By Patricia M Davidson, PhD, MEd, RN, FAAN


Prompted by the well-documented failings of systems to provide safe and reliable environments, there is an increased focus on the ‘quality and safety’ of health care.  Unpacking this nomenclature is important to ensure these important goals of reducing harm and promoting satisfaction are achieved.


A number of system, provider and patient factors contribute to an environment that promotes the quality and safety of health care. Understanding the interface and interaction of these discrete elements is critical for improving the way in which we, as health professionals, deliver health care and most importantly the level of satisfaction of patients, their families and communities.


In addition to the complex technical elements of health care, a range of systems and interpersonal interactions contribute to the level of quality and safety of health care. Put simply this relates to how we as a myriad of individuals, both professional and non-professional, function as a team. This involves respect for individuals as people, appreciating their unique contribution to the team and working together to achieve shared and negotiated goals. And beyond the rhetoric of person-centered care this also means that the patient is part of the team- front and center, for real. This model challenges the commonly expert-focused, hierarchical models of health care delivery.


The critically important and intensely human dimension of interactions often leads to ethical issues in how we interact with our colleagues and patients and also how we behave as health care professionals in promoting an environment that supports and enables a culture to promote ‘quality and safety’.


As a professional body, nurses have a duty of care to promote, monitor and deliver a safe environment for patients. This extends beyond our own individual practice to observing and monitoring the behaviors of others. Identifying inferior practices and acting on these is fraught without a system that identifies standards, monitor these and holds individuals accountable for these without fear of retribution. Sadly the literature on whistleblowers demonstrates the price that many individuals pay for taking a stand.


The situation of whistleblowers commonly occurs when individuals feel forced to act alone, often anonymously and commonly feel that their voice is unheard or unwelcome.


So what does this have to do with ethics? Well values of respect, dignity and trust are critically important. Within internationally recognized ethical frameworks:  nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering” (International Council of Nurses, 2012) .This is often easier said than done. It requires nurses to work collegially, respectfully and cohesively with their colleagues, be committed, credentialed and competent and also be prepared to have a voice.


However without a health care system that truly advocates for the principles of quality and safety and supports and values critique, reflection and a spirit of quality improvement, this important voice is often lost, lonely and disempowered.


So what do we need to do as nurses to support and enable this model of a health care system? Firstly, we have to talk about the vision of collegial and ethical practice that promotes the quality and safety of health care; secondly we have to model behaviors we consider trustworthy and respectful and thirdly, we have to be part of the wave of change. We need to be at decision making tables, having a voice and creating the system we want to be part of.


Join us in working out how to achieve this important vision and follow our conversation on Twitter at #nursingethics and watch for the exciting outcomes of our conference in August in Baltimore, where nurses from around the United States will discuss this important issue in health care.



Patricia M Davidson, PhD, MEd, RN, FAAN
Dean & Professor
Johns Hopkins University
School of Nursing

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Nursing Ethics
Patricia Davidson

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