Professional Obligations and Responsibilities
by Connie Miyao, RN, BSN, Nursing Practice Consultant
Many of us were shocked by the news of the recent arrest of a registered nurse accused of sexually assaulting three women in the Portland area. As nurses, many of us are questioning how a nurse could commit such acts and wonder what actions we can and must take to ensure patient safety.
Nursing creates a relationship of trust with our patients. ONA believes that all nurses should be aware of the standards that nurses are obligated to uphold, and we must regularly review and fully understand the actions we are required to take both ethically and legally to protect patient safety. The foundation of quality nursing care includes nurse practice acts, practice standards, and professional codes of ethics. Familiarity with these documents is necessary to enable nurses to take the necessary steps to assess practices or actions they do not believe are right and to help prevent future abuses.
Board of Nursing Guidelines
Oregon’s specific law, the Oregon Nurse Practice Act (ONPA), regulates the practice of nursing and all nurses should review the following sections of the ONPA which identify Scope and Standards of Nursing Practice for All Licensed Nurses (OAR 851-045-0040), professional practice standards for Registered Nurses (851-045-0060) and specific instances where conduct derogatory to the standards of nursing (851-045-0070) may be occurring.
Oregon law mandates that licensed nurses report suspected violations of the ONPA to the Oregon State Board of Nursing (OSBN). Anyone knowing of a licensed nurse whose behavior or nursing practice fails to meet accepted standards for the level at which the nurse is licensed, “shall report the nurse to the person in the work setting who has authority to institute corrective action. Anyone who has knowledge or concern that the nurse’s behavior or practice presents a potential for, or actual danger to the public health, safety and welfare, shall report or cause a report to be made to the Board of Nursing” (851-045-0090).
Failure of any licensed nurse to comply with this reporting requirement may in itself, constitute a violation of nursing standards.
ANA Professional Resources
Registered nurses have three professional resources provided by the American Nurses Association (ANA), to inform decision-making and guide practice.
First, the “Code of Ethics for Nurses with Interpretive Statements” lists the nine provisions that establish the ethical framework across all roles, levels and settings.
Second, the “Nursing’s Social Policy Statement: The Essence of the Profession” conceptualizes nursing practice, describes the social context of nursing and provides the definition of nursing.
Third, the “Nursing: Scope and Standards of Practice, Second Edition” outlines the expectations of the professional role of the registered nurse.
ANA’s code of ethics details the goals, values and ethical precepts that direct the profession of nursing. It clearly obligates the nurse to be aware of threats to safety of the public and to practice in a way that upholds the safety of the patient. A code of ethics is a fundamental document for any profession as it delineates a social contract with the society we serve, as well as ethical and legal guidance for all members of the profession.
Nurses must practice using professional standards while remaining cognizant of the societal influences and consequences of their care. Human rights issues emerge in health care settings when individuals are unable to assert their rights. Refusal to provide reasonable and necessary care violates a patient’s human rights. Examples of this would be ignoring the complaints of a patient based on a personal characteristic such as ethnicity or age, or personal history, such as being incarcerated.
Having The Moral Courage to “Speak Up”
Moral courage involves the willingness to speak out and do what is right in the face of forces that would lead us to act in some other way. Nurses advocating in the best interest of the patient may find themselves experiencing adverse outcomes at times. All nurses in all roles across all settings must commit to working toward creating and sustaining environments that support moral courage.
Every day, nurses and their health care colleagues are confronted with challenging situations where effective communication is essential and difficult. Assertive communication is an honest, direct, and appropriate focus on solving a problem. The use of assertive communication is imperative not only to patient safety and to quality patient care, but also to utilizing the chain of command. Nurses must be vigilant to the acts of others in the health care environment. Each nurse has a professional responsibility to communicate with peers when their practice deviates from ethical and legal standards. Each nurse also has the responsibility to report using the chain of command specific to the practice setting. Engaging the chain of command ensures that the appropriate supervisors, managers and administrators know what is occurring so appropriate action can be taken by those responsible to do so.
So let us take this opportunity to review our professional obligations and responsibilities. We must continue to take actions that support and reinforce the social contract with our patients that keeps our commitment ever present; a social contract that is based upon the virtue of caring.
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