RWJF Executive Nurse Fellow Brings Nursing Perspective to Bioethics

Jan 14, 2015, 9:00 AM

Cynda Rushton, PhD, RN, FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics and a professor of nursing and pediatrics at Johns Hopkins University. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2006-2009). In 2014, she was named a Hastings Center Fellow for her work in bioethics.

Human Capital Blog: Congratulations on being named a 2014 Hastings Center Fellow. What does this fellowship mean for you and your career?

Cynda Rushton: It’s a wonderful honor to be included in this interprofessional group of scholars of bioethics. It’s a terrific opportunity to cross-pollinate with great thinkers and leaders and to think about some of the most vexing ethical issues in health care. It’s going to be a rich container for dialogue, learning, and leadership.

HCB: How will the fellowship work?

Rushton: Fellows have the opportunity to help guide the direction of the Hastings Center, which is an independent, non-partisan and nonprofit bioethics research institute in New York. The center’s mission is to address fundamental ethical issues in the areas of health, medicine, and the environment, and we’ll be bringing up issues that we think deserve more in-depth scholarship and research. This summer, we’re having a retreat where we will be able to work together around issues of common concern, particularly in the area of bioethics.

HCB: What will you focus on as a fellow?

Rushton: My focus has been on how to create a culture of ethical practice in health care. I’m interested in what is required to create that culture and what kind of individual competencies need to be in place to support people to practice ethically and reduce moral distress.

HCB: Would you describe the health care system as an ethical place to practice now?

Rushton: Of course, people are practicing ethically to the extent they’re able to in the environment where they work. But this is a particularly important time to reorient ourselves back to our values and be very intentional about putting in place both individual competencies and support systems that enable people to do that. There is plenty of room for improvement and innovation.

HCB: How will your background in nursing influence your fellowship?

Rushton: There are just a few nurses who are fellows of the Hastings Center. My participation is an opportunity to bring the perspective of nursing into bioethics. I think it’s an important opportunity to infuse the perspective of nursing into the bioethics conversation.

HCB: Why are more nurses needed in conversations about bioethics?

Rushton: Nurses are at the point-of-care and have an orientation toward whole-person care. Their perspectives differ from physicians and policymakers because of that very intimate connection to the lives of patients and their loved ones. Often, nurses are aware of ethical issues that other disciplines overlook. Take the Ebola virus, for example. The fact that nurses did not have sufficient training or equipment to treat people with Ebola is a complex ethical issue. When nurses are asked to provide care, they are ethically required to do so. But in this case, treating patients with Ebola meant putting themselves at personal risk without the necessary safeguards.  

HCB: What other ethical challenges do nurses face today?

Rushton: Nurses struggle when they are not able to provide the care or services they believe their patients need and when they have to determine whether the care they are providing is promoting quality-of-life or simply prolonging suffering at the end of a patient’s life. They grapple with issues around privacy and access to information in the electronic age; the appropriate use of technological advances in medicine; and the balance between a health care institution’s financial concerns and quality and safety concerns for patients.

HCB: Does the field of ethics represent a new frontier for the nursing profession?

Rushton: That’s a very interesting question. From the very beginning of our profession, all the way back to Florence Nightingale, ethics has been a part of nursing practice, and the Code of Ethics for Nurses has been a longstanding guide for the profession. The Institute of Medicine’s report on the nursing profession, however, was largely silent on ethical aspects of nursing practice. We can’t think about the future of nursing without having a strong foundation of ethics. There’s more and more evidence that nurses must be more skilled in how to recognize and address ethical issues in everyday practice, wherever that practice is. That is part of what I’ll be doing as a Hastings Center Fellow. The center has already identified some key areas of interest, but I will have an opportunity to help refine that strategic agenda.

HCB: Did your experience as an RWJF Executive Nurse Fellow prepare you for this role and, if so, how?

Rushton: The RWJF fellowship was truly an incredible learning experience. Every single element was valuable in deepening my leadership capacity and my ability to work on complex ethical problems. One of the things I valued the most about the fellowship was that it gave me the opportunity to reach out to people outside of my profession and gain new ways of seeing things and new frameworks for addressing problems.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.