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Nursing Ethics in the 21st Century


In August 2014, an important summit of 50 nurse leaders was held in Baltimore to discuss nursing ethics for the 21st century. The summit was sponsored by the Johns Hopkins School of Nursing and Johns Hopkins Berman Institute of Bioethics.

Nurses’ work environments are rapidly changing.  These changes present challenges for nurses who strive to serve their patients, families, and communities while fulfilling nursing values.  At the same time, change presents an opportunity for nurses to reflect on and re-evaluate their role in the healthcare system and to redefine what their true ethical obligation is to patients.

Pressures on the nursing profession reflect rapid changes in American society and in the health care system, including:

  1. The increasing diversity of patients, families, and nurses
  2. Hospital patients who are sicker and have more complex chronic conditions and hard-to-treat infections
  3. Ethical issues which persist across the lifespan for patients of all ages
  4. A growing number of patients in all settings—hospitals, nursing homes, rehabilitation centers, at home—who suffer from dementia
  5. Rapid technological changes including electronic data and record-keeping that require advanced skills
  6. Growing emphasis on disease prevention, personal responsibility for health, and public health approaches, without commensurate increases in public health budgets or size of the workforce
  7. Increasing tension between individual interests and the interests of populations of patients, communities, and the broader society—that is, between personal health care and public health
  8. Pressures to make care more efficient and less costly that are shifting the locus of care from hospitals to the community
  9. New payment models that put pressure on all health care organizations

Nurses feel these pressures and the intense array of ethical issues they raise.

Current nursing ethical guidelines are insufficient to handle many of the personal, societal, technological and other complex issues that medical professionals encounter on a daily basis.  As the role and responsibility of nurses increase within all healthcare settings, grey areas of practice increase.  These greys areas create a need for new, clearer guidance for nurses to address patient needs while meeting their ethical responsibility and values. 

Some of the ethical issues nurses encounter include:

  • Patients that can’t be helped within the established system

  • Breaches of confidentiality

  • Health disparities

  • Respecting and working with a vast array of cultures

  • Coping with pain and suffering

  • Technology unwanted by patients

  • Inadequate staffing

  • Prolonging suffering to keep patients alive

  • Personal bias affecting care delivered

  • Tension between efficiency, quality, and safety

The summit participants concentrated on describing ways in which nursing as a profession could have a positive influence in four critical domains: clinical practice, education, research, and public policy.

Several key themes emerge from the reports of the four domain groups:

  • The need for a more intentional and proactive approach to ethical practice

  • Ethical practice is a key feature of accountability and personal responsibility across domains

  • The significance of moral distress in the daily lives of nurses

  • The interplay among nurses’ competence in ethics, the environments where they practice, and the culture that either supports or constrains integrity and ethical behavior

  • The need for inter-disciplinary and cross-organizational efforts and partners and strong dissemination plans

  • The importance of building on existing work, activities, and commitments

  • The value of a diverse set of funders for this work, including pooling funds from multiple sources

  • While changing the culture of health care is a long-term project, changing the work environments for individual nurses can be started now

Nurses are being asked to take on increased leadership positions and responsibility within facilities.  Nurses have always had a strong sense of ethics to guide their service to patients.  As leaders, they have a duty to help determine how healthcare will be delivered, how patient needs will be addressed and what it means to practice ethical nursing in the 21st Century.  The Summit in Baltimore was a first, but very important step in that process.

Information about the Summit can be accessed here -