1. Diggins, Kristene

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As a Christian advanced practice nurse, I have found my spiritual convictions must govern how I respond to ethical dilemmas in the workplace environment. As APNs we often are in leadership roles in nursing, and how we respond to ethical/moral conflict can set the example for other nurses. We may not realize that our decisions may influence clinicians around us. Because of this, we must prayerfully consider how to respond in moments of ethical dilemma. Biblical principles such as "do to others what you would have them do to you" (Matthew 7:12, NIV) are foundational.

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I have often thought about the influence my decisions in ethical situations can have on nurses with whom I work. Sekerka and Bagozzi (2007) have asked, "What induces people to act in morally courageous ways as they face an ethical challenge in the workplace?" They note that nurses practice with moral courage when they are confronted with situations that pose a direct threat to patient care.


The role APNs can play in ethical problem solving became clearer when I worked with a particular geriatrician in a long-term-care facility. As nurses, we sometimes felt he was overly cautious and did not allow all the care that could be provided for patients in the nursing home setting. For me, this came to a moment of crisis where I had to stand up to him, and in so doing stand for the biblical principle of the dignity of life.


One day a nursing home patient, whom I'll call Mary, stopped breathing. As nursing staff administered lifesaving measures, I went to call 911 for emergency response services. This physician pulled me aside and told me that it is often best to avoid heroic measures in nursing homes. He kindly suggested I not call for emergency care even though we thought she was having a heart attack. When I finally understood he was suggesting we let the patient die, I looked him in the eye and told him I could not do that and continued with the phone call. Emergency medical services (EMS) arrived and provided care, but Mary died before she was transferred to the ambulance. Although she had dementia, she did not have other chronic health conditions and appeared to live a satisfying life in our care home. We later learned she died of a massive heart attack.


As I looked on with the other nurses during Mary's care by EMS, I thought about the value of each individual life. It occurred to me I could not have lived with myself if I had not called EMS. She did not have a DNR (do not resuscitate) order in her chart. Neither she nor her family had reached the decision to not extend lifesaving measures. Although the outcome was not what I had hoped, I thought about Jesus' challenge to care for everyone, even those society labels as the least of these (Matthew 25:40). As Christian nurses, we are called to care for everyone he puts in our path according to his compassion, as well as to respect his/her wishes.


After this experience, other nurses began to question physician orders when they were concerned that care patients needed or patients and families requested was not being provided. Some thought care in the home improved, including care this geriatrician authorized for his patients.


Mary's death gave me the opportunity to remember how important it is for me to live out biblical principles in the workplace. It was a humbling and sobering experience to realize standing up for my convictions could influence other nurses around me. As I reflect on Jesus' words to "do to others what you would have them do to you," I begin to grasp how important this principle is in our day-to-day work as nurses. The "ethic of care" we provide is not a set of hard and fast rules. Rather, it is a way of practicing based on a foundation of Christ-like love, compassion, and confidence.


Sekerka, S., & Bagozzi, R. (2007). Moral courage in the workplace: moving to and from the desire and decision to act. Business Ethics: A European Review, 16, 2, 132-135. [Context Link]