Article W1: Role of an ethicist

Operationalizing the Nurse Ethicist Role

• The concept of a nursing role with ethics expertise is over 30 years old.
• Nursing practice significantly contributes to the ethical practice of healthcare, supported by a strong basis in ethics and social justice.
• Nurse ethicists are skilled in nursing practice and ethical theories, which enables them to guide nurses in complex ethical situations.
• There’s a need for discussing specific job responsibilities for nurse ethicists, with recent job postings suggesting healthcare institutions value and recruit for this role.
• The paper emphasizes nurse ethicists should define their role to address ethical dilemmas and conflicts in healthcare effectively.
• It describes essential elements for a nurse ethicist job description in a clinical setting connected to academic programs, based on experience and literature.
• Nurse ethicists enhance healthcare organizations and ethics teams by adding value.

Introduction

• Nursing is patient-focused, relationship-centered, and provides continuous care, offering insights into the patient experience which is crucial for ethical decision-making.
• Nurses face moral hazards due to their position which makes it difficult to voice ethical concerns.
• These experiences, contributed to moral distress first identified in nursing in 1984, have been the focus of empirical study and conceptual debate.
• Moral distress is an organizational issue that increases the likelihood that nurses will leave.
• Dedicated nurse ethicists can use ethics expertise to mitigate moral distress.
• A dedicated nurse ethicist role can also improve overall nursing care, patient outcomes, and the effectiveness of bioethics teams.
• There is a need to differentiate the nurse ethicist role due to the recent increase in “nurse ethicist” job postings.

Training and Preparation

• Training should involve a focus on adequate training and preparation for ethics support and recommendations to clinical nurses with direct patient care access.
• Ethical problems include balancing burdens/benefits which occur in relation to the complexity of family dynamics and potential social issues in a diverse society.
• Gaining credibility in this role includes:
• Clinical experience in nursing
• Knowledge of ethical theories and concepts
• Application of theories to practice through ethics consultation
• Critical care settings are particularly valuable because of the experience with team dynamics.
• Ethics training in nursing remains incomplete; Some nurses receive dedicated ethics instruction, while others have ethics woven into the curriculum.
• Nursing ethics expertise, is often overshadowed by ethical dilemmas and therefore nurses are ill equipped to deal with ethical challenges.
• Nurse ethicists should have adequate education, understanding of ethical theories, and appreciation for the history of nursing ethics.
• Academic degrees, are beneficial to have, especially advanced degrees because they indicate levels of knowledge, skill and expertise.
• There's a trend toward requiring a terminal degree and fellowship training at leading bioethics centers.

Clinical Ethics Consultation

• There’s an increasing amount of nurses conducting clinical ethics.
• Studies discuss the role of "nurse ethicist" including Mary Lund (RN, PhD Nurse Ethicist) as far back as 1998.
• Some authors use the terms: nurse ethicist, clinical ethicist, healthcare ethics consultant, and bioethics consultant interchangeably but there is a distinction in the roles.
• Clinical ethics consultation should be integral to the nurse ethicist role, especially since nurses frequently encounter ethical challenges and are ethics consultation requesters.
• Hierarchies in healthcare can prevent nurses seeking ethics assistance.
• Nurse ethicists use a relationship-centered approach, blending nursing and ethics theories which helps in assisting with communication.
• The nurse ethicist adds value by sharing understandings of ethical issues, spearheading practices, and routinizing the inclusion of ethics.
• It also helps to assist nurses and patients' in decision-making forums

Education

• Nurse ethicists build ethics capacity and capability through ethics education.
• Nurses at the bedside are pivotal in preventative ethics work.
• Studies show nurses do not feel equipped to cope with the arising ethical issues

Research and Scholarship

• Nurse ethicists should build research programs to move nursing ethics forward and mentor nurses in empirical research.
• Aim for these is to better understand healthcare delivery challenges, then to translate research into improving care.
• Analysis show Cooperation between physicians and nurses was one of the most prominent issues.
• Recently, this research has contributed greatly to an understanding of moral distress and the impact of perceptions of the ethical work environment.
• Nurse ethicists integrated into a hospital ethics consultation service can research consult themes.
• All scholars/researchers must disseminate scholarship at academic/non-academic forums.
• Disseminating work elevates visibility for the potential impact of the role.
• Peer review will enhance work credibility and promote change in patient care.

Health Policy

• Policy work is often politically fraught, complex, and value-laden.
• Nurses still experience barriers that prevent them from obtaining a seat at the table.
• Nurse ethicists provide perspective on policy sensitive to ethical challenges, practical realities, implementation issues and risk to nurses, patients and families.
• Policies continue to uniquely influence due to bedside nurses caring for dying patients still requiring a full code order due to surrogate disagreement.
• They also disseminate their work to influence their organization's policies related to codes.

Characteristics of the Nurse Ethicist

• Nurse ethicists strive to show a socially embedded practical knowledge.
• The capacity and skill to exceed in the areas of responsibility calls for more than just education and training.
• Nurse ethicists should exhibit moral courage.
• They have an obligation to address oppressive systems to model moral courage in nursing practice.

Reporting Structure

• The role is to promote nurse ethics practices and influence ethical practice broadly.
• It would have report structure linked to the department of nursing and to the institution's infrastructure.
• Links might be advisors to nurse leaders, faculty in department or leader in the clinical ethics committee.
• It fosters separate roles in nursing ethics in the organizational structure versus subverting the role to medical ethics alone.
• Ideal of maintaining footing within dual organization structures is believed to be superior alone.

Challenges and limitations of the nurse ethicist role

• Requires the ability to work effectively within challenging environments and ethically complex situations which calls for steadfastness, courage, knowledge and communication.
• Requires ingenuity, innovation, and bravery, they must develop genuine relationships and be a role model.
• Role must be recognized as having authority to create positive change when they serve as change agents.
• This has a potential to contribute to silos between bioethics and hierarchies which would call for delineating areas of specialty not power.

Conclusion

• The aim is to define the nurse ethicist role in supporting stakeholders.
• It's the authors' contention that the primary responsibilities comprise:
• Providing ethics education for nurses to increase reflection
• Supporting conditions for patient care that is consistent with goals, supports medical processes, and promotes nursing care
• Contributing to empirical research that generates knowledge for navigating challenges nurses face
• Collaborating on policy work, and positively impacting medical practice and promoting social justice
• This requires a sensitive approach to apply knowledge to everyday challenges that stimulates moral improvement and can improve nursing practice.