Fundamentals - Principles, part 1: Nursing Profession and Ethics

by Meris Shuwarger July 12, 2021

In this article, we'll give you an introduction to the governing bodies and laws that apply to nursing, as well as nursing ethics. The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

State Board of Nursing

Every state in the US has a State Board of Nursing. Each state's State Board of Nursing governs nursing licensure requirements for the state.

In the US, all of the State Boards of Nursing together make up the National Council of State Boards of Nursing (NCSBN). NCLEX exams are also developed and owned by the NCSBN.

Nursing Practice Act

Each state has a Nursing Practice Act set forth by its State Board of Nursing. The Nursing Practice Act is a document outlining a set of laws that defines qualifications for licensure, nursing titles, and a nurse's scope of practice. A scope of practice is what a nurse is allowed to do with their licensure (e.g., RN, PN) in a given state.

If you practice nursing in multiple states, you will be required to know what your scope of practice is in each state.

Evidence-Based Practice

Evidence-based practice means using the best data and evidence from research to guide nursing practice.

Evidence-based practice means not doing something just because that's the way it has always been done, or because it's easier for the nurse. Evidence-based practice is choosing nursing actions and interventions based on peer-reviewed data that show those actions to be beneficial for patients.

Evidence-based practice is an important concept for nursing that will feature heavily in your nursing education—you may even take a class in it.

American Nurses Association

The American Nurses Association (ANA) is a professional organization to advance and protect the progression of nursing, and they are the group that establishes the ethical standards of care for the nursing profession.

What is the difference between the State Board of Nursing and the American Nurses Association?

State Boards of Nursing are governmental agencies that set laws for nursing practice, while the American Nurses Association is a non-governmental organization that establishes ethics for nursing practice.

Ethical Principles

Autonomy

In nursing, the ethical principle autonomy is a patient's right to make their own healthcare decisions. For example, a patient has a right to refuse treatment.

Advocacy

In nursing, the ethical principle advocacy is to promote and protect the patient's rights, health, and safety. In other words, nurses must advocate for their patients' best interest. For example, a nurse practicing advocacy would notify the provider about a concerning change in a patient's condition.

Beneficence

In nursing, the ethical principle of beneficence simply means to promote good. For example, if a patient has been in the hospital for weeks, a nurse showing beneficence might take that patient outside for some fresh air.

Nonmaleficence

In nursing, the ethical principle of nonmaleficence is to avoid causing harm. For example, a nurse demonstrating nonmaleficence would perform multiple checks before administering medication to avoid a dangerous medication error.

The difference between beneficence and nonmaleficence may seem subtle, but you can remember that beneficence is promoting good and nonmaleficence is avoiding harm by remembering that the prefix mal- means bad (think malnourished, malfunctioning, malpractice, malodorous, Maleficent from Sleeping Beauty…) We created our Medical Terminology flashcards to make breaking down words into their parts easy, so you never have to be confused by an unfamiliar word on an exam!

Justice

In nursing, the ethical principle of justice means to treat fairly. For example, if you were juggling multiple patients, you would not provide better care based on who has the best insurance. Nurses practicing justice do not provide care to patients differently based on their race, gender identity, sexual orientation, or religion. Nurses practicing in a just manner provide care equally amongst their patients.

Fidelity

In nursing, the ethical principle of fidelity means to be faithful or loyal, which means that you keep promises to patients. For example, a nurse who told their patient they were coming back in 30 minutes to check on their pain, would either come back, or delegate somebody else to come back if they got tied up.

Veracity

In nursing, the ethical principle of veracity means to tell the truth—to never lie to patients or give them knowingly false reassurance, which is also lying. For example, if a patient was starting chemotherapy and asked about the side effects, a nurse practicing veracity would be honest about the side effects they could expect with chemotherapy.

Ethical Dilemma

An ethical dilemma is a conflict in values that cause distress and controversy, and in the nursing practice this could be for the nurse, the patient, or the patient's family.

An example of an ethical dilemma you might encounter in your nursing career is: the daughter of an intubated patient with terminal cancer does not want her mother to have opioid pain medication due to religious reasons, even though she is in severe pain.

Ethics Committee

In nursing, ethics committees are institutional groups that provide guidance in ethical dilemma situations. Nursing ethics committees are made up of an interdisciplinary group, which comprises people from different fields in the healthcare profession. For example, an interdisciplinary group could comprise a nurse, a doctor, a social worker, and a hospital chaplain.

These ethics committees review real ethical dilemmas encountered in the hospital (or other facility) setting, review the related literature, hear from affected parties, and assist in mediation between patients, families, and treatment teams.

It is important to note that ethics committees provide recommended courses of action, but do not impose decisions. For example, if there was an ethical dilemma, and the committee reviewed the situation and made a recommendation, the patient or family may choose not to take that recommended course of action. However, the institution's ethics committee did get the opportunity to explain what they believed to be in the patient's best interest, or what was ethically correct.

