tools to stay psychologically and physically whole.” (pg. 1). Healthcare organizations also bear
responsibility for managing risk and protecting nurses. To manage such risk and protections,
healthcare organizations should have in place policies and procedures which address such items as:
conscientious objection, grievances, complaints, compliance reporting, root cause analysis, resource
allocation, etc. Nurses should be able to communicate any identified risks through the appropriate
organizational channels so adequate safeguards can be initiated. Although this Bill of Rights for
Registered Nurses addresses professional rights and is not a legal document, nurses have an ethical
responsibility to know the legal obligations and protections provided in the state(s) where they
practice.
• Organizational support for the registered nurse is a non-negotiable necessity. Healthcare
organizational leaders, administrators, managers, and providers need to understand contracted,
mutually accepted employer-employee expectations during such times where nurses may struggle
with the parameters of any work or volunteer requirement(s). It is incumbent upon the particular
healthcare organization to provide adequate safeguards such as risk-reducing equipment, enforce
protective procedures that minimize risk, educate staff members concerning risks, and engage in
research to identify actual and potential risks that impact nursing care. Leaders who model
transparent decision making and self-care, while advocating for nurses’ safety, wellbeing, and
resiliency, meaningfully inform healthy work environments. It is crucial for nurses, and their
employers, to fully consider the importance of taking care of physical, mental, and emotional needs.
Background
Even with the benefit of early recognition and guidelines for prevention, nurses experience increased
personal risk while providing patient care. Potential risks include exposure to: pandemic viruses,
cytomegalovirus, hepatitis, human immunodeficiency virus, severe acute respiratory syndrome, the threat
of bioterrorism agents, bubonic or pneumonic plague, smallpox, Ebola virus disease, other emerging
infectious diseases, violence in the community, and natural or man-made disasters. Violent and combative
behaviors of patients also pose dangers to nurses. Catastrophic events can require nurses to evaluate their
risk and responsibility for patients in unique and unimaginable situations. Workplace dilemmas may be
present in a variety of settings, including acute and chronic care facilities, community clinics, home care, and
schools, among others.
Provision 2 of the Code states that “the nurse’s primary commitment is to the patient” (p. 5) and provision 5
states that “the nurse owes the same duties to self as to others” (p. 19). These obligations can conflict, for
example, during pandemics when nurses must continually care for critically ill infectious patients, often
under extreme circumstances including insufficient or inadequate resources and uncontained contagion.
Nurses must decide how much care they can provide to others while also taking care of their own health
and well-being. Nurses struggle with feeling physically unsafe in these response situations, where scarce
resources exist and such items as personal protective equipment (PPE) may be inadequate. Nurses are
concerned about professional, ethical, and legal protection when asked to provide care in such high-risk
situations, such as a pandemic (Ulrich et al., 2020). They must be supported in these very difficult decisions
by the organizational systems in which they provide care and by society.
For assistance in resolving questions about risk and responsibility, “nurses must engage in discernment,
carefully assessing their intentions, reflectively weighing all possible options and rationales, and formulating
clear moral justifications for their actions. Only in extreme emergencies and under exceptional conditions,
whether due to forces of nature or to human action, may nurses subordinate human rights concerns to
other considerations. This subordination may occur when there is both an increase in the number of ill,
injured, or at-risk patients and a decrease in access to customary resources and healthcare personnel” (ANA,
2015, p. 33).