Do ends justify the means? The Code of Ethics for Nurses encompasses more than just patient care

By | 2022-05-06T15:27:16-04:00 January 23rd, 2014|0 Comments

Hypothetical case:

Carol Taylor, RN, PhD

Glenda is simply amazing. Always a straight A student, she worked one year in critical care after being licensed to practice professional nursing and then went to a prestigious nurse anesthetist program, which she completed with honors. For the past five years she has been practicing in a community hospital where she is well-respected. Her husband was the CFO for a small company and, together with their two children, they lived in a beautiful home. Last year her husband was laid off and has been unable to find another job. Her daughter, who was born prematurely, has ongoing, serious health challenges. Glenda enrolled in an online DNP program knowing that she will soon need this credential. She is barely making Bs and for the first time in her life is floundering with trying to manage work, school and home responsibilities. She shares with a trusted RN colleague enrolled in the same DNP program that she feels like a failure. “The harder I work the more behind I seem to get.”

With characteristic flair she designed an intriguing research study that entails interviewing patients on post-anesthesia experiences. It took her “forever” to get her institutional review board’s approval and she now finds herself with little time for data gathering. She tells her colleague she needs to fabricate data — make up patient interviews to get her population to a size where her statistics can be significant. “I can’t believe I’m doing this, but I have to finish this program and there’s no other way I can complete the research study on time.”

Her colleague struggles with how to respond to this situation.
When the American Nurses Association’s Code of Ethics for Nurses was last revised in 2001 a new provision was added. It reads: “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth” (provision 5). Interestingly, the drafters of the code used “duty” versus “rights” language in describing their ethical responsibilities. One can choose whether to exercise a right, but duties must be honored. Provision 4 of the code also addresses each nurse’s accountability and responsibility for individual nursing practice, including nursing judgment and action. Provision 3 of the code, “The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient” obligates her colleague to act on questionable practice. While the primary purpose of this provision is clinical care, it obligates nurses to report incompetent, unethical, illegal or impaired practice.

Glenda’s next decision can affect more than just a class grade; it may affect her professional integrity and the respect of colleagues.

Consider the following scenarios and code violations

Scenario 1:

Glenda’s colleague confronts her with the seriousness of submitting fabricated data and Glenda elects to take an incomplete.

Glenda’s decision to go back to school to earn her DNP is admirable as it demonstrates her commitment to maintain competence and to continue her professional growth. But Glenda has a duty to preserve her integrity and she would be violating this duty by fabricating data for her research study. Provision 4 of the code addresses each nurse’s accountability and responsibility for individual nursing practice, including nursing judgment and action. Her colleague’s timely critique (provision 3) helps her to realize the seriousness of fabricating data, which helps her decide to change course.

Scenario 2:

Glenda’s colleague warns her about the code violation, but Glenda submits false data anyway. Her colleague reports Glenda to the school. The colleague’s decision is consistent with provision 3 and the reporting of questionable practice. Clearly by choosing to fabricate data Glenda is failing to exercise accountability and responsibility for her research and jeopardizing research integrity. Glenda is failing to meet the duties articulated in provisions 3, 4 and 5. She is not exercising accountability and is sacrificing research integrity to achieve a personal short-term goal. Possible repercussions include being dismissed from the DNP program and being reported to the state licensing board.

Scenario 3:
Glenda’s colleague decides to comply with Glenda’s plan and helps her to fabricate the data. In this instance Glenda’s colleague fails to meet provisions 3-5 of the Code and may suffer similar repercussions.

Editor’s note: Students should consult with faculty and program advisers immediately if they are struggling to meet their academic goals.

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