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  1. Howland, Wendie A. MN, RN-BC, CRRN, CNLCP, LNCC via ajnoffthecharts.com

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"Promoting Nursing Students' Ethical Development in the Clinical Setting" (Teaching for Practice, November 2017) makes the explicit assumption that all clinical faculty are adequately prepared to behave and model ethically because they are nurses with experience in ethical challenges. However, "one would hope the instructor would stand up for what's right" does nothing to address instructor assessment, training, and preparation for clinicals. As we all know, hope is not a plan. So, I must disagree with the authors' characterization that "this type of instruction requires no formal background in ethics."

 

Deans and program directors might be excused for not requiring clinical faculty to have had a series of formal ethics classes, but they get no free pass to send clinical faculty into facilities without a clear set of expectations about ethical practice. The example of the "drug-seeking" patient is instructive; I know clinical faculty who would think nothing of agreeing with the staff nurse's assessment and passing along the bestowed wisdom of denying adequate pain relief to somebody with a "pill problem."

 

"And, without substantial background and formal training in the field of ethics, how can clinical instructors succeed?" Indeed.

 

In my experience, a seminar for faculty with scenarios on these issues in the weeks before clinicals begin would open some eyes-including those of deans. These scenarios should involve chronic pain patients ("drug seeking"), battered women ("Why doesn't she just leave him?"), the homeless ("lazy, unemployed, get a job") and addicted ("drug seeking, no willpower, no character"), undocumented people ("They think they deserve as much as real citizens"), ethnic/religious populations ("They don't value life/feel pain as much as we do anyway"), and people in legal custody ("Criminals don't deserve better treatment").

 

It was not that long ago that many nurses and clinical instructors behaved shamefully toward AIDS patients; some of the things I saw nurses do in those terrible times were not only ethically indefensible, but breathtakingly cruel. There is no reason for me to expect that things have changed that much with a new generation of nurses at work; there's always a "less deserving" population to dehumanize for some reason.

 

Wendie A. Howland, MN, RN-BC, CRRN, CNLCP, LNCC via ajnoffthecharts.com