Introduction
Ethical dilemmas are a common issue in nursing and happen when there is no easy choice relating to right and wrong. Such situations call upon the nurse to make an important decision with critical implications. Each choice has potential consequences, with the nurse, having to pick the set of consequences that most suits ethical and professional requirements. ANA Provision 3-3.6 of the ANA Code of Ethics is unique in that whenever it comes into application, an ethical dilemma must ensure. The said provision involves protecting patients from a colleague who, for some reason has a professional impairment (ANA, 2015). In such a scenario, failing to intervene may place the patient in the kind of risk that may even have fatal consequences. On the other hand, intervention means accusing a colleague of an element of incompetence or a psychological issue, which can have devastating consequences to a professional relationship. The critical nature of ANA Provision 3-3.6 brings to the fore the very nature and importance of the ANA Code of ethics itself. The code exists inter alia became of the complicated and sensitive nature of the nursing profession and its implications on the primary stakeholders, the patients (ANA, 2015). In the application of ANA Provision 3-3.6 it is advisable to err on the side of caution as far as patient safety is concerned as the professional implications of implementation are less permanent than the danger posed by an impaired nursing officer in active practice.
The ANA Code: History and Application
Whereas the ANA only published its first Code of Ethics in 1950, the concept goes as far back as the 18 th century. The idea of a Code of Ethics among nurses stems from their status as being clinical practitioners on their own right, rather than assistants who only act at the instructions of the doctor. According to Bernstein (2019), among the initial proponents of the concept that nurses have an obligation to patients that rises above obeying physician instruction is renowned nurse Florence Nightingale. The ideas and concepts propagated by Nightingale feature prominently in the ANA Code of ethics. These ideas include the need for proper training, testing, and certification for all nurses. Further, Nightingale advocated for egalitarianism in the treatment of patients. Patient advocacy was also an important component of Nightingale’s ideas, which involved nurses acting and champions for patients. Finally, the said renowned nurse argued that the nursing profession and its practices should keep evolving and improving to the benefit of the patient. In 1893, the Farrand Training School for Nurses developed the nursing version of the Hippocratic Oath and named it the Florence Nightingale pledge in honor of the prominent nurse.
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Similarly, the ANA developed the initial Codes of Ethics in 1950 and published it as a basic guide for all its members. In line with Nightingale’s concept about the continuous betterment of the practice, the said code has undergone regular review and revision to augment its efficacy and relevant to nursing practice. From the perspective of application, the ANA Code of Ethics is the basic rulebook for practice for members of the ANA. The organization expects all members to adhere to its provisions fully and without exception in all areas of practice. For clarity, following hospital policy or physician instruction is not a defense for breaching the provisions of the ANA code of ethics. Breaches to the express provisions of the ANA attract disciplinary measures from the ANA to protect the integrity of the nursing protection and for the safety of patients and other nurses (ANA, 2015).
ANA Provision 3-3.6: Meaning, Justification, and Application
ANA Provision 3-3.6, titled Patient Protection and Nurse Impairment, relates to the complicated yet likely scenario, where a nurse needs to protect patients from a colleague (ANA, 2015). The concept of protecting patients from a fellow nurse stems from the nature of the nurse-patient relationship. In order for the said relationship to function as expected, the patient has to trust the nurse fully. For example, most pharmacological interventions include the introduction of potentially poisonous substances into the body of a patient orally, through injections or intravenously. It takes a high level of trust for patients to allow the nurse to introduce such substances into their bodies repeatedly. Normally, every nurse is worthy of such trust due to the high level of training and commitment associated with the profession. However, nurses are also human beings, making them fallible. For example, a nurse can develop a physical or psychological problem and be unaware of its extent or implications. Conversely, just as with other humans, a nurse may be abusing addictive substances and unwilling to admit that such abuse affects professional abilities. A nurse may also be fatigued, stressed or depressed and unable to function at optimum or even reasonable capacity. It is not incumbent upon patients to evaluate clinicians before trusting them with their health and lives. Such an impaired nurse will this still have the full trust of patients, to their potential detriment.
