Duties to Self: The Nurse as a Person of Dignity and Worth

Interpretive Statement 5.1, Duties to Self and Others

This IS gives a brief introduction to the provision. It states that “the same duties that we owe to others we owe to ourselves,” so that if we are to do good for others, not inflict harm; see people as ends in themselves and not as means to other ends; and the like, we should apply these same precepts to ourselves. The remainder of the IS prescribes ways in which we can meet these ethical demands.

Interpretive Statement 5.2, Promotion of Personal Health, Safety, and Well-Being

This IS may in some ways be personally more difficult for many. It demands that nurses “practice what we preach” with regard to health, safety, and well-being. While it is expressed in more modern language, this section has a close affinity with the early ethics literature that commanded nurses to attend to personal “rest, food, and exercise.” But there is specific application to nursing practice as well. Nurses must protect themselves from the risky aspects of nursing, such as exposure to pathogens, and not cut corners. Nurses must be alert to signs of compassion fatigue within themselves and take care to address it. Breaks and meals are important and should not be skipped. Family and friends are essential to well-being—work-life balance should be maintained. As Aikens asserted in 1916, nurses must develop “a symmetrical life” (p. 163). Family, friends, and colleagues are a part of achieving a symmetrical life.

Interpretive Statement 5.3, Preservation of Wholeness of Character

The next IS emphasizes that nurses are integrated beings; there is no separation between personal and professional—we are one and the same person. Nurses are persons who have core values that come from both personal and professional lives; these core values give rise to particular moral points of view. Nurses are free to express their moral point of view and, in instances of ethical issues that arise in the course of work and as members of what the Provision calls a “community of moral discourse,” have a duty to express their moral perspective. Wholeness of character acknowledges that nurses are moral agents with specific values, but they are also social, political, cultural, and ethnic beings with a variety of perspectives that make up who they are as individuals. When patients ask for nurses’ views on the weather, the economy, broccoli, or “How about them Phillies?,” nurses are free to respond with their personal perspective. The caution is that such expression must avoid undue influence on the patient and must remain within the bounds of compassionate, respectful, and competent care.

Interpretive Statement 5.4, Preservation of Integrity

This IS is the longest in this provision. It focuses on the preservation of integrity as one aspect of wholeness of character. It recognizes that a wide range of threats to integrity may arise in the course of practice. Nurses are sometimes instructed to lie to patients, to falsify records, and more. There are two reasons not to obey these instructions: They are simply wrong; but also, the consequence of these actions can harm one’s own moral self-regard. This interpretive statement also recognizes the threat of abuse, perhaps even violence, that nurses may face. No one may abuse a nurse—no one. It does not matter whether the abuser is a patient, a family member, a physician or other health professional, or another nurse: no one may abuse a nurse. Immediate action must be taken to stop the abuse and report it. Practice environments can also place nurses in situations in which staffing patterns, colleagues, or low work-group standards may compromise nursing values and ideals or may be an outright violation of the Code. The Code is the non-negotiable ethical standard for the profession and an expression of nursing values, obligations, virtues, and ideals (ANA, 2015, p. vii). While compromise is the nature of human interaction (not to mention marriage and legislation), there are limits to compromise. Compromise must be integrity-preserving; it may not extend to compromising the standards of the Code, and it should not involve compromising deeply held personal values.

Nurses may always refuse to participate in that which is unethical or illegal or would harm the patient. However, there are differing moral evaluations of some clinical interventions, such as abortion and gender reassignment surgery. Where an intervention is legal, yet regarded differently on moral grounds, nurses may refuse to participate if such participation would violate their moral values. This is at the heart of what the Provision calls “conscientious objection.” Note that this term speaks to refusing to participate in a specific treatment: it does not extend to caring for a patient who had the intervention. The interpretive statement makes note of the proper procedures for indicating either moral objection or conscientious objection to specific interventions. Finally, the interpretive statement addresses instances in which nurses might find themselves employed in a morally impoverished setting that will not, and whose inhabitants do not intend to, change. What is the nurse to do? Leave. Leave before you are either compromised morally, to your own harm and detriment, or you are implicated as complicit in the unethical activities.

Interpretive Statement 5.5, Maintenance of Competence and Continuation of Professional Growth

This short but important IS identifies competence as a self-regarding duty rather than as a means to adequate patient care. Competence certainly has an effect on the quality of patient care, but it is self-regarding in that it has a profound effect on moral self-regard, self-respect, and self-esteem, and plays a role in the meaningfulness of work. Continuing competence means continuing education. In short, it means that nurses must be committed to lifelong professional learning. Lifelong learning and competence are part of professional growth and have been seen as such since the earliest nursing ethics literature.

Interpretive Statement 5.6, Continuation of Personal Growth

The last IS in this provision is about continued personal growth. It draws upon the understanding, noted above, that we are integrated persons, and that the personal and professional are united within us. Therefore, what causes us to grow professionally affects us personally, and what causes us to grow personally affects us professionally. In this section, then, we come full circle: the nurse is an integrated being of dignity and worth.