The nurse participates in establishing, maintaining, and improving
healthcare environments and conditions of employment conducive
to the provision of quality health care and consistent with the
values of the profession through individual and collective action.
6.1 Influence of the environment on moral virtues and values
6.2 Influence of the environment on ethical obligations
6.3 Responsibility for the healthcare environment
6.1 Influence of the environment on moral virtues and values
Virtues are habits of character that predispose persons to meet their moral obligations;
that is, to do what is right. Excellences are habits of character that predispose
a person to do a particular job or task well. Virtues such as wisdom, honesty, and
courage are habits or attributes of the morally good person. Excellences such as
compassion, patience, and skill are habits of character of the morally good nurse.
For the nurse, virtues and excellences are those habits that affirm and promote
the values of human dignity, well-being, respect, health, independence, and other values central to nursing. Both virtues and excellences, as aspects of moral character,
can be either nurtured by the environment in which the nurse practices or
they can be diminished or thwarted. All nurses have a responsibility to create,
maintain, and contribute to environments that support the growth of virtues and
excellences and enable nurses to fulfill their ethical obligations.
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6.2 Influence of the environment on ethical obligations
All nurses, regardless of role, have a responsibility to create, maintain, and contribute
to environments of practice that support nurses in fulfilling their ethical
obligations. Environments of practice include observable features, such as working
conditions, and written policies and procedures setting out expectations for nurses,
as well as less tangible characteristics such as informal peer norms. Organizational
structures, role descriptions, health and safety initiatives, grievance mechanisms,
ethics committees, compensation systems, and disciplinary procedures all contribute
to environments that can either present barriers or foster ethical practice
and professional fulfillment. Environments in which employees are provided fair
hearing of grievances, are supported in practicing according to standards of care,
and are justly treated allow for the realization of the values of the profession and
are consistent with sound nursing practice.
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6.3 Responsibility for the healthcare environment
The nurse is responsible for contributing to a moral environment that encourages
respectful interactions with colleagues, support of peers, and identification of issues
that need to be addressed. Nurse administrators have a particular responsibility
to assure that employees are treated fairly and that nurses are involved in decisions
related to their practice and working conditions. Acquiescing and accepting
unsafe or inappropriate practices, even if the individual does not participate in the
specific practice, is equivalent to condoning unsafe practice. Nurses should not
remain employed in facilities that routinely violate patient rights or require nurses
to severely and repeatedly compromise standards of practice or personal morality.
As with concerns about patient care, nurses should address concerns about the
healthcare environment through appropriate channels. Organizational changes are
difficult to accomplish and may require persistent efforts over time. Toward this
end, nurses may participate in collective action such as collective bargaining or
workplace advocacy, preferably through a professional association such as the state
nurses association, in order to address the terms and conditions of employment.
Agreements reached through such action must be consistent with the profession’s standards of practice, the state law regulating practice, and the Code of Ethics for
Nurses. Conditions of employment must contribute to the moral environment, the
provision of quality patient care and professional satisfaction for nurses.
The professional association also serves as an advocate for the nurse by seeking
to secure just compensation and humane working conditions for nurses. To
accomplish this, the professional association may engage in collective bargaining
on behalf of nurses. While seeking to assure just economic and general welfare
for nurses, collective bargaining, nonetheless, seeks to keep the interests of both
nurses and patients in balance.
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