Archive for the ‘codes of ethics’ Category

Unionization by health professionals is a touchy subject. And when it’s not, it ought to be.

See this story by James Warren for the New York Times: Finally, Nurses Are Set to Vote on Unionizing

The American Federation of State, County and Municipal Employees is still at it and will finally get a representation election next Wednesday and Thursday among about 270 registered nurses at one of the group’s locations, Our Lady of the Resurrection Medical Center.

It’s a drawn-out, nearly decade-long tussle fit for the times. The union has met resistance and filed 50 complaints about unfair labor practices with the National Labor Relations Board. The company voluntarily settled 18 of the 50 complaints brought against its various properties before any federal hearing….

Interestingly, Warren’s article makes absolutely no mention of the fact that nurses are not just regular employees, that they are health professionals. Nurses are licensed professionals with a code of ethics and an avowed commitment to the public good. That makes them pretty different from municipal employees or auto workers. That’s not to say that they shouldn’t unionize. But it does raise concerns about nurses joining unions that are not exclusively unions of nurses. Unionization has a purpose, and unions have their goals. But the goals of a union can quite easily conflict with the goals to which a health professional swears upon joining the profession.

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This is Part 1 in an series of postings we’ll be doing on the role of critical thinking in Nursing Ethics, here on the Nursing Ethics Blog.

Let’s start with a definition. Critical thinking can be defined as “the systematic evaluation or formulation of beliefs, or statements, by rational standards.”*

In terms of nursing ethics, that definition has several crucial elements.

The first has to do with the word “systematic.” Thinking critically about ethical standards in nursing is “systematic” in that it has to do with the application of distinct procedures and methods. At times, that might involve the use of very technical tools, such as the tools of formal logic, to assess the validity of arguments. In other cases, it will involve looking for well-known patterns of good or bad reasoning, including for example the many fallacies to which human reason is sometimes subject. In other cases, being systematic will simply mean looking carefully at the various parts of an argument (its premises and conclusions) and at how the argument is structured, in order better to assess its strengths and weaknesses. Thinking critically about nursing ethics means doing something more than having an opinion. It implies a careful, systematic approach.

Here’s an example. Imagine a fellow nurse, one administering a clinical trial, says to you, “If someone is my patient, then I owe that person a duty of care. Right? And according to the relevant regulations, I owe the participants in this clinical trial a duty of care, so they must therefore count as my patients!” That’s an ethically significant conclusion. But is the argument leading to it a good one?

At some level, that argument may sound plausible, and to many nurses, the conclusion will be an attractive one. But someone skilled in critical thinking might recognize that that argument has the following form:

If P, then Q.
Therefore, P.

Arguments of that form are pretty common (so common, in fact, that they’ve been given a technical name, “affirming the consequent”) and they are always, always faulty. The premises of an argument with that structure simply cannot support that conclusion. But good critical thinkers will also recognize that the failure of this argument doesn’t automatically spell doom for that argument’s conclusion: it just means that someone needs to try again.

The second implication of the definition of critical thinking offered above has to do with what it says about about “evaluation” and “formulation” of beliefs. This implies that critical thinking is to be applied to evaluating existing beliefs as well as to the process of building new ones. In terms of nursing ethics, then, critical thinking can be used in two ways. First, it can be used as part of reflective practice, as part of evaluating our own current beliefs about what constitutes ethical or unethical nursing practice. Second, it can be used in formulating new ethical standards, for example when a new code of ethics or is being devised.

The third implication has to do with the words “rational standards.” Those words imply that particular views about nursing ethics (or bioethics or professional ethics, more generally) ought to be judged by how well they are supported by good reasons. That is, a commitment to thinking critically about nursing ethics means only adopting points of view that you have good reasons to adopt, and committing to values you have good reasons to be committed to, rather than adhering to stale, unexamined beliefs or doing things a particular way “because that’s the way we’ve always done it.”

As this series progresses, we’ll look at different elements of critical thinking, and how some of the specific skills of critical thinking can be applied to thinking about nursing ethics.

*Lewis Vaughn and Chris MacDonald, The Power of Critical Thinking, 2nd Canadian Edition, Oxford University Press, 2010.

