Practice Tip of the Week: Ethical Duty in the Time of COVID-19
Tuesday, March 24, 2020
Posted by: Laura Lang
By Cindy Zolnierek, PhD, RN, CAE
Most nurses are familiar with our duty to the patients under our direct care. We know we have a duty to promote safe environments for patients (Texas Administrative Code §217.11) by ensuring our behavior meets a certain standard of care. And, we may be aware that the Code of Ethics for Nurses with Interpretive Statements also speaks to our role in supporting a safe environment. The patient environment usually conjures up images of the clinical situation of the patient. The coronavirus pandemic reminds us of the need to consider environment as a much broader context.
Civic duty and safe environments
A pandemic is “the worldwide spread of a new disease.” An outbreak of the coronavirus was first documented in Wuhan, China in December 2019. Three short months later, the disease caused by the virus, COVID-19, has spread across the world affecting almost 380,000 people (43,721 US citizens) in 195 countries and territories.
So, how do we as nurses promote safe environments for our “patients” — defined as “individuals, families, communities, and populations” (ANA 2, p.10) in the midst of a pandemic?
Federal, state, and local edicts have been issued in attempt to reduce spread of COVID-19 which is transmitted through droplet or airborne means. Such directives have included restricting nonessential travel, physical distancing (gatherings of less than 10 and maintenance of interpersonal space of at least 6 feet) and sheltering in place.
Nurses have both a civic and a professional duty to abide by such restrictions – however inconvenient they may be. So, yes, we must cancel our travel, minimize our social contacts, stay at home when not at work. Like it or not, we are role models for our community. We understand disease transmission and are called to do our part – not only at the bedside, but in our communities as well.
Personal duty and self-care
Nurse also have a duty when treating patients to make sure they protect themselves, and in doing so, protect their next patient from being exposed. This task has been made difficult by the lack of PPE. TNA is advocating at the state level (and ANA at the national level) to increase the availability of PPE for health care professionals on the front lines.
Nurses who have been exposed to the novel coronavirus, or who have symptoms of COVID-19 must self-quarantine, for the safety of coworkers and patients. Even if the nurse is unable to obtain a test, isolation is the best precaution to take.
Ethical dilemmas in providing care
As health care resources become scarcer, some providers are already having to make difficult decisions about who gets care. We have limited beds and ventilators in the state, and we could soon except to face similar decisions.
Physicians and nurses have the duty to plan, safeguard and guide. Ultimately the decision to prioritize one patient over another in both China and Italy came from a utilitarian framework of allocating resources to patients with the best chance of survival. However, as providers are forced to make difficult choices, moral distress is inevitable. (Read one nurse’s personal experience with moral distress. Members, sign in to read about moral distress related to electronic health records.)
There are no easy answers to the situations we face during this crisis. As nurses, we enjoy public esteem as the most honest and trusted profession, and that honor comes with responsibility.
“The authority for nursing…is based on social responsibility... which derives from a complex social base and social contract”
ANA, 2010, Social Policy Statement, p. 5-6
The nursing profession’s trusted position in society imposes a responsibility to provide the very best health care.