Episode Transcript
[00:00:00] This is the All1Nerds podcast where we are bridging the gap between the stethoscope and the soul and getting back to the human side of healthcare.
[00:00:15] Powered by Riverside did you know that nurses face ethical dilemmas quite frequently in their daily practice? And some common situations involve end of life care, patient confidentiality, and conflicts between personal beliefs and patient needs or wishes. Now, these ethical dilemmas can lead to more distress, which can lead to emotional, psychological and even physical symptoms that impacts both the nurse well being and the quality of patient care.
[00:01:00] Welcome to this episode of All One Nurse, where I'm your host, Nurse Chanel Tompkins, and today it is just me and you as we dive into a topic that's very near and dear to me, which is the Nursing Code of Ethics. Because in today's healthcare landscape, this code is more than just a set of guidelines. It is the bedrock of our profession, ensuring that we deliver care that is not only competent but also compassionate and just.
[00:01:26] Now in this episode, first we're going to explore four main principles of that code that shapes the Code of ethics and its provisions and how these principles shape our decisions and actions, while two, drawing from personal insights that have guided me through my nursing journey. And then three, we'll step into the shoes of our patients, considering how ethical care fosters trust and a sense of dignity in the most challenging times. How do we handle these things? And in these stories and reflections, I hope that we both gain a deeper understanding of how the Code of ethics is not just important, but essential to our practice. And last but not least, I want to leave you with a motivating call to action that will challenge you. But also I want to celebrate you as a nurse who chose to be in the nursing profession. And don't forget to stick around to the end of the episode that you can find so that you can find out how to connect with me, your host, Nurse Chanel Tompkins, and what I have planned so that new nurses and nursing students can connect with me in the form of mentorship. And it's going to be free of charge, so no worries there. Be sure to stick around to learn about some of the upcoming topics that I want to unpack here on All One Nurse because I feel like it's very important now. I'm super excited, so go ahead and click that subscribe button before we dive right in. The reason why you should subscribe is so that you don't miss another episode. Okay, don't miss another episode of the All One Nurse podcast. Now getting right into it. Talking about the Nursing Code of Ethics. It is a long standing tradition that dates back to Florence Nightingale, who really adapted or created the modern nursing title, right? But come the 1950s, the American nurses association actually established these standards into a code. And about every 10 years, the American Nursing association has changed or revised it. And I love that because it continues to evolve in nature to address contemporary healthcare challenges as it applies to this period in time, like racial discrimination and equality, equitable healthcare and the advance in technology and the call to do more on a global scale as a profession, as a nursing community, through our nursing organizations. And this code just ensures that nurses have a clear set of ethical principles to guide our profession and responsibilities. There are four main ethical principles that the Nursing Code of Ethics is built on. And those four principles are patient autonomy, which is the right of patients to make their own decisions about their health care based on their values, beliefs and preferences. And then you have beneficence to do good, promoting the well being and best interest of others, always acting with kindness and a genuine intent to help. And then there's justice, not showing partiality and making sure that you provide fair treatment to everyone, regardless of their background, their circumstances or, or beliefs. Right? And then last but not least, non maleficence. And this is to do no harm. To do no harm. To be honest, I didn't know about non maleficence until I got into nursing school, which rightfully so, because we're talking about nursing, taking care of people, but with non maleficence. I hope you don't want to intentionally hurt anyone, but here I'm thinking about that careful consideration to make sure that I don't unintentionally hurt someone in my role as a nurse. Providing care. Now these ethical principles ensures that care is delivered in a manner that is fair, safe and respectful. It ensures that patients, that every patient that we encounter feels valued and that they feel heard. And the most recent revision had nine provisions in 2015, and now there are actually 10 provisions and. And in addition to listening to this episode, if you're a reader, I encourage you to check out the links below in the description because I've included an article published by Nurse.org titled what is the Nursing Code of ethics? Updated for 2025 now with the code of Ethics. It's crucial because I believe that it just truly lays the foundation for trust, accountability, and again, compassion. I've heard nurses say, I've heard people say, stop calling nursing a calling, to even, not even go the spiritual route, because I am a Christian, I am a Jesus love. And I feel like I abide by even scripture where it says, whatever you do, work at it with all your heart, as if you're working for the Lord and not for men, not for people. So when it comes to nursing, because I am taking care of people, I want to make sure that I do it as if I'm working unto the Lord, because I have to answer to how I treat someone and how I affect someone, right when it's within my means and my control. Like, we can't control them getting sick, but we can control how we handle them, how we provide care to them, which hopefully is individualized care. And so with that, yes, you know, for some, it may not be a calling, but I believe that we are all called to do the right thing, to do the right thing by those who are and trusting