ingly important in health care ± in the form of evidence based guidelines ,clinical
governance ,performance management and so on. Certainly the good nurse must
take the latter into account and will ,by and large ,be happy to work towards
publicly defined standards. But a nurse who has not only a sense of his or her
personal accountability as a professional but also a strong sense of ethical integrity,
and embodies nursing virtues such as courage ,will want to aim above' public standards and ± where necessary ± critique ,challenge or expose them. A number of the ethics authors in the second half of this book point to ways in which ethics can be personally more demanding than the requirements of the law or of pro- fessional norms. Hence ,in the end ,a serious engagement with ethics highlights some of the tensions between nursing as an ethical role and nursing as a professional or legal or institutional role ± between the individual nurse and the nurse as part of the system. It is plausible to suggest that in the few years since the first edition of this book was published there has been a substantial increase in these kinds of ten- sions ,and hence a heightening of importance for nursing ethics. On the one hand more and more emphasis is given to personal accountability in an ever growing range of health care agendas and settings. On the other hand there is a develop- ment and consolidation of both national and institutional policies ,frameworks and guidelines. In many respects nurses are expected todo everything' ± including
to be both personally responsible and to jump through other people's hoops!
This suggests that as well as cultivating courage nurses increasingly need to
cultivate a form of constructive scepticism. They need ,for example ,to engage
constructively with the systems of clinical governance that are put in place within
their institution. Many things depend upon institutional systems and standards
being in place. However ,if they see aspects of these systems as misguided or
ineffective ± or if they find that they seem to be expressed only in apparently
meaningless and self-referential jargon ± they ought to explore means of saying so.
In the health service the emperor is often quite naked and real standards some-
times depend upon people pointing this out!
So developing one's own personal standards is essential ,but it is not a sufficient
basis for establishing good nursing. Individual nurses cannot be expected to pull
themselves up by their own boot straps. Only the exceptional few could achieve
high ethical standards in an unethical environment. It is essential that the cultures
and institutions of nursing foster the virtues of nursing. This is why it is important
to continue the shift towards a philosophy of nursing founded upon ethical
commitments. This is why it is important to have professional values and stan-
dards articulated in public documents and policies. This is why it is important for
nurses to be able to debate the underlying principles and the particulars of ethics.
2.7 Notes and references
- Macleod Clark ,J. 61993) From sick nursing to health nursing: evolution or revolution? In
Research in Health Promotion and Nursing6eds Wilson-Barnett ,J. & Macleod Clark ,J.
Macmillan ,Basingstoke. - Oakeshott ,M. 61962) The Tower of Babel. InRationalism in Politics.Methuen ,London.
TheEthicalDimension 29