Provision 4
Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and provide optimal care.
4.3 Ethical Awareness, Discernment, and Judgment
Ethical awareness involves understanding that all nursing actions have ethical implications to the extent that they support or detract from nursing goals of providing an ethical good or end. Moral identity as a nurse entails the internalization of moral values and virtues, dispositions, obligations, relational maturity, and ethical comportment. In the process of educating nurses, the moral norms of nursing are instantiated during the formation of the moral identity of the nurse as a nurse. These norms arise from within the tradition, narrative, and community of nursing and find expression in the everyday ethical comportment of nurses in every nursing relationship. In the nurse-patient relationship, for example, ethical judgment is inseparable from clinical know-how. Here, ethical discernment and judgment are an embodied enactment of nursing’s norms that is attuned and responsive to the context, changing status and circumstances, and subjective experience (human responses) of patients to their health situation. In the nurse-to-society relationship, nurses’ ethical awareness, discernment, and judgment engage with social structures that positively affect health and seek to alter forces and uproot structures that damage health. Ethical awareness, discernment, and judgment, then, are expressions of the good intrinsic to nursing, its values, virtues, obligations, and ends, with a vision for the health and well-being of patients, for the health and well-being of society, and for the common good. For nursing, ethical discernment and judgment exist within the everyday ethical comportment of nurses (e.g., compassion, attentiveness), in every relationship, under changing circumstances and demands; they are not fundamentally decisional-, problem-, or conflict-focused. In situations of dilemma or conflict, nurses draw upon a range of ethics resources to inform their judgment. Additionally, when ethical problems have their roots in social disadvantage or political movements, nurses use their education and knowledge to influence change through professional collaboration and advocacy. For nurses, ethical discernment and judgment are a way of being-a-nurse toward the recipients of nursing care and toward those in need of nursing.