The nurse promotes, advocates for, and strives to
protect the health, safety, and rights of the patient.
3.3 Protection of participants in research
3.4 Standards and review mechanisms
3.5 Acting on questionable practice
3.6 Addressing impaired practice
The nurse safeguards the patient’s right to privacy. The need for health care does
not justify unwanted intrusion into the patient’s life. The nurse advocates for an
environment that provides for sufficient physical privacy, including privacy for
discussions of a personal nature and policies and practices that protect the confidentiality
Associated with the right to privacy, the nurse has a duty to maintain confidentiality
of all patient information. The patient’s well-being could be jeopardized and the fundamental trust between patient and nurse destroyed by unnecessary access
to data or by the inappropriate disclosure of identifiable patient information. The
rights, well-being, and safety of the individual patient should be the primary factors
in arriving at any professional judgment concerning the disposition of confidential
information received from or about the patient, whether oral, written or electronic.
The standard of nursing practice and the nurse’s responsibility to provide quality
care require that relevant data be shared with those members of the healthcare
team who have a need to know. Only information pertinent to a patient’s treatment
and welfare is disclosed, and only to those directly involved with the patient’s care.
Duties of confidentiality, however, are not absolute and may need to be modified
in order to protect the patient, other innocent parties, and in circumstances of
mandatory disclosure for public health reasons.
Information used for purposes of peer review, third-party payments, and other
quality improvement or risk management mechanisms may be disclosed only under
defined policies, mandates, or protocols. These written guidelines must assure
that the rights, well-being, and safety of the patient are protected. In general, only
that information directly relevant to a task or specific responsibility should be
disclosed. When using electronic communications, special effort should be made
to maintain data security.
3.3 Protection of participants in research
Stemming from the right to self-determination, each individual has the right to
choose whether or not to participate in research. It is imperative that the patient
or legally authorized surrogate receive sufficient information that is material to an
informed decision, to comprehend that information, and to know how to discontinue
participation in research without penalty. Necessary information to achieve an
adequately informed consent includes the nature of participation, potential harms
and benefits, and available alternatives to taking part in the research. Additionally,
the patient should be informed of how the data will be protected. The patient has
the right to refuse to participate in research or to withdraw at any time without
fear of adverse consequences or reprisal.
Research should be conducted and directed only by qualified persons. Prior to
implementation, all research should be approved by a qualified review board to
ensure patient protection and the ethical integrity of the research. Nurses should
be cognizant of the special concerns raised by research involving vulnerable groups,
including children, prisoners, students, the elderly, and the poor. The nurse who
participates in research in any capacity should be fully informed about both the subject’s and the nurse’s rights and obligations in the particular research study
and in research in general. Nurses have the duty to question and, if necessary, to
report and to refuse to participate in research they deem morally objectionable.
3.4 Standards and review mechanisms
Nursing is responsible and accountable for assuring that only those individuals
who have demonstrated the knowledge, skill, practice experiences, commitment,
and integrity essential to professional practice are allowed to enter into and continue
to practice within the profession. Nurse educators have a responsibility to
ensure that basic competencies are achieved and to promote a commitment to
professional practice prior to entry of an individual into practice. Nurse administrators
are responsible for assuring that the knowledge and skills of each nurse
in the workplace are assessed prior to the assignment of responsibilities requiring
preparation beyond basic academic programs.
The nurse has a responsibility to implement and maintain standards of professional
nursing practice. The nurse should participate in planning, establishing,
implementing, and evaluating review mechanisms designed to safeguard patients
and nurses, such as peer review processes or committees, credentialing processes,
quality improvement initiatives, and ethics committees. Nurse administrators
must ensure that nurses have access to and inclusion on institutional ethics
committees. Nurses must bring forward difficult issues related to patient care
and/or institutional constraints upon ethical practice for discussion and review.
The nurse acts to promote inclusion of appropriate others in all deliberations
related to patient care.
Nurses should also be active participants in the development of policies and
review mechanisms designed to promote patient safety, reduce the likelihood of
errors, and address both environmental system factors and human factors that
present increased risk to patients. In addition, when errors do occur, nurses
are expected to follow institutional guidelines in reporting errors committed or
observed to the appropriate supervisory personnel and for assuring responsible
disclosure of errors to patients. Under no circumstances should the nurse participate
in, or condone through silence, either an attempt to hide an error or a
punitive response that serves only to fix blame rather than correct the conditions
that led to the error.
