Doing the right thing: nurse leaders and codes of ethics in nursing

Nurses have been delivering nursing care to anyone who needs it and wherever it is needed for centuries. The nursing profession of today has evolved from the reforms of nursing ushered in by that remarkable polymath of Victorian England, Florence Nightingale. Nursing care is now delivered in a very complex system, and nurses, as women, form the majority of the health care workforce, so how nurses deliver nursing care matters. Since 1993 nurses in Australia have been guided in delivering that care in an ethical manner by the Code of Ethics for Nurses in Australia (2008) (the Code), and it applies to nurses as clinicians, managers, researchers and educators. Although the focus of most nursing ethics scholarship and decision-making is the micro or nurse-patient level, ethics is also applied at other largely unrecognised levels. They are the meso (nurse-institution); molar (nurse-corporation); macro (nurse-society); and mega (nurse-global community) levels. Nurse leaders, defined as (senior) nurses in formally designated leadership positions, have the capacity to initiate and implement change at all these levels. They also have a responsibility to do so ethically and in Australia, in accordance with the Code. There is a dearth of research, both nationally and internationally, on how nurse leaders are taught to meet these ethical obligations: in Australia it is effectively nonexistent. There is also very little research on the application of ethics at the five levels and on how (or if) nurse leaders use codes of nursing ethics to guide them in their ethical decision-making processes. The above constitutes the premises for the thesis which investigates how nurses historically and currently understand (nursing) ethics and the role of codes of ethics in guiding their practice. The research methodology is that of philosophical analysis and a guiding principle which underpins it is the questioning of assumptions and how that (should) inform ethical decision-making at the nurse leadership level. Barbara Carper’s seminal ‘fundamental patterns of knowing in nursing’ provides the framework for the analysis of the Code: the Carperian reading of the Code. Although the Code is necessary to nurse leaders because of its status as a mandated competence, the reading shows that it is profoundly inadequate as an ethical action guide. Consequently, a major recommendation of the thesis is that as well as being taught (nursing) ethics as a subject, more importantly, nurse leaders need to be taught the methods of philosophy. That education facilitates the enactment of reasoned moral choices and robust ethical decision-making especially at levels beyond the micro, the level where most nurse leaders function. This thesis has uncovered many areas where a great deal more research is required, and this is reflected in the recommendations which principally concern education and philosophy in nursing, but also codes of ethics at the nurse leader level.