ANA Provision 3-3.6 outlined the onus of all practicing nurses in the event of an impaired nurse. Using relatively strong and compulsive language, the opening statement of the section indicates that nurses have the obligation to protect patients, the public, and the nursing profession for the vagaries caused by such an impaired nurse (ANA, 2015). For a start, nurses have the obligation to be in the lookout for signs of impairment in their colleagues. As per the act, in the case, a nurse notices such signs, the nurse should take steps to ascertain the veracity of the signs. After the nurse is relatively certain on a balance of probabilities that an impairment exists. The next step would be to involve the relevant administrative authority such as supervisory personnel.
From a different perspective, the nurse also has a duty of care to the colleague that the nurse suspects of being impaired. The duty includes the right to approach the impaired nurse with compassion and offer assistance in overcoming the cause of impairment and its implications. Based on this provision, nurses should not make a spectacle out of their impaired colleagues but rather use compassion to assist, rather than accuse the impaired colleague. An important component of ANA Provision 3-3.6 is that it takes into cognizance the ethical dilemma involved in the issue. The dilemma has four main components, which are the provisions of ANA Provision 3-3.6, administrative rules, labor relations issues, and the rule of law (ANA, 2015).
For a start, when intervening in an impaired nurse scenario, a practicing nurse should observe the applicable rules, regulations, and procedures set by the administration of the healthcare institution. Adherence to such rules is important to ensure that the nurse does not end up having to deal with the institutional disciplinary measures. Secondly, some forms of nurse impairment such as some illnesses or substance abuse can jeopardize a nurse’s employment. Employment revolves around laws, rules, and regulations allied to labor relations. The reporting nurse should take cognizance of such rules when intervening in the case of nurse impairment (ANA, 2015). Finally, the issue of nurse impairment also involves legal issues. For example, some accusations can attract liability under tort laws for issues such as libel. Similarly, nurses as with any humans have a right to keep their health-related issues private, inter alia under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Conversely, accusations revolving around issues such as the abuse of narcotics fall under state and federal criminal laws. When applying ANA Provision 3-3.6, the nurse needs to take cognizance of all the administrative, labor relations, and legal issues involved and their respective implications. Where necessary, the nurse can also seek professional or even legal advice before the intervention. In spite of the complexities revolving around the application of ANA Provision 3-3.6, it is important to note that the provision is mandatory. Any nurse who realizes that a colleague is impaired had an unalienable duty to intervene. Finally, the code also provides for protection for nurses who act in adherence to its provisions. As per ANA Provision 3-3.6, healthcare institutions should take steps to protect nurses who act on the provision from retaliation or related adversities (ANA, 2015).
Conclusion
If the practice of nursing were easy and straightforward, there would be no need for the ANA Code of ethics as every petitioner could easily tell right from wrong. However, as reflected by the analysis on ANA Provision 3-3.6 as outlined above, nursing practice will sometimes involve ethical dilemmas where any decision that the nurse makes has potential for adverse ramifications. To ease the process of determining what to do in the case of such a scenario, the ANA came up with a Code of Ethics. The said code inter alia analysis situations that nurses face practice and instruct them on how to handle them. It is important to clarify that in practice, the code of ethics is a set of instructions, not recommendations. The provisions of the code are mandatory and outline what he ANA expects of all its members. For example, by virtue of ANA Provision 3-3.6, any practitioner who notices that a colleague is impaired should intervene in order to protect the patient, the public, the profession of nursing, and the impaired colleague. However, due diligence is necessary in applying the provisions of ANA Provision 3-3.6 as it may have major implications for the impaired nurse and the reporting nurse. The said code provides instruction to ensure that all parties are protected in the process of implementation.
References
Bernstein, R. (2019, August 26). The History and Application of Nursing Ethics. Retrieved from https://online.husson.edu/nursing-ethics/ .
ANA. (2015). Code of Ethics for Nurses. American Nurses Association (ANA) . Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/ .
