I am a nursing instructor but first and foremost I am a Registered Nurse. I belong to the College of Registered Nurses of British Columbia and therefore must abide by the Canadian Nurses Association’s Code of Ethics.
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My dual role of nurse and instructor creates an array of ethical dilemmas. When one role conflicts with the other I find myself often mystified. One example is when I am teaching in the hospital and observe poor nursing practice I ask myself must I report each and every minute breach of best practice or only the actions that could blatantly harm a patient? This line is fine and difficult to define clearly. The next quandary in this situation is what the proper process is for reporting it? If I were an RN working on a unit I would fill out an Incident Report but as a visiting Nursing Instructor do I just report it to the Unit Manager or Nurse Leader first? There isn’t a clear defined answer to this dilemma.
Teaching aside, nursing ethics unto themselves are extremely complex. Ethical issues range from whether a nurse who morally disagrees with physician assisted suicide is obligated to participate in the assisted suicide procedure or can a nurse care for her family member or whether a nurse is always a nurse even in the nurse’s personal time. The latter asks the question about if I do something unethical or morally wrong in my personal life is this reportable to my Registering board (CRNBC)? The answer is yes. This article looks at two scenarios: a nurse who makes racist remarks on social media or a nurse who is stealing from his neighbour.
Both are reportable to the College. We are always portraying the image of nurses and acting immorally in our free time is still wrong and punishable.
When these ethical dilemmas are encountered I help my students navigate these as best I can. Moral residue is something I come up against on a somewhat frequent basis as a nursing instructor. It is a common cause of burn out in health care workers, especially nurses and doctors. Rushton states that “breaches of ethical values and principles affect a person’s whole being in varying degrees of intensity and consequence” (p. 3). A common phenomenon that has a compounding effect over time is when the health care system does not allow for the nurse to carry out their deeply held professional values of providing holistic and client centered care. These values make up the strong moral foundation of the nursing profession. Sometimes my students encounter health care workers that also breach these upheld values and morals. I think too that this moral residue tends to hit hard for me because I am threading these values into everything that the students are learning. All that they learn is derived from this foundation; to be caring, compassionate, client centered and empowering. For me, this further solidifies the importance of these core values for nursing and that it is my duty to ensure they are being carried out. When a breach in these values occurs I am left feeling raw each and every time. The moral residue builds up over time.
I navigate these situations with my students using the CNA’s Code of Ethics and CRNBC’s standards of practice. These documents provide a general guideline to help define a problem but not a clear cut path to making that difficult decision on how to proceed. There is a 12 page Standard of Conduct document at the College I work at that was devised to help identify and resolve ethical conduct and conflicts of interest. This document is helpful for my role when working at the College, however it does not address the ethical dilemmas that the crossover of roles (nurse vs. instructor) and settings (working in a health care institution) create.
This reflection has helped shed some light on how our school department should have a specific and formal Ethical Framework and Code of Conduct that could help nursing instructors navigate these murky waters. A colleague of mine devised the following document called Professional Practice Issues 2017. I have started implementing this process to help my students navigate through these difficult situations. Another colleague I know is currently working on this gray area as a special project. I am keen to learn what she has compiled and am inspired to help her with her project.
Canadian Nurses Association. (2008). Code of ethics for registered nurses. Retrieved at https://www.cna-aiic.ca/~/media/cna/page-content/pdf-fr/code-of-ethics-for-registered-nurses.pdf?la=en
Canadian Registered Nurses of British Columbia. (2017). Retrieved at https://www.crnbc.ca/Pages/Default.aspx
Rushton, C. (2013). Ethics in critical care: Principled moral outrage: An antidote to moral distress. AACN Advanced Critical Care, 24(1), 82-89.