Stay tuned for our next article where we'll cover Informed Consent and a patient's right to refuse!


Full Transcript

CATHY: Hi, I'm Cathy with Level Up RN, and this is the first video in our Fundamentals of Nursing video playlist. This playlist is designed to help you learn the most important concepts and facts that you need to know to be successful on your nursing school exams, on the NCLEX, and in nursing practice.

So this information is not only going to be important for your Fundamentals class, it's also going to lay a strong foundation to help you be successful with the rest of nursing school.

These facts and concepts will come up over and over again in all of your classes, including Nursing Leadership later on, because a lot of leadership classes are also focused on nursing-fundamental information. So as we go through this playlist, we'll be following along with our Fundamentals of Nursing Flashcards, 2nd edition.

You don't need our cards to get value out of this playlist; however, they are definitely helpful because there's a lot of information we're going to cover, and it really takes repetition for this information to sink in. And a combination of reading and reviewing that information on flashcards and then hearing it in the videos can really help you to learn this information and to have it really solidified in your mind.

So this video playlist can be used by both RN as well as PN students. So if you are an LVN or LPN student, it's just important to remember your scope of practice. There's going to be certain things that we talk about that you are not allowed to do as a practical nurse. So in general there's a huge amount of overlap between RN students' and PN students' curriculum, but just keep that in mind in terms of your scope of practice.

In this video playlist I'm actually going to hand the reins over to key member of our Level Up RN team. Her name is Meris Shuwarger and she was a supplemental instructor at her college, at Chamberlain University where she greatly helped the students that she taught and improved their scores in school. There's really no better person than Meris to take you through this information and to help you learn those facts and concepts that you need to know. So without further ado, I'm going to hand it over now to Meris.

MERIS: Hi. I'm Meris, and in this video we're going to be talking about the nursing profession and about nursing ethical principles. I'll be following along with our Fundamentals of Nursing Flashcards, which are available on LevelUpRN.com.

So if you have these, you can follow along with me. I'm going through cards one, two and three in the Fundamentals deck. If you stay to the end, I am going to tell you a story about my first day of clinical, and I promise you, you won't want to miss it. So let's get started.

So I'm starting here on card one from the Fundamentals Principles section, so this is going to be covering the state boards of nursing. It's covering the Nursing Practice Act, and evidence-based practice. So on the back of the card you can see that we talk about all of these things in depth.

So what is the State Board of Nursing? Well, as the name might imply, this is a state agency that governs essentially what the requirements are to become a nurse in that state. So they are the regulatory agency for nursing.

The Nurse Practice Act is a very important one to know, and if you notice on the card here - I'll show you - it does have something that is bold and red. When you see that bold, red text, you need to focus in on that. We've made that bold and red on purpose to call your attention to it.

So the Nursing Practice Act is the document that defines a nurse's scope of practice. So a scope of practice, you may have heard that before, it's what you're allowed to do with a given licensure in a given state.

So here in Ohio, what I can do as a registered nurse compared to what a respiratory therapist or a medical doctor, an MD can do. They're all different and I know what I'm allowed to do because I look at the Nursing Practice Act.

So that's very important to know, and if you do practice in multiple states, you will be required to know what your scope of practice is in each state.

The other thing that we talk about on this card is Evidence-Based Practice. This is so important for nursing, and this is something you're going to hear over and over. You might even take a class in this. But evidence-based practice is using the best data we have to guide nursing practice, meaning we don't do something just because that's the way it's always been done, or because it's just easier for the nurse. We do things because we have peer-reviewed data that says we can show that this is beneficial for our patients in this way. That is what evidence-based practice is. So it's utilizing the best evidence from research to guide our practice.

So now moving on to card number two. Card number two is going to talk about the American Nurses Association, and then it's also going to get into some ethical concepts that we're going to need to know as nurses. So if you look at the back of the card here, it's got a lot of bold red information, so I would really pay attention to that.

So what is the American Nurses Association? You'll hear them called the ANA. They are going to be the group that establishes the ethical standards of care for a nursing profession. So remember we've talked about the Nurse Practice Act. That's the scope of practice. The ANA, it kind of sounds like they would be responsible for that, but they're not. They set the ethical standard for nurses.

So when we talk about ethics, there's something that you need to know called an ethical dilemma. And an ethical dilemma is essentially just a conflict in values that causes distress. So this could be something that's for the nurse, for the family, for the patient themselves.

So we give you an example here on the card, but there's so many ways that you can have an ethical dilemma, and it's any time that there's a conflict or a disagreement between maybe what the family wants and the patient wants, or what the doctor thinks is in the patient's best interest, those sorts of things. So you will hear this come up time and time again in nursing school, because it's important to know what do we do if we have an ethical dilemma?

