Four Ethical Obligations of Democratic Nurse Leaders

We’ve heard it all many times during endorsement time, “this patient is a V.I.P.” This translates to an unspoken requirement that nurses respond more rapidly to the patient and his or her significant others, explain procedures and treatments more thoroughly, and even make rounds more often to oversee the patient and his needs. Even management makes effort to improve the general process and specific details concerning the delivery of care for this “V.I.P.”

Totally opposite this, we have also witnessed marginalized patients who may be poor, unemployed, uninsured, of a different race, color, sexual orientation or ideology experience disparities and inequities in healthcare.

The management likewise does not exert extra effort to make rounds or “go the extra mile” for the welfare and needs of this patient.  This sad reality continues to happen every day in many if not most healthcare settings. As a system who is supposedly responsible for the treatment and healing of individuals and communities, we somehow fail in huge proportions to advocate for needs of the vulnerable. While almost by default, the system and workforce jump to meet the demands of rich and powerful “V.I.P.”

As healthcare providers, we ourselves may have experienced discrimination or unjust treatment because of our different nature in comparison with other people we work with, be it in terms of appearance, color, religion, or orientation.

At Transform Nursing, nurses are encouraged to urgently wake up, make a stand, and fight to eliminate social injustice in nursing and healthcare, in general, to provide top- quality, client-centered care to everyone we serve; as well as acquire for ourselves a deep sense of justice, respect, and peace in the different milieus we do work in.

We owe this service and compassion to those we serve in society, especially the victims of social injustices, to our profession, and to ourselves. If we have not yet made the first step to this end, may we embrace reality, and begin to work for change.

Ethically Caring For Everyone

Nurses today are at the frontlines of caring for vulnerable groups who have issues with the quality of care, access to non-judgmental treatment, and other disparities and social justice concerns because of race, color, orientation, or beliefs. Health disparities remain rampant in American healthcare systems and around the globe. As nurse leaders and advocates, it is our role to honor and implement the American Nurses Association (ANA) Code of Ethics to support and protect the rights of marginalized health populations. This new Code of Ethics for Nurses was published by ANA in 2015 together with a call for nurses to stand up for social justice, human rights, and health disparities.

In particular, provision eight (8) states that the nurse should collaborate with health professionals and the public to promote health diplomacy, reduce health disparities, and foremost, to protect human rights. The provision promotes that nurses advocate for equal treatment among vulnerable communities despite gender, identity, sexual orientation, socioeconomic and immigration status, among other factors.

We are tasked as powerful moral advocates to keep these essential aspects of human dignity aligned. Moreover, our commitment to prioritizing our patients and their rights are reinforced by these guidelines, even if it requires standing up to law enforcement personnel and immigration officials

Nurses as Change Agents

Our unique role in society places us in a position to care for individuals holistically, protecting dignity and human rights. In a time where upheavals and political uncertainties are rampant, it is imperative to take on the role of change agents and defend social justice on a day to day basis. We can choose to intervene. Nurses in history have done their part. It is our time to rally for rightful change and protect at-risk communities that we serve.

The First Move

To be effective agents of social justice, we may begin by critically evaluating the major determinants of health, including personal attributes, health behaviors, accessibility of healthcare, socioeconomic and cultural factors (Reutter & Kushner, 2010).

As your coach in Transform Nursing, I will assist you in a variety of situations and experiences involving these relevant concerns, and work with you to enhance the process from assessment to evaluation whether for your patients in the community, acute care settings, or even people you work with such as members of the healthcare system.

Variables of race, spirituality, culture, health disparities and other ideologies are in interplay and should be given focus. The application of social determinants and health concepts are also crucial. I will provide you with relevant questions that will aid you in reflecting, and for long-term, equip you in working effectively with your own team or organization.

In this light, we shall utilize nursing strategies that will combine social justice concepts with goals of your particular community or institution, and importantly, generate results that will make a difference in the practice. It is significant to include both social and physical determinants, and in the process manage communities or groups as a whole, instead of managing them as separate entities.

So whether you work as a hospital, school, rural nurse or community nurse-activist, we will find connections among factors such as poverty, racism, sexism, socioeconomic, and political situations to paramount issues in health inequalities. These connections we shall include in a customized formula that best suits your own work life.

The Ethical Obligation of Nurses

It is important for us to be involved in methods that offer an explicit voice to major decisions in policy or procedures affecting our institutions and nation as a whole. The impact of our role on improving policy for patients should be evident, although many of us may question initially whether we make a difference at all given the enormity of social injustices and health disparities we face on a day to day basis here in the US alone.

But with deep reflection and a sincere desire to voice out just and reasonable causes, I believe that we can effectively utilize our expertise in clinical care and close relationships with our patients to make a significant and long-term contribution. We only need to have the courage to step up and claim what we envision through conscientious and well-planned action.

