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Letter by The Nursing Vision to the American Nurses Association


The Nursing Vision
24 E. Mount Vernon Pl. #3
Baltimore, MD 21202-2332

February 7, 2002

President Mary Foley
American Nurses Association
600 Maryland Ave. SW
Suite 100 West
Washington DC 20024-2571

Dear President Foley:

We would like to urge you make the Code of Ethics for Nurses with Interpretive Statements free and readily available, so that nurses may have easy access to an essential document addressing their professional responsibilities. Nurses need the Code to help them advocate for the profession, to defend their actions if their conduct is questioned and to provide guidance about their obligations in resolving difficult ethical issues. Many nurses are not familiar with the content of the Code and will continue to be unaware of these essential standards without widespread dissemination and accessibility to the Code. In particular, providing free internet access to the Interpretive Statements would be an excellent way to encourage ethical conduct and uphold the standards of the nursing profession.

Let us explain why we believe the Code with Interpretive Statements should be freely available. First, the Code provides guidance to nurses who are confronted with difficult ethical problems in their everyday practices. Recent surveys indicate that nurses are often placed in positions that they find morally untenable, and as a result their sense of integrity and self esteem suffers. If nurses had ready access to the Code and the Interpretative Statements that explain its general principles, it would help them resolve or at least better understand these problems.

Second, the Code could play an important role in advocacy for the profession. We have formed The Nursing Vision, a group of graduate students at Johns Hopkins University School of Nursing (JHUSON). Like you, we want to improve the public image of nurses so that people will want to join our profession to reduce the nursing shortage. We are working with some professors at JHUSON and the Board of Directors of the Emergency Nurses Association to persuade the television show "ER" to portray nurses in a more accurate and positive way. Among our concerns was an episode that showed a nurse obtaining improper access to a patient's records from another nurse, with no apparent awareness of the impropriety of this action on the part of the characters or the show.

We had difficulty using the Code to support our point that the show might wish to consider that nurses do have ethical obligations. After some confusion stemming from the fact that current ANA membership cards appear to display the old Code, we consulted the new Code, only to discover that the word "confidentiality" does not appear in its nine basic provisions. We realized we would need to attach the Code with Interpretive Statements to our letter to "ER" to make our point. However, the Interpretive Statements are not available online, even for purchase. Without ready access to them, we are at a disadvantage in trying to describe our work to the "ER" producers and others with great influence over how we are regarded.

Judging from our contacts with "ER," it seems one of our biggest problems is that our profession is misperceived. We are portrayed as subservient workers who do the bidding of physicians and have no independent responsibilities. For instance, one "ER" web site sums up the profession as "[providing] care to patients based on orders written by doctors." And that statement comes from one of the most progressive shows in terms of its portrayal of nurses. It is more difficult to counter such misstatements without ready access to the Code, which provides an effective "mission statement." In the digital age, people expect everything to be available on the computer. Few TV or movie writers are going to access the Code if we send it to them on paper.

Third, the Code can be an important asset to nurses when their role is questioned by others who may not fully understand it. In one instance of which we are aware, a physician complained about a staff nurse who had explained to a 10-week pregnant patient the risks of taking a category C medication the doctor had prescribed. The physician thought the patient just should have been given the medication, without comment. In this case, the Code, if easily accessible, could have been cited with exact language, in provision 3.5, to show that the staff nurse was ethically bound to advocate for the patient. And just as nurses need to defend themselves in everyday circumstances in the workplace, they need to defend themselves before courts of law. Improving access to the full, detailed Code could be a great help in such situations. The lawyer of one nurse we know of was seeking but failed to obtain the detailed Code the day before trial began. With free web access, that would not have happened.

For nurses, the Code is as important as other vital codes of conduct that are easily accessible in our society. Neither the US Constitution nor federal statutes are copyrighted. Citizens need access to those so that they know how to behave and can defend themselves when accused. For similar reasons, nurses need easy access to the Code. Indeed the Code itself, in provision 3.5, requires nurses to be knowledgeable about it, along with laws and other relevant standards. Since there is no other Code of Ethics for the profession and the entire profession is held accountable to the Code, we believe that the Code with Interpretive Statements, should be free and freely available to all nurses. Of course, we think the whole world should know what we do, and one of the best ways to educate the world would be to distribute the Code with Interpretive Statements.

We voice our concerns under provision 7.3 of the Code, which states that nurses shall advance the profession through knowledge dissemination. Copies of the detailed Code should be in every health care work place, hanging in break rooms, nurses' stations, medications rooms, nurse managers' offices and hospital lobbies, so that everyone is aware of nursing responsibilities. Like water, the Code should be free and freely flowing, so that nursing and society may thrive.

Thank you very much for considering our request.

Yours sincerely,

Johns Hopkins University School of Nursing Professors

Martha N. Hill, Ph.D., RN, FAAN, Interim Dean JHUSON, Professor of Nursing, Director, Center for Nursing Research

Jacquelyn Campbell, Ph.D., RN, FAAN, Professor of Nursing, Associate Dean for Ph.D. Programs and Research

Linda C. Pugh, Ph.D., R.N.C., Associate Professor of Nursing

Cynda Hylton Rushton DNSc, RN, FAAN, Assistant Professor of Nursing, Faculty, Phoebe Berman Bioethics Institute

Joan Kub, Ph.D., RN, Assistant Professor of Nursing

Dan Sheridan, Ph.D., RN, CNS, Assistant Professor of Nursing

The Nursing Vision--Graduate Students at Johns Hopkins University School of Nursing

Keren Ben-Or, RN, MSN, CRNP-Peds, Ph.D. student

Richard Kimball, RN, MSN, MPH, Ph.D. student

Gina Pistulka, RN, MSN, MPH, Ph.D. student

Christine Stainton, RN, BSN, BA, MSN student

Sandra Summers, RN, BSN, MSN/MPH student

cc: Dr. Gladys B. White, Director, Center for Ethics and Human Rights, ANA


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