us to care for them, because they only get one life. They only get one life. Now, just to tie in some of my own personal insights and some meaningful stories of how ethical principles have guided my decisions and influenced patient outcomes, as well as helped me to prevent moral distress, we are called to be the patient's advocate, to stand up for the patient. And sometimes that's hard when, especially when you haven't lived the experiences that a lot of our patients have lived, especially when the patients are older and you're coming out of nursing school and you're young. I can remember being young and going out to take care of patients, and I cannot really sympathize with them because I haven't lived enough to understand what all they're going through. But at the same time, just looking at wanting to do the right thing and knowing that patients have a right to make the decisions for themselves, after hopefully being well informed and educated on the situation or the diagnosis and the treatment options, then it's just like, well, how can I just go in here and just let them know that I'm here? And as a patient advocate, you know, whether you're an introvert or an extrovert, meaning, you know, extrovert, you're very social, you're outgoing, you like to be around other people, and you don't mind talking, right? Introverts are more quiet, inward thinkers, but introverts still make good nurses. And I actually did a podcast episode on Nurse Converse. Shameless plug there on why introverts make great nurses. So go check that out whenever you get a chance. But either way, we have to consider the patient. We have to consider what the patient actually wants. What do they understand about what's going on with their care, and then what do they actually want? After hopefully being fully informed on their treatment options, if they want treatment at all. A good example of this is an experience where patient has terminal cancer and their kidneys fail and they need dialysis, but the patient refuses dialysis. And for me, I'm thinking, well, if you receive dialysis, you will live a little bit longer and enjoy more time with your family. But to the patient, it was the quality of life, the continued decline to their quality of life. And just to give you some context, now, I am a person of color who stays in the mid south area of the United States. And so I see a lot of patients on dialysis, a lot of patients of color. I have family members who have been on dialysis for years. And so without dialysis, they will not. They would not be here. And so I'm just like, okay, I'm not getting it. I don't. You want dialysis, right? You're not going to live without your kidneys being able to filter toxins. Your potassium level is going to go up, all the things.
[00:10:01] But then I can remember exiting the patient's room and with the physician. And the physician basically makes the comment, because in my mind, I'm like, I'm going to talk to this physician because I need to advocate for this patient. But the physician makes the comment, you have to commend a patient like that. You have to commend them like they knew their wishes and they stood on it. And so it was like, hmm, I caught myself. And I'm like, I didn't think of it like that. Wait, wait a minute. Let me, let me change my perspective. This patient was tired of being poked on, tired of dealing with all the things that came with trying to sustain their life at this point. And they wanted to be comfortable and they wanted to be surrounded by loved ones.
[00:10:54] Comfort and family was what this patient wanted. And so I was just like, okay, this patient doesn't need my competence. This patient needs my compassion, and they need my respect.
[00:11:09] They need for me to respect their wishes. And so that really changed my perspective because at first I was like, I need to. We need to do something to get this patient to get dialysis so that they don't just die.
[00:11:23] But then when I really looked at the patient and the patient's perspective and their wishes, their beliefs at this time in their plan of care, I needed to respect their decision. Even though in my heart I probably meant well, but that was my belief, my experience versus their belief, their experience that they're actually Experiencing. So that was one significant moment in my nursing journey that I honestly had to say, wait a minute. Stop, stop. You're not considering the patient. Even though I feel like I'm considering this patient, I wasn't considering the patient. I believe, like, we do a lot of these things. Let's say, you know, working at cvicu, a patient comes in with vascular issues, and for whatever reason, they do not want their extremity removed. And so instead of having the extremity removed, the patient passes and I'm just like, oh, my God, take the leg off. Take it off.
[00:12:28] But if this patient did not want this amputation, we had to respect their wishes and provide them pain medication, comfort, and go from there. Go from there.
[00:12:42] And then there's always ethical dilemmas or issues that may cause you to really self reflect on your own personal biases, on your own personal values and your own beliefs. But when we are taking care of patients, we actually have to see it. Even though we're advocating for them and we're their advocate, we have to make sure we're advocating the right way. That's in their best interest. Now, just getting into patient perspective, for me, it's like, what do you do when you're a nurse, but you're not the nurse or the patient, but you're actually a family member?
[00:13:18] How do you navigate being in that position when it's not your child that's younger than 18 years of age? So what do you do? What do you do? I think for me, I struggled recently. Struggled with knowing, wanting to know enough to advocate for my loved one. And then on the flip side, not wanting to be that person that nursing staff can see from a mile away because you're coming in with all the demands, right? It's like, as a nurse, we know, like, I really want you to order X, Y, Z. I need for you to get them up. I need for you to bathe them. I need. I need all these things.
