Ethical Implications of Workarounds in Critical Care

Gallup pollsters repeatedly report that the public views the nursing profession as the most ethical and honest profession.¹  This level of public trust is humbling and is a reminder of the enormous responsibility the nursing profession bears. The American Nurses Association’s (ANA’s) Code of Ethics for Nurses²  provides the indisputable requirements for professional practice. One of the 9 provisions states, “the nurse promotes, advocates for and protects the rights, health and safety of the patient.” To fulfill this obligation, nurses must possess the clinical competence, wisdom, and skill to recognize situations that may undermine the quality and safety of patient care and work in systems that support them to do so.

Critical care nurses work in systems that are complex, rapidly changing, and beleaguered with financial and workforce pressures. One response to these challenges is to find alternative ways to make an insufficient or detrimental system work for...