Provision 5
The nurse has moral duties to self as a person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competence.
5.2 Wholeness of Character
The concept of wholeness of character highlights the duty of nurses to be their authentic selves in their practice of nursing. Wholeness of character requires that nurses acknowledge their uniqueness, individual creativity, perspectives, moral points of view, and their specific life experiences. This ethical concept acknowledges that in addition to prioritizing those entrusted to their care, nurses are moral agents influenced by distinct cultural, political, religious and/or spiritual, and social values. Courage and vulnerability are required for nurses to be fully who they are as individuals. This helps ensure that nursing, as a profession, mirrors the populations we serve. Prejudicial discrimination within the nursing profession ought not be tolerated. Nurses’ individuality is respected, and their contributions should be honored. This fosters a safe space where individual expression is supported in the professional work environment. Nurses create a moral milieu in which moral perspectives may safely be expressed, values are clarified, issues that impact health equity are identified, and difficult and intentional conversations occur. This space does not extend to prejudicial behavior that belittles, bullies, or demeans; opinions that are inconsistent with nursing values or not rooted in scientific fact; or acts that promote structures designed to marginalize, dehumanize, disadvantage, or harm specific groups. The ethical construct of wholeness of character provides nurses with the opportunity to create the personal-professional boundaries they require, while promoting intentional presence and human connection in the workplace.
When nurses care for those whose health conditions, attributes, lifestyles, or situations are stigmatized, or encounter a conflict with their own personal beliefs, nurses ought to and must render compassionate, respectful, and competent care. A nurse may not object to care due to a patient’s unique attributes that are part of the patient’s identity. At times, nurses may feel their personal values conflict with their professional values. Examples may include disagreements around when life begins and how life ends. Additional examples include the role of the nurse with respect to mandatory reporting of reproductive healthcare decisions, economically driven care, or gender affirming care. Conscience-based objection is an important right in order to promote personal integrity but must be balanced with the patient’s right to care and dignity. Conscience-based refusals to participate exclude personal preference, prejudice, bias, convenience, or arbitrariness. Acts of conscience-based objection may be acts of moral courage and may not insulate nurses from formal or informal consequences. Nurses who decide not to participate on the grounds of a conscience-based objection must communicate this decision in a timely and appropriate manner. Such refusal should be made known as soon as possible, in advance and in time for alternate arrangements to be made for patient care. Seeking support may be helpful when facing the inner and external conflicts brought about by these fraught situations.