Monday, 3 October 2016

Ethical Dilemmas

Nursing has a Code of Ethics but how nurses process it depends on the decision-making tools and discipline-specific standards as we explore an ethical situation, the context and the relationship between the stakeholders.
Nurses disseminate the code of ethics and make it practical through standards or policies and procedures. Below are two lists of standards that guide my practice as a nursing educator at Vancouver Community College (VCC).
1. Educates others to learn about ethical practice.
2. Educates others to provide care in a manner that preserves and protects client dignity.
3. Demonstrates honesty and integrity.
4. Clearly and accurately represents self with respect to name, title and role.
5. Educates others to protect client privacy and confidentiality.
6. Educates others to recognize, respect and promote the client’s right to be informed and make informed choices.
7. Promotes and maintains respectful communication in all professional interactions; & educates others to do the same.
8. Treats colleagues, students and other health care workers in a respectful manner; educates others about respectful communication and ways to effect positive behaviour change in the workplace.
9. Recognizes and respects the contribution of others on the health care team.
10. Makes equitable decisions about the allocation of resources under one’s control based on the needs of learners.
11. Identifies the effect of own values, beliefs and experiences in carrying out educational activities; recognizes potential conflicts and takes actions to prevent or resolve.
 12. Assists others in identifying ethical issues; consults with the appropriate person or body; takes action to prevent or resolve and evaluates the effectiveness of actions.
13. Implements educational activities that support the initiation, maintenance and termination of nurse-client relationships in an appropriate manner.
Standards of Conduct for VCC: (this may be a college employee specific link)
A. Honesty and Integrity
B. Gifts and other complimentary items
C. Workplace relationships
D. Employment of family members
E. Privacy and confidentiality
F. Conflict of interest
G. Outside remuneration
H. Political activity
I. Legal proceedings
J. Public comment, unauthorised representation or association
It was interesting to look at the similarities and differences between the nursing Code of Ethics, the CRNBC ethical standards for Educators and the VCC Faculty standard of conduct. The major common ethic is that of privacy and confidentiality. A second commonality is that of Honesty and Integrity which aligns with the nursing Being Accountable. A comparison shows the differences due to the general nature of the VCC standards vs. the nurse educator standard which seem to be more profession-specific. The nurse educator ethics seem more relationally focused than the standards for the VCC faculty. When I use the Kidder method of ethical decision making or even many of the models described in the nursing code of ethics, there is a large emphasis placed on understanding the context (as cited in PIDP 3260 handout; CNA, p. 39-40). Often that contextual understanding doesn’t delve into all the factors that a relational inquiry would.
As a nurse educator, I have been teaching a method of ethical inquiry that seems to be more relationally focused. Nurses and nursing students learn to understand and refer to ethics in all their practice. Doane & Varcoe state, “Nursing is relational, and each interaction is situational.” (2015). All nursing occurs in a context filled with aesthetic, ethical, sociopolitical and empirical factors that require each nurse to be a continual critical thinker and inquirer of the knowledge these factors bring to a situation (Doane & Varcoe, 2015, Chapter 6).
How is that code of ethics realized in a specific nursing situation? The thinking takes on: an intrapersonal (self-reflective) understanding of being a nurse, an interpersonal understanding of collaboration, and finally a contextual understanding of all the types of information we gather as we deliberate. (Doane & Varcoe, 2015, Chapters 3 & 4) It is up to the nurse to critically disseminate that information and relate it to a particular ethical situation.
For example as a nursing educator:
Intrapersonally - What ethical values do I bring to a situation? Do I value the relationship with the student higher than the public safety that I am charged to protect as an RN?
Interpersonally - How do I use my power over a student? I can assign marks to student work fairly knowing the marks can significantly impact a student’s life.
Contextually - What is going on in a situation? Are there historical, economic, socio-political, physical or even linguistic factors that affect the ethical decision-making process.
This process of inquiry hopefully can incorporate all the factors related to each ethical situation that a nurse or even an instructor encounters. No matter what method an instructor chooses to decide what to do with an ethical dilemma, the basics are the same, get the facts, collaborate with others, make a decision and act on it.

Canadian Nurses Association (2008). Code of Ethics Retrieved from
College of Registered Nurses of BC (n.d.) Professional Standards for Registered Nurses and Nurse Practitioners. Retrieved from
Doane, G. H., & Varcoe, C. (2015). How to nurse: Relational inquiry with individuals and families in changing health and health care contexts. Philadelphia: Lippincott, Williams & Wilkins.
Kidder, R. M. (1995). How good people make tough choices. New York: Morrow. As cited in VCC PIDP 3260 handout (2016) Retrieved from
Vancouver Community College (February 6, 2015) Standards of Employee Conduct & Conflict of Interest, (02.06.2015. Replaces: VCC Code of Ethics (10.26.2000) and Employment of Relatives Policy B.2.12 (10.08.1996) Retrieved from

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