Ethics in perioperative practice—duty to foster an ethical environment

AORN Journal,  Sept, 2002  by Patricia C. Seifert

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Collective bargaining and workplace advocacy may offer additional options and should be consistent with professional standards, state laws, the code of ethics for nurses, and above all, the provision of ethical patient care. (26) The ANA supports collective action in two ways, including

* collective bargaining (ie, the formation of a union to represent the interests and concerns of RN employees) and

* workplace advocacy (ie, development of strategies to advocate for RN staff members not represented by collective bargaining agreements). (27)

Collective action often results when organizational changes necessary to promote an ethical environment are unlikely to occur without the added collective pressure to improve working conditions and patient care in the practice setting.

PROMOTING AN EFFECTIVE WORK ENVIRONMENT

Administrators frequently must deal with their own ethical dilemmas as a result of their concomitant duty to patients and to the employing institution's business objectives. When patient and corporate goals are not congruent, administrators face difficult choices. One author proposes 10 principles for ethical administration that can align administrators' dual roles and duties as patient advocates and organizational stewards (Table 2). (28) These principles can help administrators reconcile the interests of the multiple parties and stakeholders, maintain trust, enhance productivity, and promote safe and ethical patient care. These principles reflect universal values that offer guidance to all health care workers constantly faced with unpredictability.

Dealing with unpredictability; resolving ethical issues, problems, and dilemmas; and maintaining an ethical culture are not the sole duties of administrators. Staff nurses also share a duty to promote an effective work environment. AORN's "Standards of perioperative professional performance" specify that collegiality (ie, contributing to the professional growth of peers, colleagues, and others) and collaboration (ie, cooperating with patients, coworkers, and others to achieve optimal outcomes) are part of a nurse's duty to foster an ethical and therapeutic environment. (29) Respect, trust, and collegiality are critical for maintaining an environment where individuals can use their knowledge and skill to deliver patient care. When the necessary knowledge and skills are lacking, as with, for example, new graduates or experienced nurses just starting at a new health care facility, experienced staff members should display collegiality and collaboration toward their less expert colleagues. A toxic culture where new or inexperienced employees are shunned or made to feel unneeded or unwanted is not only unethical, it also is likely to have problems retaining staff members. In an era of severe nursing shortages, health care workers have a duty to their patients and colleagues to foster a nurturing, caring culture. It is inconsistent to declare that compassionate patient care is practiced in a setting where compassion is not demonstrated by staff members toward their peers and colleagues.