July 8, 2020

Honesty and Ethical Standards Among Nurses, Part 1: First Reactions

If you are a nurse, you have most likely heard by now that yet another Gallup poll indicates that nurses are viewed by the American public as most honest and ethical among a range of occupations. Gallup has been studying U.S. public opinion of the honesty and ethical standards of various occupations since 1976. Nurses were included in the survey beginning in 1999. Since then, with the exception of 2001, when firefighters were included following the World Trade Center attack, nurses have topped the list by a comfortable margin.

The results of this poll were published in December 2018. For nurses, the trend simply continues, and it is almost monotonous to hear about it from the management level within health care organizations. Personally, for a variety of reasons, I do not react with excitement when I hear the Gallup results touted in my organization. I actually have mixed feelings about such results, and I would like to think through a few of the reasons for my reaction in this and upcoming posts. I am only one nurse among many, many nurses in the United States, and what I offer here are my opinions on this matter. Still, I believe my opinions make some sense of the reality of our times in health care.

It strikes me as rather awkward that I have never heard any of my fellow bedside nurses mention this trend in ratings, and I have often wondered why that is. As I said, I have frequently heard the trend cited, although not the source, by management in my organization. People act for reasons, generally. So, I think there must be a reason management senses a need to reiterate the Gallup result, whereas there may be no perceived benefit for bedside nurses to cite the result.

Nursing as a profession is engaged in what will probably show itself to be a generations-long process of upgrading the actual knowledge and expertise as well as the interprofessional reputation of nursing. Unlike the contemporary medical profession–and the biomedical research fields from which it is derived and with which it is allied–nursing has struggled to establish itself as worthy of the social cachet afforded to those other natural science-allied fields. Consider the current trends toward degree inflation in nursing, whereby the BSN is becoming the new ASN/ADN and the DNP is similarly surpassing the MSN. Consider also the abundance of PhD programs in natural science and other traditional fields versus the relative scarcity of PhD programs in nursing schools.

In this context, I believe the frequency of citing the Gallup poll trend by nursing managers and leaders is intended in part to bolster the interprofessional prestige of nursing relative to medicine and the natural sciences. In addition, there is a certain amount of buy-in that must be achieved from nurses generally. For nursing to succeed in elevating its reputation as a field, nurses must believe in their product, so to speak. This belief will positively reinforce public perception of the honesty and ethical standards of nurses.

However, the reality of bedside nursing is not always consistent with enthusiastic affirmation of this rating trend. Bedside nursing is grueling, and nurses are frequently placed in no-win situations. Resources, both material and personnel, are often seemingly insufficient. The ethical dilemmas that thus arise from the work environment of nurses can easily leave nurses questioning their own integrity. On one hand, this is a reason management may reiterate the Gallup result. On the other, do nurses even believe what Gallup says the American public thinks of them? Does the answer to that question make any nursing shift easier to navigate?

I have known enough nurses and observed enough of the work of nurses to say that many do occasionally succumb to unethical behaviors. While I do not condone any unethical behavior on the part of nurses, I would suggest that many nurses make little of such poll trends because they either do not see themselves as honest or ethical or because they suspect the opinions of the American public are not standards by which they should measure themselves.

If there is a basis for honest and ethical standards in nursing–and I believe there is–it cannot be found in public relations or interprofessional reputation. It must be derived from transcending ideals or standards. In many ways, the same standards that govern nurses’ behavior in their work as nurses govern their personal lives as well. Perhaps we should be considering how we can promote wholeness among nurses in this regard as a way to increase overall integrity and thereby bring the Gallup poll trend into alignment with the reality of nursing life.

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