Introduction

What makes a code of ethics an important document for nurses? Generally, a code of ethics functions as a tool for professional self-definition. As nursing continues to strengthen its model of professionalism, the relationship between that model and a code of ethics must be seriously considered. The mere existence of a code provides a positive argument that a group self-identifies as "professional," not just as occupational. In fact, the formulation of "a code of ethics itself is commonly taken to be one of the defining marks of a profession." (Alexandra, p. 226) Professionals recognize that they must embrace specific responsibilities and obligations to those they serve to legitimately call themselves professionals. A code, then, functions as a reminder of these duties to both the practitioner and the public. As Alexandra and Woodruff write, "...membership in a profession...entails duties, but also rights...of a distinctive kind."(Alexandra, p. 227) A Code of Ethics outlines these distinctive duties and rights.

Fundamentally, then, a code serves as the written word, or the public document, declaring how professionals think of themselves individually and collectively and the serious responsibilities they have embraced. Indeed, the written word can "have a striking influence on our attitudes, understandings, and sometimes our behavior." (Fitzpatrick, p. 1) Without a codification of duties and behaviors, the risk of losing professional clarity is high, especially for health care providers who practice in the midst of an ethically challenging environment. The written word provides that clarity and the moral power that flows from it.

The recently revised "Code of Ethics for Nurses with Interpretive Statements" also reflects nurses' expanded professional roles as administrators, care coordinators, educators, quality assurance managers, and researchers, as well as providers of direct patient care. All nurses in today's health care environment are faced with multiple ethical challenges which are related either directly or indirectly to cost-conscious hospitals, managed care payment plans, nursing staffing problems, the looming nursing shortage, and complex medical conditions that affect not just individuals, but whole communities.

In the current health care delivery system and as a result of these expanded responsibilities, the relationship between nurses and patients has been challenged more than ever. Nurses face "ethical issues and stresses in intra-professional and inter-professional relationships not envisioned in years past." (Walleck, p.366) The revised Code is now available to help nurses navigate this new "moral paradigm" in an era "when hospitals have become marketplaces...". (Curtin, p.56) The nursing profession is challenged to assume a new mantle of leadership and relocate the patient at the center of health care.

The Code is the promise that nurses are doing their best to provide care for their patients and their communities while supporting each other in the process, so that all nurses can fulfill their ethical and professional obligations, as well as meet their own professional and career goals. In the midst of these challenges, the Code of Ethics exists as concrete evidence of nursing's thoughtful and considered ethical commitments. Although nurses are still deeply committed to caring, they can no longer "care" at the expense of being disempowered in relationships and systems. The Code of Ethics should contribute to what Rankin refers to as "empowered caring." (Rankin, p. 194)