As our healthcare environment continues to become more complex and challenging, the need for nursing practice experts who also have expertise in ethics is apparent. Issues related to social justice, allocation of healthcare resources and the futility of healthcare at the end of life are all examples of ethical scenarios that DNP graduates may find themselves facing in their various roles.
Although it may be presumptuous to describe a DNP graduate as an ethicist, a DNP graduate will likely be looked to as an ethical consultant in his or her setting. The DNP graduate may be consulted about research, clinical, leadership and professional ethical scenarios.1 Further, DNP graduates will likely find themselves immersed in roles that will require them to act as ethical consultants, either directly or indirectly.
Ethics is defined as the principles of conduct governing an individual or group.2 An ethicist is someone who specializes in or is concerned with ethics.3 Peirce and Smith1 believe that an expanded view of required ethics content in DNP curricula is needed. Additional preparation in ethical content and decision making is essential for DNP graduates to become comfortable evaluating ethics scenarios. This content is currently integrated into several DNP curricula, but all DNP graduates have a responsibility to evaluate and supplement their own knowledge in ethical content and decision making.
DNP graduates may develop their own ethics "toolkit" to supplement their current knowledge base. The DNP graduate should have a basic understanding of bioethical principles, especially how they apply to possible ethical scenarios. These principles include autonomy, beneficence, nonmaleficence and justice.
Autonomy has been defined as "self-rule that is free from controlling interference by others and from certain limitations, such as inadequate understanding that prevents meaningful choice."4 The principle of autonomy includes informed consent, which describes the process by which patients are informed of possible outcomes, alternatives and risks of treatment, and are required to give their consent freely.5 Beneficence refers to the moral obligation to act for the benefit of others.4 The principle of nonmaleficence describes the obligation to do no harm. The principle of justice refers to fairness, treating people equally and without prejudice, and with the equitable distribution of benefits and burdens."6
Codes of Ethics
Additionally, the DNP graduate should be familiar with both the International Council of Nurses (ICN) Code of Ethics for Nurses and the American Nurses' Association (ANA) Code of Ethics for Nurses. A code of ethics describes standards of conduct and certain principles about responsibilities.7 Nursing frequently relies on these codes to help make ethical decisions or evaluate ethical scenarios.
The ICN Code of Ethics for Nurses was developed in 1953 and has been revised several times. This code is based on the four responsibilities of nurses: to promote health, to prevent illness, to restore health and to alleviate suffering.8 This code can be found at http://www.icn.ch/about-icn/code-of-ethics-for-nurses/. The ICN Code for Nurses is a valuable resource for DNP graduates and should be accessed readily when ethical scenarios are encountered.
The ANA Code of Ethics for Nurses details the primary goals, values and obligations of the nursing profession.9 This code is accompanied by interpretive statements that also assist nurses when evaluating ethical scenarios or making ethical decisions. The ANA Code of Ethics for Nurses is available at http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses.aspx.
Finally, DNP graduates should have a copy of and be familiar with the Nurses Social Policy Statement.10 This document describes the values of the nursing profession as well as its social responsibility, scope of practice and regulation. Understanding of these concepts may be necessary when DNP graduates in clinical or leadership roles evaluate ethical scenarios related to practice and regulation of practice. The Nurses Social Policy Statement was recently revised and is available at http://www.nursesbooks.org/Main-Menu/Foundation/Nursings-Social-Policy-Statement.aspx.
As previously stated, DNP graduates have a responsibility to evaluate their own knowledge base about ethical content and seek additional preparation if necessary. As DNP graduates develop their roles within various settings, I am confident that knowledge in ethical content and ethical decision making will be essential. DNP graduates should develop their own ethics toolkits and be prepared for their role as the experts in nursing practice.
1. Peirce AG, Smith JA. The ethics curriculum for doctor of nursing practice programs. J Prof Nurs. 2008;24(5):270-274.
2. Ethics. Merriam-Webster.com. http://www.merriamwebster.com/dictionary/ethics.%20Accessed%20February%201 30, 2011.
3. Ethicist. Merriam-Webster.com. http://www.merriamwebster.com/dictionary/ethicist.%20Accessed%20February%201 2011.
4. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 6th ed. New York, NY: Oxford University Press; 2009.
5. Burkhardt MA, Nathaniel AK. Ethics and Issues in Contemporary Nursing. 3rd ed. Clifton Park, N.Y.: Thompson Delmar Learning; 2008.
6. Butts JB, Rich KL. Nursing Ethics: Across the Curriculum and Into Practice. 2nd ed. Sudbury, Mass.: Jones and Bartlett Publishers; 2008.
7. Pozgar GD. Legal and Ethical Issues for Health Professionals. 2nd ed. Sudbury, Mass.: Jones and Bartlett Publishers; 2010.
8. International Council of Nurses. The ICN Code of Ethics for Nurses. Geneva, Switzerland: International Council of Nurses; 2006. http://www.icn.ch/images/stories/documents/about/icncode_english.pdf. Accessed Nov. 30, 2011.
9. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, Md.: American Nurses Association; 2001.
10. American Nurses Association. Nursing's social policy statement: The essence of the profession. 2010 ed. Silver Spring, Md.: American Nurses Association; 2010.