There are two types of ethics that we encounter in our nursing roles. The first is individual or personal ethics. This relates to how you are raised, the books you have read, the experiences you have had, and your religious or political beliefs. Your standard of conduct in your personal life is shaped by all of these influences. An example of individual ethics would be a “work ethic” in which you were raised to be on time to work and to not use company time for personal activities. There was no governing body or organization that placed that structure upon you, you chose it independently. There may be workers in your institution with a different work ethic than yours, and this may cause conflict.

The second type of ethics is the framework established by the leaders for the greater good. Those leaders can be of a professional organization such as the American Nurses Association or of a political group such as Republicans. These leaderships, or groups of people with common interests, come together with their individual ethics to compromise what the standards are for the rest of the population. An individual’s ethics may at times contradict the group ethic leading to an internal struggle within that nurse. Many institutions have an Ethics Committee to evaluate and maintain their professional code of conduct based on the group ethics determined by the professional organizations. This allows them to take a situation or case study and work through the personal ethics that may have led to it being a difficult or emotionally charged experience for staff and families.

If you find yourself in an ethical dilemma at work, the best thing to do is find a consensus. Enlist the support of your co-workers in helping you to find a structure and framework with which to view the situation. Get their input and listen carefully to how their personal ethics are shaping their professional view. Find out who the members of the Ethics Committee are where you work and call one of them. They can be a valuable resource for you and your patient. Know your professional organization’s standard of care and conduct. These are the guidelines by which you legally practice and this is the bottom line for your nursing practice.

Imagine this example: A nurse caring for an end stage renal failure patient. The patient is maintained on a ventilator for pneumonia. This is the third time the patient has had pneumonia in the last 8 months. She is also restrained with bilateral soft wrist restraints. The family is under the impression that once the pneumonia improves, the patient will be extubated. While caring for this patient, the nurse notices that the patient is looking at her with tears in her eyes. She appears to want the nurse to untie her and when the nurse does this, the patient immediately tries to extubate herself. When she is restrained once more, the patient continues to cry and stops making eye contact with staff.

There are some nurses who would simply medicate this patient to a sedation point. Other nurses might refuse to take care of the patient, stating that they “just can’t handle her” anymore. The ethically aware nurse would call in the Ethics committee, talk to the physician about the long term plan of care for this patient, and involve the family in this planning. There may be a palliative care consult obtained as a result of her efforts. There also may not be. That is what makes ethics so tricky.