Practice Tip of the Week | The Ethics of Self-Care

By Cindy Zolnierek, PhD, RN, CAE 

When the Code of Ethics for Nurses was updated in 2015, a noteworthy provision was introduced:

Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

A responsibility for self-care was a new and challenging concept for many nurses who were raised in a tradition of toughness where the expectation was that nurses must tolerate inadequate rest periods such as shift breaks or days off; uncivil behaviors from colleagues; and inadequate resources such as staff numbers, supplies, or functional systems. This posture was a self-defeating façade. No one, even superstar nurses, is immune from the negative and traumatic effects of fatigue and incivility. Nurses’ ingenious workarounds to systemic failures prevent organizations from implementing solutions to protect patient safety. Accepting the status quo impedes positive change.

Provision 5 called for nurses to care for themselves. It couldn’t have been more timely. As the pandemic posed unimaginable challenges to our health care systems, nurses were traumatized by infectious exposure, physical exhaustion, moral distress, and compassion fatigue. How were nurses to meet the ethic of self-care during chaotic waves of COVID-19 infections?

Working conditions of the pandemic have presented a long-needed wake-up call to all in health care. Initially, the focus was on building resilience among nurses – necessary, yet insufficient. A tradition of “toughness,” a synonym for resilience offered by Dictionary.com, has long existed in nursing.

Perhaps resilience is one leg of a three-legged stool, supported by self-care practices and positive practice environments, all in support of Provision 5 of the Code of Ethics for Nurses. Here are some things to consider in pursuing that duty to the self: 

Resilience is the ability to adapt to adversity or hardship. Resilience can be strengthened through:

• Relationships: connect with others, particularly positive people.
• Finding purpose: consider what gives you meaning in your many roles (nurse, mother, son, spouse, neighbor, etc.); set goals and reflect on accomplishments; focus on your strengths and your future.
• Embracing healthy thoughts: practice gratitude, differentiate what is and is not under your control and focus on what you have power to change, reframe negative thoughts

Self-care practices are intentional actions to attend to oneself, such as:

• Prioritizing rest, nutrition, and exercise: begin small if you need to. Aim for seven to eight hours of sleep per night, drink more water, eat more vegetables, walk the stairs or from a distant parking spot. 
• Nurturing mind, body, and spirit: wellness is holistic. Seek balance and make time for what brings you joy.
• Tuning in to your particular needs to restore well-being.

Positive nursing practice environments that embody a professional practice model and embrace decision making authority of front-line nurses, such as through staffing levels: 

• Contribute to a positive practice environment by participating on organizational committees, such as staffing, nursing peer review, clinical practice or workplace violence.
• Support colleagues who practice self-care, such as through taking breaks or saying “no” to extra shifts.
• Report incivility, workplace violence, system issues and near-miss errors.

Nursing is a caring profession, and the patient has been the obvious focus of care. Provision 5 of the Code of Ethics for Nurses calls nurses to recognize that they owe that same ethic of care to themselves. The pandemic highlights the criticality of this provision. Self-care is not an option, it is a responsibility. The old tradition of toughness has been challenged and individual nurses, as well as organizations, must shift the status quo to embrace a healthy and healing environment for caregivers as well as their patients.