In this context, I encourage nurses to consider the following tips:

  1.  Document the impact of policy decisions on vulnerable groups systematically.  Remember that applying policies in real life situations will be more meaningful for Americans who are affected at the point of care.
  2.  Do not hesitate to constructively voice out your points-of-view with leaders and policymakers. This may be an initial proactive step we can take to ensure results are generated for groups we advocate for.
  3.  Be engaged as a member or team leader where you can advocate that voices of everyone be heard. Empowerment is key to secure changes in our own teams or organization.
  4. Organize your team members towards employing strategies that you can communicate with higher-ranking leaders. Teamwork has its own benefits that will pave the way to change and improvement.

Our Contribution to the Healthcare System

To optimally contribute to the system or force badly needed changes, nurses should practice specifically assessing what are needed for the unique situation, experience or problem; we can then proceed to set our goals and communicate our purpose in our own units or organization; then with courage, the right timing, and methodology, we proceed to recommend solutions to problems in the system. This flow may seem very elementary but often remains difficult to perform when the issues involved seem enormous or complicated. But it definitely helps to go back to the basics and focus on the specifics.

In addition, we must remember that the exercise of our moral agency should be independent of the outcomes that follow. Hence, it is imperative that our role in preserving the integrity of human beings be accomplished, even when we run short of achieving our goals. And even more importantly, we should take risks when opportunities are at hand. We should not hesitate to take action, even if only to sound the alarm, and not be passive or silent when something needs to be done. Our patients and communities need our help today. We should do this to rightfully keep the professional vows we have committed to as nurses. After all, caring for social justice is a primary purpose of the nursing profession that we should continue to uphold.

In the end, we realize that involving in movements or promotion of social justice will not be easy, but knowing and seeing improvements in health outcomes and the well- being of our patients and communities at the forefront will make it worthwhile. Truly we can make a difference with each small act of courage.

Responding to Health Needs

The role nurses play spreads throughout the clients’ lifespan, and in all possible settings. Come to think of it, we work to improve the health of individuals and populations as defenders of human rights and social justice because it is the right thing to do. Responding to the pressing needs of our time, we should include SMART goals geared to change how things work in society to address problems in poverty, access to healthcare, as well as conditions and treatment for vulnerable groups. All this is possible if we make the right decisions, act conscientiously, and voice out genuine care for the health of communities, families, as well as our own.

Passion and Advocacy

To become effective advocates for change and social justice, I believe that we should be passionate in setting and commit to our goals to better our organizational systems and unify the nursing workforce (and healthcare in general).

Collectively, we can make a difference in the lives of people we serve with the right tools in coaching, which I would like to offer you in Transform Nursing. We should not only persist in working to relieve the suffering of marginalized groups but advocate for the prevention of health inequities and social injustices. Apart from this, we should be visionaries and role models who inspire our colleagues to work beyond borders, think out of the box, and influence the wellness of large communities and even nations.

Transforming Social Justice Obstacles to Leadership Goals

To transform social justice problems into solutions, nurses need to take on a strong leadership role that will critically transform the healthcare system one step at a time. Yet, not all nurses think that they should become leaders, especially at the beginning of their careers. There is an urgent call in the healthcare system for nurses to step up and produce leaders who will represent the largest workforce in healthcare from the bedside to the boardroom because as a profession we need to evolve to the needs of the times to be able to deliver high-quality care, in collaborations with leaders from other health professions.

For many years, society has not viewed nurses as leaders in health institutions. But today, we are called to be leaders equipped with skills and competencies to assess, design, implement and evaluate needed reforms for the healthcare system. Moreover, we should act in collaboration with physicians and other health professionals towards promoting reforms across the system.

Furthermore, research applied to practice in nursing must continue to identify and develop evidence-based enhancements to care. These enhancements must be validated and adopted through changes in policy. Nursing research, practice, and theory must work hand in hand to better policies and care for patients.

Being accountable in collaborating with other members of healthcare, we should take full responsibility in identifying problems and unproductive areas, devising and carrying out strategic plans, monitoring improvement over time, and making adjustments and needed reassessments to realize goals at a personal and organizational level.

It is high time nurses polish their abilities to shape policy, rather than just be molded by policy. Collectively, we should be consistent in speaking the language of policy, engaging in socio-political processes, and working cohesively as one profession. In particular, we should dynamically be involved in commissions, committees, and boards where major decisions are being made. To realize this, we must build strong partnerships based on respect and collaboration with stakeholders, clinicians, public and private officials, and sustain our advocacy for improvements especially for the vulnerable groups that we serve. This influential and collaborative leadership style has been associated with improved patient outcomes, reduction in disparities and medical errors, better workforce performance, and patient satisfaction (Joint Commission, 2008).

In the end, may our voice be the voice of the people we serve. May our voice be the voice of more than twenty million nurses globally today. May this voice transform the world one day at a time.


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