3.5 A cting on questionable practice
The nurse’s primary commitment is to the health, well-being, and safety of the
patient across the life span and in all settings in which healthcare needs are
addressed. As an advocate for the patient, the nurse must be alert to and take
appropriate action regarding any instances of incompetent, unethical, illegal, or
impaired practice by any member of the healthcare team or the healthcare system
or any action on the part of others that places the rights or best interests of the
patient in jeopardy. To function effectively in this role, nurses must be knowledgeable
about the Code of Ethics, standards of practice of the profession, relevant
federal, state and local laws and regulations, and the employing organization’s
policies and procedures.
When the nurse is aware of inappropriate or questionable practice in the provision
or denial of health care, concern should be expressed to the person carrying
out the questionable practice. Attention should be called to the possible detrimental
affect upon the patient’s well-being or best interests as well as the integrity of
nursing practice. When factors in the healthcare delivery system or healthcare
organization threaten the welfare of the patient, similar action should be directed
to the responsible administrator. If indicated, the problem should be reported to
an appropriate higher authority within the institution or agency, or to an appropriate
There should be established processes for reporting and handling incompetent,
unethical, illegal, or impaired practice within the employment setting so that such
reporting can go through official channels, thereby reducing the risk of reprisal
against the reporting nurse. All nurses have a responsibility to assist those who
identify potentially questionable practice. State nurses associations should be
prepared to provide assistance and support in the development and evaluation of
such processes and reporting procedures. When incompetent, unethical, illegal, or
impaired practice is not corrected within the employment setting and continues to
jeopardize patient well-being and safety, the problem should be reported to other
appropriate authorities such as practice committees of the pertinent professional
organizations, the legally constituted bodies concerned with licensing of specific
categories of health workers and professional practitioners, or the regulatory agencies
concerned with evaluating standards or practice. Some situations may warrant
the concern and involvement of all such groups. Accurate reporting and factual
documentation, and not merely opinion, undergird all such responsible actions.
When a nurse chooses to engage in the act of responsible reporting about situations
that are perceived as unethical, incompetent, illegal, or impaired, the professional organization has a responsibility to provide the nurse with support and assistance
and to protect the practice of those nurses who choose to voice their concerns.
Reporting unethical, illegal, incompetent, or impaired practices, even when done
appropriately, may present substantial risks to the nurse; nevertheless, such risks
do not eliminate the obligation to address serious threats to patient safety.
3.6 Addressing impaired practice
Nurses must be vigilant to protect the patient, the public, and the profession from
potential harm when a colleague’s practice, in any setting, appears to be impaired.
The nurse extends compassion and caring to colleagues who are in recovery from
illness or when illness interferes with job performance. In a situation where a
nurse suspects another’s practice may be impaired, the nurse’s duty is to take action
designed both to protect patients and to assure that the impaired individual receives
assistance in regaining optimal function. Such action should usually begin with
consulting supervisory personnel and may also include confronting the individual
in a supportive manner and with the assistance of others or helping the individual
to access appropriate resources. Nurses are encouraged to follow guidelines outlined
by the profession and policies of the employing organization to assist colleagues
whose job performance may be adversely affected by mental or physical illness or
by personal circumstances. Nurses in all roles should advocate for colleagues whose
job performance may be impaired to ensure that they receive appropriate assistance,
treatment and access to fair institutional and legal processes. This includes
supporting the return to practice of the individual who has sought assistance and
is ready to resume professional duties.
If impaired practice poses a threat or danger to self or others, regardless of
whether the individual has sought help, the nurse must take action to report the
individual to persons authorized to address the problem. Nurses who advocate
for others whose job performance creates a risk for harm should be protected
from negative consequences. Advocacy may be a difficult process and the nurse
is advised to follow workplace policies. If workplace policies do not exist or are
inappropriate—that is, they deny the nurse in question access to due legal process
or demand resignation—the reporting nurse may obtain guidance from the professional
association, state peer assistance programs, employee assistance program
or a similar resource.
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