[00:13:53] But how do you just, as a nurse, be a family member? I think I wanted to just throw that out there when it comes to patient perspective and think about, you know, being in the position of being the family member of a patient that's near and dear to me. It really makes me think about the nursing code of ethics and how others actually treat patients. And, you know, we sit here, we get to observe how other nurses are nursing. Not to say they're doing anything wrong, but at the same time, it's like, I felt helpless, and I felt like I have all this knowledge, but I have no control over the narrative, I have no control over the outcome. But luckily, my loved one made it home in that. You know, witnessing healthcare from the other side of it, I got to see how providers can make decisions from their specialty. But then it's like nobody's talking to each other or they fail to provide what I feel is individualized care. Like, did y'all even talk to each other before you ordered this medication? Given a person's age, giving a person's history, health history, what may have been eligible for them early on in life may not be eligible for them now when it comes to a form of treatment. And so I think that we have to be mindful of that as healthcare providers, because would you do open heart surgery on a 90 year old patient versus a 40 year old patient just based off age alone? I probably wouldn't. I wouldn't take the risk. So it's like, at what point do we, because of the patient's treatment or the standard of care that comes with a diagnosis, how do we make sure that it is still individualized for that patient, for that patient? Because one thing that we have learned is that we learn textbooks, but then we get in here and we face reality and some patients are just different. I remember having a patient who was frequent with high blood sugars come in with DKA and would come out of the icu and of course they would have all the snacks. And I can remember in my young nursing mind, I'm like, I'm going to get their blood sugar down to normal and I'm going to just continue to educate them, y'all. A normal blood glucose for this patient was like hypoglycemia because their body was so used to running at high levels. And so I actually had to call the physician, give that patient a half an amp of dextrose, and by the time the physician walked up, the patient was coming back too. And I had only got the glucose down to like 100 and something. But because this patient was used to glucose levels running at like 3, 4, 5, 6, 700, it's like 100 was like hypoglycemia for this patient. So that taught me that, hey, treat your patient, be mindful of your patient, make sure the care is safe for them, even though it's standard protocol or insulin protocol, all that it was unsafe for that patient because their body was so used to running at a higher level blood glucose level, which was crazy, I promise you, crazy. But I've seen it. And another thing is that I love that we're considering the patient's social determinants of health. And this goes back to like the environment in which they live in the support system. They may have their finances, not just their finances, but their access to healthcare. Like, I think that that is a big portion, a big portion of what influences their outcome as well. And so I love that, you know, as a nurse, you may say, Chanel, I don't have time for a lot of this, but I promise you it is like the foundation of that individualized care plan for that patient. When you honestly go in and you ask that patient, how are you doing?
[00:17:53] How's your day been? And just let the patient talk, like for introverts. And one thing I point out is that introverts, they are very observant and they're good listeners.
[00:18:03] They're good listeners because they don't want to talk anyhow. So I encourage you to go in and listen to your patient. And listening will tell you a lot about that patient because we can know so much. We can know diabetes like the back of our hand, heart failure like the back of our hand, post op care for patients that undergo coronary artery bypass grafts. Right, like the back of my hand. But that means nothing to that patient if I'm not listening to that patient and what all of this means for that patient. So I act. So that's another thing that we have to consider. Just with that going right into my call to action for you to challenge yourself to identify the nursing code of ethics in your everyday, everyday practice. Because to be honest, you're doing it anyway. When you're abiding and you're abiding by hipaa, you're not sharing patients information, you're considering the patient throughout the day and you, and you're anticipating their needs and Nurs. Nursing 101 is performing a head to toe assessment, right? Doing that head to toe assessment and actually using a stethoscope. Yes, I said it. Actually taking in a stethoscope to listen to your patient's heart and lung sounds and actually touching your patient, do an assessment. And when you document, you document your work because you're doing all of this work and you're documenting it. So you document it accurately and then you communicate with other healthcare professionals. This is giving you a seat at the table, letting and communicating between teams, interdisciplinary teams. When you're doing your rounds, knowing what's going on with each patient. And I know you're like, chanel, I don't have time for this. But you do have Time. You do have time, because these are your patients that you get the pleasure of taking care of. And I just pat you on the back for even being in a position to take care of patients, being in the nursing profession, because is it easy at the bedside? Most of the time it's not. But is it worth it? Yes, it is. Especially if you go in with a positive attitude, if you go in with the right perspective and the right heart posture. It is a really great profession to be in. And the best thing about it, continue to grow. Whatever that means for you, whether it's personally in your role as a nurse, like whatever that growth means to you. I pray that you will grow in every area of your life and really just consider what