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In a recent article from the Chronicle of Higher Education, a “ghost writer” talks about the proliferation of students having papers and assignments written by others. The writer mentions nursing students in particular as a frequent client of his services. Here’s the story: The Shadow Scholar: The man who writes your students’ papers tells his story

With respect to America’s nurses, fear not. Our lives are in capable hands — just hands that can’t write a lick. Nursing students account for one of my company’s biggest customer bases. I’ve written case-management plans, reports on nursing ethics, and essays on why nurse practitioners are lighting the way to the future of medicine. I’ve even written pharmaceutical-treatment courses, for patients who I hope were hypothetical….

The ghost writer mentions the fact that these nurses “can’t write a lick”. It is, however, much more than that. Asking someone else to write your paper for you necessarily means you will not learn what it is you’re supposed to learn form the assignment, which is a far more serious consequence.

I’ve been teaching nursing students for many years now and the topics of plagiarism and cheating is one that comes up again and again. Here are a few things I try to communicate to my students: From the moment that they walk in the door on the first day of university in a nursing degree program, the expectations of them are much higher than the expectations of a student in a non-professional program, like a history or political science major. Nursing students are evolving professionals with clear responsibilities for the lives and well being of others, from the moment that they set foot in a patient care area. When a history major has someone else write her paper on the outcomes of civil wars in the sixteenth century, there are two results: First, she is quite clearly cheating. Second, she’ll know little to nothing about the civil wars in the sixteenth century, if asked later, since someone else did her research and wrote her paper. However, when a nursing student has someone else write his paper on the pathophysiology of cancer, those same two things happen but with more serious implications. Yes, the nursing student, like the history student, has cheated. But the nursing student will end up knowing little to nothing about the pathophysiology of cancer, something a nurse should know.

I realize that, sometimes, the demands we put on what are often very young nursing students struggling to manage heavy academic workloads, shifts in their clinical placements, and personal commitments, can be overwhelming. Students in all kinds of professional programs balance very intense programs, clinical placements and multiple responsibilities. And yes, the demands are extreme at times. as are the demands of nursing work, across all settings. But to cite overwhelming demands as a valid excuse for cheating is to diminish the very real importance of learning positive, constructive and responsible ways of dealing with stress and overwork, something nurses and nursing students must be encouraged to do.

The public has always put a great deal of trust in nurses. Time and time again, in surveys of the public, nurses rate very high in terms of degree of public trust. This trust forms the basis of the therapeutic relationship that nurses are able to form with patients and families. The public doesn’t want nurses who cheat or who get others to do their work for them. Instead, they want nurses who they can trust to both deliver safe and knowledgeable care in the most routine situations and also in life-and-death circumstances.

The public expects that if a nurse has a degree and has, by virtue of that degree, claimed to study how drugs interact and how intravenous therapy should be delivered, he’ll actually know this and be able to apply this knowledge to the care of others. If nursing students are, as the ghost writer here suggests many are, paying for their papers to be written by others, they are not only cheating themselves but also the patients who expect a high level of both professionalism and knowledge from nurses.

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By Sharrie Williams, for CBS News 4 Miami: Nurses Head To Haiti On Teaching Mission

In September two Jackson Memorial Hospital nurses with more than three decades of experience between them took that knowledge and compassion to Port-au-Prince.

They volunteered to help Haitian nurses in the aftermath of January’s devastating earthquake and now, the two are going back again to try and help the crippled Haitian medical community….

Of course, this is just a local news story, and there’s not much that’s unique about it. Many, many nurses have participated in humanitarian efforts in Haiti and other places. I’m posting this story just to make a brief point about role models, and the value of examples. Very often — regrettably often — the word “ethics” comes up in contexts where someone has done something bad. A scandal of some sort arises, or someone is accused of violating their Code of Ethics. But ethics, of course, is about far more than that. Ethics isn’t just about avoiding wrongdoing. It’s also about doing good things.

To most members of the public, getting on a plane to go and help in Haiti must seem utterly heroic. And, to be sure, the nurses in the story quoted above deserve praise — what they’re doing is truly wonderful. But it’s also worth remembering that, within the nursing profession, the line that most of the public sees between “just doing your job” and going “above and beyond” gets blurred. Nursing, as a profession, calls upon its members to go “above and beyond” on a daily basis. That’s part of the ethics of being a nurse. But of course, there are limits. Even nurses are only human. There’s only so much anyone can do, only so much anyone can give. I think one of the core ethical challenges for the nursing profession is, on an ongoing basis, to think about just where the profession itself will draw the line between what it considers “above and beyond,” and what it considers just everyday heroism.

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