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Ethics Consultant

Think of it as an emerging DNP role.

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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.

Defining Terms

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.

References

  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.

 


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Well, I'm going to speak for the silent majority who are afraid to go against the grain or rock the boat:

Unless the individual wants a DNP and wants to be employed at the University level and/or wants to do research; thinking of making it a mandatory requirement in the future is wrought with problems and a monumental mistake for the following reasons:

*the amount of money spent in obtaining a DNP will never be recouped - MD's are taking 30 years to pay back their student loans and their salaries are not as they were in the past along with being placed in a higher tax bracket based upon their gross income; burdens their payback ability. If you want to become Dr", go to Medical School: becoming a specialist in the area of your research will not make you a better practitioner overall.

*the Medical community will really cause you quite a bit of grief with the title in front of our names even though it will have DNP on paper after the printed name.

*pushing for this is just another example of "NURSING" having an inferiority complex and wanting to justify their existence: accept the fact that we do a GREAT job and provide a GREAT SERVICE to the community and go to bed at night feeling good about that. I LOVE WHAT I DO!

This will never fly; Nursing can't even get RN licensure on the same page - how many years has it been and still no progress. The DNP should be a voluntary, individual choice and not a mandated choice.

The DNP is not the BE ALL/END ALL of our profession.

The DNP does not move "our profession forward". It just satisfies ego(s). You want a DNP, that's fine, but don't make it a requirement, it should be an optional choice. Do MD's require all their clan to go for a fellowship? This is for one's own optional personal and professional growth. This mandate will go the way of the EDSEL FORD of the 50's. This is truly the most ridiculous idea the powers that be could ever dream up! You have bought into the propaganda, because you are part of it; and according to "Cognitive Dissonance Theory", as proven by Milliken, Festinger and Lowell in the 50's, You always justify anything you have paid a price for or expended energies towards. The greatest majority of the supporters of making the DNP a mandatory requirement are those who already obtained their DNP and need to justify their decision to obtain it, spend the money for it and expended the rigorous energy needed to obtain it. Just as "Cognitive Dissonance Theory" has proven. I have not exhausted any type of resource, nor expense to justify nor influence my decision making, so I can look at things quite objectively.

Doctors have a guaranteed job waiting for them upon graduation, NP's do not. New graduates are having a heck of a time obtaining their first NP position and still have to work as a BSN to stay gainfully employed in order to pay their normal expenses let alone paying back their advanced degree, which added 2 more years of didactic and the additional financial debt incurred along the way. I, myself back in 1998 did not obtain a job as an NP until 5 months of very aggressive searching and the only job I was offered was in a dialysis center. I never worked a day in dialysis, but was given the job despite 2 other NP applicants with dialysis/ESRD experience applying for the job. Why did I get the job? I was offered this position because I was offered a under-market salary; I had an excellent Medical/Internal Medicine background as a BSN and because the Navy had this program for transitioning retirees which paid the employer $5,000 kick-back incentive if they hired the Vet. So, my employer paid me below market value and obtained a kick-back to hire me as well.

NP's are thriving as a result of a "Perfect Storm" scenario!

Lets review the facts:

IN THE BEGINNING, if it wasn't for money, insurance companies would not have given the NP the right time of day. It was their cost savings that allowed us to progress to where we are today.

a. First DRG's came along for cost savings

b. Physicians practice CYA Medicine because of the litiginous nature of this country, thus ordering all tests whether appropriate or inappropriate

c. As a result, reimbursement dropped and then reimbursement to the MD dropped, following suite.

d. Insurance companies initially wouldn't give the NP the right time of day, but one genius realized that if they reimburse NP's at a reduced rate over the MD, WOW, what a cost savings there would be. As a result, insurance companies have become our best friend. This led to continual decrease in reimbursement of the physician.

As a result, MD's left the Primary Care/Internal Medicine specialties:

The physicians did it to themselves. Primary Care/Internal Med docs are not adequately reimbursed by their standards and point of view, so there are less and less MD's going into these specialties. Someone has to fill the void; NP's to the rescue. If it wasn't for that, NP's would still be trying to get in the front door. As Gordon Gecko said in "WALL STREET": GREED IS GOOD! Greed by MD's put us on the map and we are definitely here to stay! GO GREEN.

The new mandate for DNP as the only way to become an NP after 2015 will break the Universities back. Now that it will require 4yrs vs 2 yrs and alot of money and time on the part of the RN applicant, compounded with the lack of to miniscule payback on the other end; this program will go the way of the dinosaur. If I have to expend all that time and money for virtually no difference at the end of the day, I'll go to Medical School, and any rational thinking applicant will see this as wwll. This is not ROCKET SCIENCE to be able to figure this out.

As a result, access to care will get worse because of lack of providers because of the decisions of the "Powers That Be". This was really thought out well - lol

A DNP will not make the NP any better as a Clinician. We already outshine the MD community in patient approval and outcomes. So, now you are "beating a dead horse" and expect more people to want to ride this non-productive creature.

Then there is the "PUSH-BACK" from the Medical Community, that has deeper pockets than the NP Community.

DNP: "Doctor of Nursing Practice." Excuse me, no matter what you say or might think, "WE PRACTICE MEDICINE" with a Nursing DNA in our heritage.

When we order a medication, the bottle says Dr/MD, not NP, no matter how often you tell the pharmacist the we are NP's and not MD's. The DNP will not change anyone's perception of us no matter how hard you try to justify our existence.

Arbitrary decisions such as mandating that the DNP become the "Law of the Land", should be brought to the rank and file "Professional Body" for discussion and a vote. I didn't realize that GOD has died and left a few in charge of the working majority, without the majorities approval. If this isn't a case for our profession to unionize as a professional body to protect against poorly thought out and emotionally based decisions, I don't know what is?

Michael O. Mahler, CRNP, ANP-BC


Michael  Mahler ,  Nurse Practitioner,  WRNMMCFebruary 17, 2013
Bethesda , MD




     

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