matters to you so that you can show up authentically in the space of a nurse, right? That you're not trying to juggle being one way in one area of your life and then being another way in another area of your life, but to really show up authentically for yourself. And I just challenge you to really reflect on your own personal values, your own biases that you may have. And if you can truly set those biases aside and start to see the patient and really look at those 10 provisions that has been revised by the, by American Nurses association so that you can really just enhance your role that you're already performing anyhow as a nurse, so that we can really get back to the human side of healthcare, so that we can bridge that gap between the stethoscope and the sole, which is my mission statement for all one nurse. But I hope that this episode has left you feeling a little more empowered, a little more uplifted and ready and willing to continuously do the work that's needed in the nursing profession. And yes, you know, when we, when it comes to moral distress, we can actually talk about a lot the constraints by the healthcare organizations that a lot of nurses work for, the lack of resources, the lack of staffing. And let's not even get into workplace violence. And before we could talk about workplace violence, when we're talking about patients being violent to nurses, we also have to think about that culture of meanness. Like that culture that sometimes we as nurses sit on these nursing units in the hospital setting. Like, we have to really evaluate and leave a lot of that at the time clock because we're here for patients. Yes, I work in staff development, but I get to see y'all. I get to see a lot and I get to hear a lot because I help facilitate nursing orientation. And the worst thing ever is for nurses not to feel for a new nurse to feel like they cannot be genuinely happy about their new job and their new role as a nurse.
[00:22:43] We should not be intimidating. We should not be tearing them down. We should actually be doing our job. We should be caring for our patients and not cutting corners. Because a lot of the protocols that set in place by our organizations, hospitals and other organizations are meant to protect the patients and protect our license. You know, if you have a scanning feature, actually use it. Scan the patient's armband that's actually on the patient's arm, asking for their name and date of birth every time.
[00:23:13] And when it comes to, like, the 10 rights of safe medication administration, the one right that I love is the right to assess. If I give this patient this medication based on my assessment of them and of their record, reviewing their chart, all that good stuff, will I get the desired.
[00:23:31] Will I get the desired outcome if I gave them this medication? I think that alone is a great safety stop when it comes to just passing medications. Safe medication administration. But when we think about it, this nursing code of ethics is just really like the bible of what we do. And so hopefully you can just evaluate yourself in how you work in your daily practice. And I challenge you to just continue to grow on a scale when it comes to knowledge, when it comes to compassion, and when it comes to providing services in a way that's fair across the board, whether this patient is administrator, CEO, or they're homeless from the corner down the road. So how can we treat people fairly, fairly and provide healthcare to all individuals in a way that's equal? Now, in wrapping up this episode, let's talk about my new nurses and my nursing students. I would love to get with you on Patreon on Thursdays at 8pm Central Time to just spend an hour just connecting and talking in a more intimate space so that, you know, even if it just leads with how you're doing, even if it leads with you're having issues with one topic and one subject of nursing, and then we kind of dive into that subject or we get into prayer, words of affirmation, or just life and how to help navigate situations or challenges that you face. I'm just being honest. I still face them in the health care profession. And as for upcoming episodes, I would love to unpack men's health. And who better to talk about men's health than another man? And so I'm actually looking into a guest speaker who is well versed, very specialized, and a big men's advocate. And he's also a man. And so I'm really looking forward to it. So whenever he schedules will be dropping that episode as well. But we're going to talk about men's health so that we can kind of get past that masculinity and that stoicness that men have to where it affects their well being. Because if you actually look at studies, women live longer than men. So how do we get men to really own their health and start having conversations and not feeling like you can't. I need our men too be healthy just as well as U.S. women. Right. And then another topic I want to talk about is maternal health. I really want to talk about maternal mortality, especially in the United States, and how women of color are at a higher risk of dying. And so I just think that that's a really big topic too that I would like to unpack. And the month of May is Stroke awareness month. So I'm looking forward to a guest. We gotta talk about stroke because stroke affects so many people. And that's why it's another reason why men. It's important for men to know their health status, right? Because sometimes it's hard to get men to go seek care unless they really need to seek care. And I've also been in network or connecting with individuals who are not nurses. And so I'm really looking into like some bonus episodes because even though you're they're not a nurse, they're still passionate about self care, passionate about mental well being and things like that. So it's like how do we get these individuals just to supplement what my nurses speak on. And so I'm excited about that as well. Now, before I leave you today, I want you to just be mindful to keep learning through ongoing education and through self reflection as tools to remain ethically sound and ethically grounded. Now, until next time, let your light shine.
