By Gloria Ramsey, JD, RN
Associate Professor, Graduate School of Nursing
Department of Health, Injury, and Disease Management;
Assistant Research Professor, School of Medicine
Department of Medical and Clinical Psychology
Director, Community Outreach and Information Dissemination
Uniformed Health Services University of the Health Sciences
Center for Health Disparities Research and Education
Why I Chose This Path
I chose to become a nurse-attorney because as a disabled young nurse I felt increasingly left out of the medical decision-making process, and I believed that the law would empower me to become both a more successful self-advocate and an advocate for the countless others who, due to disability, education, language skills, etc., were also being ignored.
Early on, I learned that some people equated my loss of the ability to walk with an inability to continue to practice as a competent nurse. They also wondered whether my gender, race and ethnicity were factors in my diagnosis and treatment recommendations. These experiences made a powerful impression on me, and during my illness, while reading an article in a professional journal, RN, that spoke of new career pathways for nurses, I became intrigued by one career in particular: nurse-attorney. Two principles that underlie the study of ethics — autonomy and respect for persons — drew me to the law. Patients have choices, and when those choices are informed, they ought to be respected.
I contacted The American Association of Nurse Attorneys (TAANA) and learned that there were no courses per se leading to a combined degree as a nurse-attorney, and that I would have to go to law school. So I set out to find an ABA-accredited program that offered the most health law-related electives. Seton Hall University School of Law, my school of choice, was the right fit for someone interested in combining both careers.
Ethical and Legal Challenges Faced by Nurses
Nurses who provide care across all settings regularly confront and are challenged by ethical and legal issues. Some of the most frequently cited legal and ethical issues concern advance directives, competence and decision-making capacity, decisions about life-sustaining treatments, organ and tissue donation, pain management, participation in research and the use of ethics committees.
When asked, nurses report that care of the dying is perhaps the most difficult and emotionally charged issue they face. How much should I do? Am I doing too much? What is too much? When should I stop? When should I let go? Nurses who understand the legal and ethical frameworks within which these questions arise, and such issues as the influence of culture and religion on decision making, are best prepared to provide optimal care to patients and families, to be zealous advocates on their behalf, and to work in effective collaboration with the Palliative Care and Hospice personnel who also care for the dying.
But nurses must be able not only to identify and address methods of problem solving relevant to the practice setting in which they work, and to the unique ethical issues in that setting — they must also be able to actively participate in policymaking, ethics committees and other formal forums for dispute resolution.
To that end, the American Nurses Association (ANA) has been active in developing Ethics and Human Rights Position Statements and has been involved in many of the policy issues our nation faces. For example, in 2000, the ANA Board of Directors addressed the need for nurses to participate actively in the public debate and to be able to speak to the ethical implications of policy developments. The ANA Board of Directors also determined that nurses must be present on governmental and nongovernmental ethics and policy boards engaged in examining the scientific, ethical, legal and social implications of advances in cloning and related technologies. The Board also recommended that continuing education programs focusing on the scientific and ethical intersections among issues such as cloning, gene therapy and stem cell advances be designed for nurses.
While each of these recommendations is empowering for nurses, I believe that some are not being implemented vigorously enough. I am concerned that we have done a better job of addressing issues related to the care of dying persons and to withdrawal of life support than to issues such as stem cell research and genetic testing. Nurses in daily practice do not feel adequately prepared to address these more complex and complicated ethical, social and political concerns. More needs to be done to equip graduate nurses to address many of the controversial issues in health care today.
While I was teaching at NYU from 1994–2005, we addressed this need. With the generous support of the Teagle Foundation, Inc., we were able to build upon our existing nurse-ethics efforts to establish relationships with other key New York City organizations and colleagues in order to link our students and faculty interested in this field of study. The mission of what became the NYU Program in Bioethics was to strengthen ethics education in baccalaureate programs and to prepare nurses to actively participate in ethics research, practice and policy efforts. Our objective was to equip nurses to articulate, analyze and respond to the complex ethical, legal, social and political aspects of their educational, practice and research roles. The NYU College of Nursing sponsored forums and conferences and collaborated with Montefiore Medical Center/ Albert Einstein College of Medicine to offer a Certificate Program in Bioethics and the Medical Humanities. In addition, research opportunities for students and faculty were explored. Each of these efforts was designed to position well-poised nurses into the pipeline to become leaders in nursing ethics education and practice, thereby advancing the ANA Board’s recommendations.
Having worked with civilian nurses my entire professional life, I am honored and most pleased to have been recruited to the Uniformed Services University of the Health Sciences in Bethesda, Maryland, to work with military nurses. Our motto, “Learning to Care for Those in Harm’s Way,” is truly a humbling thought as I present each and every lecture to our graduate and doctoral students. Since joining the faculty, my emerging clinical and scholarly interests include challenges of military ethics and, in particular, the unique challenges related to the role of the military healthcare providers in such situations as Abu Ghraib and Guantanamo Bay.
I want to add how pleased I am that the NYU Colleges of Dentistry and Nursing are working collaboratively to expand access to primary healthcare services for medically underserved New Yorkers. Creating partnerships to improve health is a fine objective. As director of Community Outreach and Information Dissemination at the Uniformed Services University Center for Health Disparities, my mission is to promote health-related change and ultimately to reduce health disparities among racial and ethnic minorities through research, education, training, community outreach and information dissemination. The NYU dentistry/nursing collaboration holds great potential to alleviate the disproportionate health burden borne by too many racial and ethnic minorities, who are dying prematurely and suffering from preventable diseases such as heart disease, stroke, cancer, diabetes, HIV/AIDS, infant mortality and vaccine-preventable diseases.
"Recently I saw an older patient who had misplaced his lower denture. Under Medicaid regulations, he was not eligible for another full lower denture until January. I wanted to begin treatment right away so that he would have his new denture in early January, on the same day that Medicaid would pay for it, but the rules prohibit it. If I were not so well acquainted with Medicaid guidelines, I might have overlooked them and proceeded to fit my patient with a new lower denture, which I believe was the reasonable and justifiable thing to do. I followed the guidelines, but wondered if there wasn’t something more that we could have done — maybe have a special fund
at NYUCD to help such patients?"
Justin J. Seaman, Class of 2008