Job action and the code of ethics

Tom is concerned about the increasing workload on his unit and fears that quality and safe patient care is being compromised. He works hard to compensate for lower staffing levels, but finds he has less time to spend providing psychosocial support to clients. He discusses this with his colleagues and seeks information from his union representative and the regulatory body in his province about what steps he should take to address the issue with his nurse manager. (Everyday Ethics, 1998, p. 25)

Nurses across Canada can easily identify with Tom. They are tired, overwhelmed, and angry. Increasingly, in province after province, they are either threatening or taking job action. Such action may include working to rule, withdrawing services (striking), or leaving the profession or the country. Such action frequently aims at better levels of patient care, and better working conditions for nurses. It is not all for themselves; nurses are hoping that better pay and working conditions will attract more recruits into the profession, and bring back those nurses who have left, alleviating both current nursing shortages and those predicted for the future.

In May, the AARN sent a letter to all Alberta nurses about the possibility of job action. The letter included answers to many questions commonly asked of the AARN on the subject. These were well written and informative, and included several statements from the Code of Ethics for Registered Nurses (CNA, 1997). The sheet listed five considerations, not part of the code itself, but meant to be suggestions for application of the code in selected circumstances.

The code consists of a preamble and a list of seven values which represent "the values to which members of the profession of nursing commit themselves. The values reflected in the code are the values that nursing as a profession has identified as important" (CNA, 1998, p.29). Reflection on these values makes the picture about job action much more complex. They are:

Without the ability to incorporate all of these values into their daily practice, nurses cannot give ethical nursing care. Across Canada nurses are saying that they do not have enough time or resources to enact these values in their workplace in a way that is meaningful. Although all seven values are relevant to job action, I will focus on the last one to show how concern for things other than current clients' safety must be part of the decision.

Practice environments conducive to safe, competent and ethical care

Nurses advocate practice environments that have the organizational and human support systems, and the resource allocations necessary for safe, competent and ethical nursing care (CNA, 1997). The following responsibility statements, meant to clarify its application and provide more direct guidance, accompany this value. Let's look at each of them:

1. Nurses collaborate with nursing colleagues and other members of the health team to advocate health care environments that are conducive to ethical practice and to the health and well-being of clients and others in the setting. They do this in ways that are consistent with their professional role and responsibilities.

This statement recognizes that individuals sometimes have little power to affect change in organizations, and that collective action will sometimes offer better results. Acting in ways that are consistent with their professional role and responsibilities may mean that nurses must sometimes speak out or take action if they are unable to fulfill these roles and responsibilities, in addition to safeguarding individual clients.

2. Nurses share their nursing knowledge with other members of the health team for the benefit of clients. To the best of their abilities, nurses provide mentorship and guidance for the professional development of students of nursing and other nurses.

As well as providing direct guidance and help to students and other nurses, nurses must protect the future of their profession so that professional nursing care will be available to those who need it. When shortages and bad working conditions exist, nurses are unable to provide adequate care, and morale suffers. Nurses must work for the provision of adequate staffing and a future supply of recruits who will replace those who retire or leave.

3. Nurses seeking professional employment accurately state their areas of competence and seek reasonable assurance that employment conditions will permit care consistent with the values and responsibilities of the code, as well as with their personal ethical beliefs.

Those who want to remain in nursing must frequently accept positions or remain in jobs that are less than satisfactory. Though many studies have revealed a nursing shortage, very few full-time positions are available. Nurses are forced to take what they can get, frequently not in fields where they have an interest or expertise.

4. Nurses practise ethically by striving for the best care achievable in the circumstances. They also make the effort, individually or in partnership with others, to improve practice environments by advocating on behalf of their clients as possible.