key: cord-0835521-0vke6rca authors: Downs, Stuart; Martin, Erik; Aaron, Brooklyn title: Leveraging the Code of Ethics to Practically Promote Ethics During COVID-19 date: 2021-10-26 journal: Nurse Lead DOI: 10.1016/j.mnl.2021.10.006 sha: 747e6db63fbd9cd60916c47cc7fba39ff62dba07 doc_id: 835521 cord_uid: 0vke6rca nan The COVID-19 pandemic has created an exorbitant number of ethical challenges for nurse leaders. We are living in and experiencing one of the greatest healthcare tragedies of all time. The capability and tenacity required by nurse leaders to make the right decision at the right time can be daunting. The literature provides insight into the many settings and conditions where the professional registered nurse must make ethical determinations about the care he/she provides. [1] [2] [3] However, we are lacking a comprehensive analysis or guide on how nurse leaders can prepare and respond to these types of ethical challenges. The year 2020 marked the 30th anniversary for the American Nurses Association's Center for Ethics and Human Rights. That year, the center received a host of concerns from nurses about ethics in practice during the public health crisis. In fact, the Code of Ethics with the Interpretive Statements 4-5 was viewed over 300,000 times last year, a 9% increase over the prior year. 6 This demonstrates the level of heightened awareness and the crucial role ethical principles and considerations play in nurses' decision-making. The American Organization for Nursing Leadership (AONL) maintains the practice of ethical behavior 7 as a core competency of the nurse manager. This includes upholding professional nursing values and standards in all scopes of nurse manager practice. Many nurse J o u r n a l P r e -p r o o f leaders today are feeling overwhelmed. They are attempting to promote and sustain ethics while facing incredible clinical challenges and supporting a workforce that is fragmented, understaffed, and burned out. Despite this devastating and unrelenting environment, our roles as nurse leaders afford us the opportunity to influence the sustainment of a caring culture 8 . Our professional position prompts a moral obligation to recognize and address ethical issues that affect both the patients and teams we serve alongside. Striving to uphold that commitment in today's practice environment is morally distressing and may be one of the contributing factors to why nearly four out of ten nurse leaders are reporting they are not emotionally healthy. 9 Nurse leaders should consider the use of a Reflexive Principlist Decision-Making approach 10 as a framework in steering ethical deliberation. This framework will guide the leader through an ethical challenge with intentional reflection on the principles found within the nursing Code of Ethics, and apply them to make a decision or take action to ensure an optimal outcome. Many nurse leaders can chronicle multiple ethical challenges that have emerged while making staffing assignments related to COVID-19 patients. Should we spread the COVID-19 patient population to different nurses to mitigate burnout? Should we cohort patients and staff to reduce the risk of COVID-19 exposure and spread? Should we make special considerations for pregnant or high-risk healthcare workers? The struggle and toil of being fair to our team and of exposing them to the least physical and emotional harm possible is real. When weighing decisions about staff allocation and assignments, each plan must reflect the fundamental priority of patients' interests. 5 Indisputably, the safety and wellbeing of our staff is important and factors into ethical decision-making around staffing assignments. Nurse leaders are struggling to balance the wellbeing of the patients and team, all the while recognizing staffs' wellbeing directly impacts the care they provide. Apply to Situation at Hand What measures should be taken to maximize staffing resources? Should contract labor be explored even though it may exacerbate the local and national staffing shortage? How will adding temporary premium pay workers impact my team that has been committed and dedicated? Should alternative care models that leverage licensed practical nurses (LPN), student nurses, or even new graduate nurses not out of orientation be explored? Do we jeopardize the contributions nurses make in alternative roles and pull them back into direct patient care roles? As nursing professionals who must act according to the nursing Code of Ethics 5 , we have an ethical obligation to place the interests of our patients first. In times of crisis, the goal is to maximize and leverage every resource available to provide the safest level of care possible. We are morally obligated to think creatively and differently than we do in normal times for the primary purpose of maintaining the best care possible for patients. All options should be explored in a collaborative manner, and all decisions should be clearly linked to patients' interests and be made transparent to all affected parties. During the present staffing shortages, we should act with heightened awareness that our actions may unintentionally further jeopardize the quality of care we can provide patients. Practically, we may be unable to adequately address staffing shortages and provide the normal standards of care during a current crisis. Preventing burnout and promoting resilience are buzz words we are hearing in conversations all around the country. The very essence of being resilient is having the ability to withstand and quickly recover from a difficult situation. The reality of COVID-19 is that this "situation" has been relentless, making it challenging for nurses to keep showing up day after day. We have all heard about the stress and burnout that the pandemic has exacerbated for the healthcare industry. What we have not acknowledged is the moral component of this stress. Nurse leaders and nursing staff all want to do the right thing, but the current healthcare crisis presents a conundrum. There are too many constraints, limitations, and adversity, and we lack the team members and medical supplies to actualize what feels right. Ethical Helps and Challenges Faced by Nurse Leaders in the Healthcare Industry Ethical Challenges in Health Care: Developing Your Moral Compass Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application Code of Ethics for Nurses with Interpretative Statements Center for Ethics and Human Rights Annual Report AONL Nurse Manager Competencies Nurse Leaders as Managers of Ethically Sustainable Caring Cultures AONL COVID-19 Longitudinal Study Effectively Engaging Engineers in Ethical Reasoning about Emerging Technologies: A Cyber-Enabled Framework of Scaffolded, Integrated, and Reflexive Analysis of Cases Authentic Nurse Leadership Conceptual Framework The Nursing Code of Ethics: Its Value, its History Practical Use of the Nursing Code of Ethics: Part I Nursing Shortage Nurse-Patient Ratios as a Patient Safety Strategy: A Systematic Review