervision and who had to make clinical and moral decisions on her (mostly) own. Confidentiality received particularly heavy emphasis as the nurse was in a position to observe the goings-on within a family home. In this early period, many nursing educators were physicians, though a nurse was often the “superintendent” of the nursing school. The shift toward nurses as nurse educators was slow in coming, accelerating after WWII, and reaching completion by the 1970s. As for research, the role of a nurse researcher did not rise until well after the 1950s. Thus, early codes would not have “needed” to address nurse educators or nurse researchers, or, of course, nurse practitioners or nurses in nonstandard positions. This Code, then, departs from
previous Codes by including all nurses in all nursing positions individually and all nurses collectively through nursing associations. This provision goes farther and specifically focuses on the role of professional associations in social ethics.

Social ethics may be defined as the domain of ethics that deals with “issues of social order—the good, right, and ought in the organization of human communities and the shaping of social policies. Hence the subject matter of social ethics is moral rightness and goodness in the shaping of human society.”¹ There are three major functions of social ethics, all of which fall within the legitimate, if not essential, sphere of the professional nursing association: reform of the profession, epidictic discourse (which is a type of public values-based speaking), and social reform.²

The first function of social ethics—reform of the profession—assures that the profession itself keeps its own house clean. Reform seeks to bring the profession and its practice, goals, and aspirations into conformity with the values that it holds dear. At times, this necessitates change within the professional community itself, seeking to move the profession toward an envisioned ideal, to bring the “ought” into conformity with the reality of the profession’s lived expression. This aspect of social ethics demands an intentional, ongoing, critical self-reflection and self-evaluation of the profession based on a range of critical theories that can assist in an incisive, rigorous self-assessment of the profession.

“Epidictic discourse,” the second function of social ethics, refers to a form of communication that takes place within and for the group. Unfortunately, epidictic has no synonym in the English language. Epidictic discourse refers to that kind of speech that reaffirms and reinforces the values that the community itself embraces, especially when they are confronted by competing values. It “sets out to increase the intensity of adherence to certain values, which might not be contested when considered on their own but may nevertheless not prevail against other values that might come into conflict with them.”³ Epidictic discourse is essentially a “rallying cry” that reinforces the group’s values to and for the group. It strengthens the values that are held in common by the group and the speaker, thus “making use of dispositions already present in the audience.”⁴ Epidictic discourse galvanizes the group to employ the group’s cherished values in order both to bring about the changes elicited by the first function of social ethics, and to move the group into the third function of social ethics—speaking the values of the group into society at large to help bring about social change that is congruent with the group’s values.⁵ Examples of epidictic speech in public address abound. A few examples include: Martin Luther King’s “I Have a Dream”; John Kennedy’s “Ich bin ein Berliner”; Franklin Roosevelt’s Pearl Harbor address to the Nation; Douglas MacArthur’s
farewell address to Congress; Patrick Henry’s “Give Me Liberty or Give Me Death.” Epidictic discourse is not solely the domain of famous men. These women’s speeches are excellent examples as well: Jane Addams’ “The Subjective Necessity for Social Settlements”; Susan Anthony’s “On Women’s Right to Vote”; Eleanor Roosevelt’s “The Struggle for Human Rights”; Sojourner Truth’s “Ain’t I a Woman?”; and Margaret Sanger’s “The Children’s Era.”

The third aspect of social ethics is that of social reform. In this, the profession critiques society and attempts to bring about social change that is consistent with the values of the group. For instance, if the group affirms affordable, accessible health care for all, it would assess the current state of the healthcare system for cost, distribution, and fairness of costs; access and ease of access by all sectors of society, including those with limitations such as mobility, age, literacy, etc. and including ethnic and minority constituencies; and openness of the system to all, including resident noncitizens, tourists, and others. It is expected that all nurses will be involved in this aspect of the profession’s social ethics. However, the actual implementation of social criticism and social change generally depends upon collective action, usually through a professional association. In order to engage in social criticism and to bring about social change, the profession must have knowledge based in theories that can guide and deepen social analysis and critique. Here we often see postcolonial, feminist, liberation, Marxist, or critical social theories employed, both to assess and critique society as well as the profession itself. (Note that these are the same theories that would be used to critique the profession itself.) In order to bring about social change, these theories and a knowledge of political and policy processes becomes essential. The resources of the professional association, including its political action committees, would then be drawn upon to support action for social change. It is important for this aspect of the profession’s social ethics that nurse educators include in nursing curricula content on ethics relating to issues of justice, social theories, nursing history related to social involvement of nursing and nurses, health policy formulation, and the state and federal political process. These three functions of social ethics (reform within, epidictic discourse, and social reform) are incorporated into the first part of the interpretive statement Assertion of Values.