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).

Nursing Standards of Ethical Practice of an Educator (Pgs. 18 -19)

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 https://www.cna-aiic.ca/~/media/cna/page-content/pdf-fr/code-of-ethics-for-registered-nurses.pdf?la=en

College of Registered Nurses of BC (n.d.) Professional Standards for Registered Nurses and Nurse Practitioners. Retrieved from  https://crnbc.ca/Standards/Lists/StandardResources/128ProfessionalStandards.pdf

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 http://moodle.vcc.ca/pluginfile.php/668606/mod_resource/content/3/Kidders%20Framework.pdf

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 http://www.vcc.ca/media/vancouver-community-college/content-assets/documents/policies/standards-employee-conduct-conflict-of-interest-a-03-06.pdf

Where would I like to be in five years?

Although not one of Benjamin's 13 Virtues, it is one of the quotes attributed to his name.

When thinking of the blog question: Where would I like to be in five years? I realized that I have always struggled with the idea of planning. My plans for professional development have always had a haphazard course. I still struggle to create a cohesive plan that would help me to succeed in my professional goals. So often "my" goals are impressed upon me by external motivating factors. I need to be involved in scholarship in order to remain a useful CASN (Canadian Associated Schools of Nursing) instructor, therefore I need to research and write. I am required to maintain a level of professional nursing development, therefore I need to take courses in my nursing field. Now I need to maintain a level of instructional professionalism and that also requires a plan to improve my teaching.
I am completing PIDP and have found it very informative it was not planned, but highly recommended when I started my work at the college. I will be going to a research strategies conference to see where I can begin to understand the workings of scholarship at a deeper level. But the conference was not planned, it happened to be something that was introduced in discussion with fellow instructors. I am hoping as I develop networks with other instructors in the college, and I will plan my professional development in a less haphazard manner. The opportunity as a regularized faculty to plan one's schedule and professional development a year in advance will help me to make my planning easier. I have many opportunities, and as the video below reminds me that after self-reflection I can do many things to continue to achieve both professional and personal goals through planning.

What Do You Want? from Worldlegacy on Vimeo.

Peer Observation of Teaching

The Practice Of Lifelong Learning In The Nursing Profession

I must admit that when I was an “ordinary” nurse in clinical practice I didn’t take the importance of lifelong learning a seriously as I should. Goepee states that “Lack of time -Negative effects of school experience - Lack of confidence -Distance from classes- Reluctance to go out at night” are all reasons given for not pursuing the practice (2001, pg. 612). I can relate to some if not all of these excuses for not participating in lifelong learning while I was still a clinician. I see those same reasons given to me by colleagues who are still working in the clinical areas. The momentum needs to begin a course of studies is usually related to its pragmatic use in practice on the ward (Pool, Poell, Berrings & Cate, 2015). Pool et al. also spoke about the differences in types of studies and reasons for them when looking a lifelong learning across an age spectrum of nurses (2015) I found it interesting to see how the older nurse in order to advance them self will go into a more formal education program to obtain a post-graduate education. I must say I am an example of that kind of reality. In today’s world of rapid changes, nurses will continue to do lifelong learning not only because it is mandated by the CRNBC (College of Registered Nurses of BC), but because they need to know something in order to effectively practice their profession.

Gopee, N. (2001) Lifelong learning in nursing: perceptions and realities. Nurse Educ. Today, 21 (8) (2001), pp. 607–615

Pool, I. A., Poell, R. F., Berings, M. C., & Cate, O. t. (2015). Strategies for continuing professional development among younger, middle-aged, and older nurses: A biographical approach. International Journal Of Nursing Studies, 52(5), 939-950. doi:10.1016/j.ijnurstu.2015.02.004

Image courtesy of Carol VanHook: https://www.flickr.com/photos/librariesrock/3679437433/in/photostream/ 

What is the difference between a college and a university?

Recently while doing looking up some information on the ideas of accreditation and professionalism I came across an interesting video describing the differences between colleges and universities. I was asking myself this question because I noted that often in colleges the faculties were much smaller. The ability of the faculty to do scholarship and research was made difficult due to lack of funding.  Yet the video described some of the essential differences in the two histories that could answer some of the questions about the differences in resources and size.

Merkx, G., (Dec 20, 2013). The historic differences between colleges and universities, Duke University Center for International Education. Retrieved on September 11, 2016 from https://www.youtube.com/watch?v=84qP88NNHsU 

Accreditation and Scholarship

Accreditation and scholarship of staff for professional programs is not an option but a requirement.

I am a nurse, and I am an educator, both of these professions require that I am registered and part of an accredited body to teach in the profession of nursing. In the past three years, the BSN program at VCC was accredited by two external organizations, CRNBC (the college of nurses in BC) and CASN (Canadian Association of Schools of Nursing) are both involved in the accreditation process of the BSN programs.