Well, the next thing on this card talks about the ethics committee, and the ethics committee is a really awesome thing that exists in most places. It is an interdisciplinary group, meaning that it is made up of people from multiple different fields of the profession. So for instance you might have a nurse, a doctor, a social worker, a chaplain, those sorts of things.

So interdisciplinary team of people whose job it is to hear about ethical dilemmas happening in that hospital or that facility, and they are going to see all of the sides, review the literature, and what is very important to know—and you'll notice we put a key point icon here—it's very important to know that the ethics committee does not impose decisions; they simply offer a recommendation.

So that means that the patient or the family may choose to proceed in a different way, but the ethics committee at least had the option—the opportunity—to explain what they believe is in the patient's best interest or what is ethically correct.

So the next card, card number three if you're following along, this covers, "What are the ethical principles in nursing?" What did the ANA set forth as the ethical principles for us? So you'll see here on the card we have a table, so we define the principles, and then we give you some examples. So I'm not going to go through all of the examples, but there's definitely lots of different ways that we can see these principles in action.

So one of the ones that you just gotta know it is the principle of autonomy, meaning that a patient has the right to decide what treatment they will and will not accept. So this is the patient's right to make their own healthcare decisions. Very important because the nurse's job is to advocate for that patient—and you'll see that advocacy is one of the ethical principles—to advocate for that patient and support their right to autonomy, meaning if a patient says, "I don't want that treatment," or, "I do want that treatment," we need to advocate for their wishes to be respected.

The next one on this list is beneficence and beneficence means to promote good.

So keep that in your mind, because the next ethical principle is non-maleficence. Non-maleficence, non meaning against, and mal- meaning bad. So do not do harm. So this is essentially to avoid causing harm.

Beneficence is promoting good. Non-maleficence is avoiding harm. The example we give you here is that if you took a patient outside to get fresh air because they've been cooped up in the hospital for weeks and weeks, that's beneficence. You're doing something good, in their best interest.

But when you check a medication label multiple times to make sure that it's the right med, the right dose, the right route, all of those sorts of things, you're performing non-maleficence because you are working to avoid causing harm through a medication error.

So let me know in the comments if that was helpful to you, because those two principles get really tricky and confusing.

The next one is justice, and this means to treat fairly. So this means that if I had a bunch of patients—let's say I have four patients and one of them has really great insurance, and one of them has no insurance, and one of them has state-subsidized insurance and the other one has kind of middle-of-the-road, I'm not providing care differently based on that, right?

I'm not providing care differently to these patients based on their race, their sex, their gender orientation, anything like that. I'm going to provide my care equally amongst my patients. Very important to practice justice.

Another one is fidelity. Fidelity means to be faithful or loyal, but in practice, really, this kind of means being someone who keeps their promises. So if I say I'm coming back in 30 minutes to check on your pain, I'm either coming back, or I'm going to send somebody to check on you if I get tied up in another room. That's fidelity.

We talked about advocacy, but the last one on this list is veracity.

Veracity means to tell the truth, and this is so important. We don't lie to patients, right? We don't give them false reassurance. That's a form of a lie. So if a patient says, "So I'm doing chemotherapy, but the side effects aren't bad, right?" veracity means that I should say, "Well, here are the side effects, and here's what you can expect." So that's what veracity means.

Okay. So that's it for the nursing profession and nursing ethics. I hope that review was helpful. In my next video, I'll be covering informed consent and the patient's right to refuse, so take care, and happy studying!

Okay. So you stayed until the end. I'm going to tell you about the first patient I ever had in clinical. I will never forget this. I was standing in the hallway. My patient was getting ready to be discharged, and they had a central line in, a CVC in, and so before they could be discharged, they had to have that removed. And they were pretty impatient to get out of there, which-- totally understandable. And we were just waiting on the nurse to come and remove it and everything.

And if you know about central lines, it's a big deal. This goes all the way to your heart in some instances, or right above the heart, so it's very dangerous to remove it, and we need to make sure you don't get an air embolism.

And my patient walked out of the room and made eye contact with me and had pulled off the dressing and had almost gotten it out, but it was sutured in, thankfully. And they said, "Yeah, can you tell the nurse to hurry up? I've almost got this thing out."

And I promise you, I have never moved so quickly in my life because I was like, "Okay. Please sit down. Please sit down, and I'll go get your nurse. Please don't touch that."

I went and got the nurse, and everything was okay, but I remember thinking, "Oh, God. Is my patient going to die on my very first day because they pulled out their own CVC?" [laughter]

So anyway, that was my first day of clinical.

Please don't forget to like, comment, and subscribe to this YouTube channel because we have so much great stuff coming for you. I hope this was helpful, and I'll see you in the next one!


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