Learn to become
an ethics leader
EDITOR'S NOTE: Janice Petrella Lynch, MSN, RN, is nurse editor/nurse executive. Also a nursing educator, she has held faculty positions at Wagner College, Skidmore College, Molloy College and Adelphi University. Jan is a member of the New York Organization of Nurse Leaders and the Greater New York Nassau-Suffolk Organization of Nurse Executives.
Two Delaware RNs are demonstrating how nurses' clinical skills and experience are the tools needed to successfully lead ethics committees. And they're spreading the word, so other nurses can do the same.
Andrea Holecek, EdD, MSN, MBA, APRN, AOCNS, NE-BC, FACHE, senior director of patient care services, Milford Magnet Program, director, Bayhealth Medical Center, Milford, Del., and Angeline Dewey, MSN, APRN, ACNS-BC, CCRN, CNRN, a clinical nurse specialist in the ICU and neurosurgical ICU, at Bayhealth's Kent, Del., campus have developed and advanced the role of nursing on the ethics committee at Bayhealth.
Building collateral respect and mutual trust with all healthcare team members takes time, but it is essential.”
— Andrea Holecek, RN
For nurses to serve as strong committee leaders, they need full support from the organization’s physicians and administration. "Building collateral respect and mutual trust with all healthcare team members takes time, but it is essential," Holeck said. "RNs are in the best position to ensure a patient-centered focus and interprofessional guidance in the ethical decisions patients and their families must make."
To serve as primary facilitator of the ethics committee, nurses must have a thorough understanding of what it means to collaborate with many disciplines. They should be able to appreciate various points of view and lead effective interprofessional meetings. Along with excellent leadership skills, the facilitator will serve as a reliable resource for RN consults, mentor new RN members and lead interprofessional debriefings as a way for the team to learn from past experiences, Holecek said.
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Get educated, be flexible and problem solve
Nurses who lead their workplace ethics committee need to educate themselves and keep abreast of the latest information and issues in healthcare ethics and must possess a passion to advocate for their patients and families, according to Holecek. They need to be flexible when working with others, not only with their time, but also in their thinking. For example, it is important they understand the patient’s right to make independent decisions that may differ from their own, said Dewey.

As creative problem-solvers, nurses can help incorporate unique patient preferences and family needs into care planning. "Nurses are working right within their scope of practice when they perform ethics consultations, that is assess, critically think, recommend and implement interventions and then reassess for the effectiveness of those interventions," Dewey said.
When leadership embraces the nurse-led interprofessional model, it empowers nurses to ultimately provide better service to patients and their families, Holecek and Dewey said. Nurses involved in ethics committees are those who are willing to go above and beyond their daily responsibilities and provide valuable insight and input into patients’ plans of care. In doing so, nurses will see increased numbers of staff-initiated consults and improved knowledge and communication of staff and the healthcare community at large on ethical issues.
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Embrace interprofessionalism
Plan for the future
To address turnover of ethical consultants, consider implementing an ongoing, formal education program for nurses who want to join the committee. Over time, as the ethical consult process is refined, nurses also can find ways to educate healthcare professionals in the community to be more proactive in advanced care planning with their patients.
Many institutions use a physician-led model for their ethics committees or involve their legal department, according to Dewey. “Our nurses do a wonderful job in performing ethical consultations and leading the team," she said. "It makes perfect sense since they are the ones who spend the most time with our patients and their families. I am proud to be a member of a committee in which nurses work closely with their interprofessional colleagues to provide patient-centered recommendations.”
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Nurses on call: A nurse on call for ethics consultations is the primary contact when an ethics consult is ordered. The nurse is contacted and begins the consultation process, which involves speaking with the clinician ordering the consult, performing a chart review and meeting with the patient, family and/or interprofessional team to determine the ethical questions and possible solutions.
Ethics consultation: The nurse on call for ethics consultations performs a brief consult by phone with the clinician who ordered it. At Bayhealth, the patient, family members, a clinician, or an employee can consult the ethics team, Dewey said. The nurse on call reviews the chart and speaks with the patient's primary nurse. Together they identify ethical questions. At Bayhealth, there is a formal ethics consultation template in the patient record that includes the patient's history, the individuals involved. It also contains information about advance directives, medical power of attorney or surrogate decision makers, issues of the case, and risk considerations and recommendations, according to Angeline Dewey, MSN, APRN, ACNS-BC, CCRN, CNRN. "The nurse completes the consultation and a summary of the formal consult is communicated via phone and/or in person to the requesting clinician, patient and family," she said.
Nurses' roles on ethics committees
Before 2009, the Bayhealth ethics committee was primarily led by physicians, although nursing and other interdisciplinary team members participated in quarterly meetings for case reviews. Ethical consults, however, were almost entirely completed by physicians, with little to no input from nursing.

Bonnie Perratto, MSN, RN-NEA, MBA, FACHE, senior vice president and CNE at the medical center, joined the committee in 2009 and knew that a greater nursing presence was needed for the committee to be interdisciplinary. Already a member, Holecek started by recruiting representatives from nursing to join the ethics committee. She and Dewey then began taking ethics calls, rotating with the facility’s on-call physicians. At present, there are about a dozen nurses who sit on the committee, and eight of them are performing ethical consultations.
Holecek and Dewey presented how they have advanced the role of nursing on the facility's ethics committee at the Magnet conference held in October 2016, in Orlando, Fla. Here they share some of their advice on how nurses can serve as leaders on their organizations’ ethics committees.
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