CRNBC assessed the BSN program three years ago. CRNBC is mandated by the Health Professions Act of BC (British Columbia) to regulate Registered Nurses (RN) and Nurse Practitioners (NP) and that includes their education. So the entries to practice standards are set by the CRNBC, and therefore the schools of nursing in BC are then assessed to ensure that they are teaching the students to a level that prepared them to safely practice with the public of BC. That program assessment is outlined in the “Nursing Education Program and Course Review Policies”. This document contains the information on how reviewers are chosen and states that the review must occur at least every seven years. The program is assessed on three standards:

•    “Curriculum -  provides the learning experiences necessary for students to achieve the RN entry-level competencies and Standards of Practice (CRNBC, n.d., pp. 7-8)

•    Students -  demonstrate progress toward the achievement of the competencies and Standards of Practice (CRNBC, n.d., pp. 7-8)

•    Graduates - of the nursing education program achieve the competencies and Standards of Practice.” (CRNBC, n.d., pp. 7-8)

Each of these standards has a set of indicators that is assessed by the reviewers. The reviewers then bring it to the CRNBC board, which includes RN’s as well as members of the public a standard that is required by the public. CRNBC recognizes CASN accreditation and therefore documents created for CASN can be used in the CRNBC review. (CRNBC, n.d., p. 17)

    CASN accredits all schools of nursing in Canada. As far as I can tell this accreditation is still voluntary, but as the accreditation becomes more recognized, it becomes more desirable (CASN, n.d.). This accreditation reviews both the college and the program of nursing (CASN, 2014, p. 4). The program is evaluated on Relevance, Accountability, Relatedness, and Uniqueness (CASN, 2014, pp. 8-9). I remember long reports were written on all the elements that were to be reviewed. Leadership, Partnerships, Resources, Teaching and Learning, Environment, Scholarship of the faculty, Program Framework, Knowledge Based Practice, Professional Growth of the students, and finally Evaluation are all elements that are considered during a CASN accreditation. Accreditation takes time for all the staff of the program. 

    CASN, CRNBC and CNA (Canadian Nurses Association) promote life-long learning and maintenance of practice competencies through learning (CNA, 2000). It was during the first year of teaching that I started the CASN Nurse Educator course. Due to unforeseen family circumstances I was not able to complete the course but am further to motivated to return and complete it because it also gives me a CNA specialty certificate in nursing education. It was when the CASN accreditation was being presented that I realized I needed to complete my nursing degree. I had a masters in linguistics, and a lot of prior experiences so had been “grandmother”’ed into teaching courses in the program. The element that encouraged this return to school was the scholarship element of school assessment. I have now completed that degree and will be able to return to the learning opportunities offered by CASN for nursing instructors both clinical and classroom teaching.

The scholarship element has also encouraged me in other ways. It is important to produce some professional works as an instructor and to that end I will be going to a research conference in fall. What I do find discouraging though both when I was working as a clinical nurse on the wards and now when I am teaching is the difficulty to find time to do the research needed for proper scholarship. Our program is small. Therefore the number of faculty is very small and keeping up to maintaining a current program, teaching and preparation is very difficult. The time needed for all these activities plus the rigors of scholarship make the work of a nursing educator very busy. It is particularly difficult for those who are term instructors and still working in the clinical areas while they are teaching. An article I read even questioned the benefits of “sessional instructors” (Peters, Jackson, Andrew, Halcomb, & Salamonson, 2011). My concern is not so much the benefits of those instructors but our ability to be able to mentor and encourage them in a timely manner while we do scholarship. The college funding of programs is less conducive to the practice of scholarship as well.

So as a nurse, I get the opportunity to participate in life-long learning in my profession as prescribed by the CRNBC and CNA. As an educator, I get the chance to take courses like this PIDP (Provincial Instructor Diploma Program) to hone my skills as an instructor. It is as a nursing instructor that I must engage in scholarship as prescribed by CASN. I may need to work on a doctorate some day, but without a doubt, I will be expected to write about some element of nursing education. It is that writing that will require research and life-long learning to be an effective nurse educator.

CASN, (2014). CASN Accreditation Program Standards (Version 5), Ottawa. Retrieved on September 11, 2016 from http://www.casn.ca/wp-content/uploads/2014/12/2014-FINAL-EN-Accred-standards-March-311.pdf

CASN, (n.d.) CASN, Accreditation, Ottawa. Retrieved on September 11, 2016 from http://www.casn.ca/accreditation/

CNA, (2000). Position Statement: Promoting Continuing Competence For Registered Nurses, Ottawa. Retrieved on September 11, 2016 from http://cna-aiic.ca/~/media/cna/page-content/pdf-en/promoting-continuing-competence-for-registered-nurses_position-statement.pdf

CRNBC, (n.d.). Nursing Education Program and Course Review Policies, Vancouver. Retrieved on September 11, 2016 from https://crnbc.ca/PracticeSupport/Documents/490EdProgCourseReviewPolicy.pdf#search=School%20Accreditation

Peters, K., Jackson, D., Andrew, S., Halcomb, E. J., & Salamonson, Y. (2011). Burden versus benefit: Continuing nurse academics' experiences of working with sessional teachers. Contemporary Nurse: A Journal For The Australian Nursing Profession, 38(1/2), 35-44. https://cclsw2.vcc.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=66646249&site=ehost-live