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Cynda Hylton Rushton is the Anne and George L. Bunting Professor of Clinical Ethics in the Johns Hopkins Berman Institute of Bioethics and the School of Nursing, with a joint appointment in the School of Medicine’s Department of Pediatrics. A founding member of the Berman Institute of Bioethics, Dr. Rushton co-chairs the Johns Hopkins Hospital’s Ethics Committee and Consultation Service. An international leader in nursing ethics, Dr. Rushton in 2014 co-led the first National Nursing Ethics Summit, convened by the Johns Hopkins Berman Institute of Bioethics and School of Nursing. The Summit, supported by strategic partners from nine national nursing organizations and seven collaborating organizations, developed a Blueprint for 21st Century Nursing Ethics. Her current scholarship in clinical ethics focuses on moral distress and suffering of clinicians, the development of moral resilience, palliative care, and designing a culture of ethical practice.

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On a daily basis, nurses face ethical challenges and are confronted with situations where there are competing values and interests. The ethical questions are many: How should nurses respond when there are limited human and material resources? How do we decide who is going to receive a scarce organ? How do we create fair and equitable access to basic health care? And how do we balance a patient’s possibility for improvement with the potential for suffering due to treatment?

These issues aren’t isolated, and in fact, they are woven into the practice of nurses in all levels and settings. Isabel Hampton Robb, first superintendent of nurses at the Johns Hopkins Hospital and principal of its training school, had a keen awareness of how ethical issues affected practice among the nurses she led. She authored the first ethics textbook for nurses in the United States and set the groundwork for the American Nurses Association’s Code of Ethics used today. The code, most recently revised in 2015, is a non-negotiable set of ethical guidelines that gives guidance to nurses and provides a framework for navigating and assessing options that are aligned with ethical values.

Often times, I think we see ethics as an extra or something separate from the care we provide patients, but we need to be competent and explicit in the ways we think and address ethical issues. So, how do we get there?

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