The American Nurses Association (ANA) designated 2015 as the Year of Ethics for American Nurses. I have personally designated 2016 as the Year of Ethics for Correctional Nurses. This year I will be blogging regularly about the Code as I write a book to help correctional nurses apply the Code of Ethics in our challenging setting. So, let’s start by doing a fly-over of the Code to get our bearings.
In 2015 the Code of Ethics for Nurses (Code) was revised to reflect the evolving profession of nursing as well as the changing social context of nursing practice. While the core values and ethical ideals of the profession are unchanging, the application and emphasis need re-evaluated regularly. In this way, the Code remains relevant and vital to nursing practice. The prior edition of the code is dated 2001 so this new edition reflects the changes in nursing practice context over more than a decade. Certainly, health care has changed in 14 years and so has correctional health care. This change is reflected in the new Code of Ethics for Nurses.
The steering committee for the code revision lists three primary intents in this current edition.
- To reflect the complexities of modern nursing
- To simplify the content
- To anticipate advances in health care
- To incorporate aids that make the Code easier to use
It is comforting that the standard nursing values of the Code remain unaltered. In the ever-changing world of nursing practice, some things never change. The professional values that under-gird your correctional nursing practice remain as they have been. Here are the key elements of our code of ethics that remain the same in the 2015 code.
The purpose of the Code remains unchanged. It provides a concise statement of professional nursing ethical values, obligations, and duties. This is foundational to professional practice and is a written support to nursing decisions that may be in conflict with other disciplines. This makes the Code of particular importance to correctional nursing practice where nursing values may be questioned by correctional colleagues. Yet, the Code is non-negotiable as an ethical standard for nurses; providing a powerful support for some nursing actions.
The Code provides guidance for nurses when working within the health care context, but it also provides an expression of our commitment to society and thus addresses ethical standards of practice for our patients and the general population. The Code expresses the normative values and expected behaviors of nurses. This codifies what the public can expect from nurses and is, therefore, a basis for determinations of nursing malpractice.
Although the wording may be simplified and the explanations modernized, the nine original provisions of the Code are unchanged in content or order. This is actually the first revision that did not alter the number or content of the Code’s provision and may indicate a stabilization of nursing values. Although nurses have had ethical guidance since 1893 with the use of the Florence Nightingale Pledge, the first formal professional code was adopted by the ANA in 1950. This Code included 17 provisions and generated much public and professional dialog about nursing values. Professional nursing practice was moving toward autonomous self-governance during this time period and the meaning of this movement was a part of the conversation.
The Code was revised in 1968, 1976, 1985, and 2001. Each time the provisions were revised and reduced to the very essence of nursing core values. By 2001 the provisions landed on nine and remain there today. These nine provisions are ordered to fall into three main groups:
- First Three: Fundamental Values and Commitments
- Second Three: Duties and Loyalties
- Final Three: Duties to Society
Key Ethical Principles
The ethical principles that underlie the Code remain unchanged. Respect for human dignity and the worth of every human being is paramount to health care provision; especially in a correctional setting. Patient advocacy is clearly evidence; as is patient autonomy and protection. Upholding all provision of the code are the twin principles of beneficence (doing good for the patient) and non-malfeasance (not harming the patient). These two principles are the foundation of all professional health care codes of conduct.
Taken as a whole, the Code clearly emphasizes the patient-centered nature of nursing practice. Even the provision describing our duty to ourselves is in order to best serve our patients through our own health, competence, and professional growth. Remaining patient-centered in the often un-patient-friendly environment of the criminal justice system is a daily challenge for correctional nurses.
The Code was meant to apply to all practice settings so it speaks to general and universal practice issues rather than specific situations. It is up to practicing nurses to make the application to their ethical dilemma. The ANA published a Guide to the Code of Ethics that provides great help in this area. Here is my review of the book.
The unique patient population and unusual practice environment of correctional nursing practice calls for specialized interpretation and application. Join me this year as we explore the Code of Ethics for correctional nurses.
Have you read the new Code of Ethics for Nurses? What do you think?