What Nurse Bioethicists Bring to Bioethics: The Journey of a Nurse Bioethicist
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What Nurse Bioethicists Bring to Bioethics
The Journey of a Nurse Bioethicist
ABSTRACT

Nurses, one of the most trusted professional groups in our society, work with patients and their families at all stages of the illness trajectory. Nurse bioethicists are a small but special subset of the nursing profession and bioethics community, focusing on the moral complexities that arise in clinical care, research, and health policy. This article examines the career trajectory of a nurse bioethicist and the clinical, educational, and research experiences that shaped her career goals. It also addresses the uniqueness of nursing and the ethical challenges that nurse's encounter in their day-today interactions with diverse patient populations and calls for distinct conceptual and empirical bioethics inquiry. Training the next generation of nurse bioethicists requires a dialogue with nursing and bioethics scholars on the academic and philosophical skill set and mentorship requirements that will advance and contribute to the broader public good.

Istarted my nursing career as a pediatric nurse working with children and their families at the Children's Hospital National Medical Center in Washington, [End Page 33] DC. My first position was a staff nurse (or bedside nurse) on a busy surgical floor called 4 Blue. To some degree, and as I reflect on that time, one is never truly prepared as a newly minted nurse or physician for the realities of becoming a clinician. So it was for me. I initially worked a rotational schedule of two weeks of days and two weeks of nights where textbook pediatric cases became everyday experiences. Caring for the most complex of childhood illnesses included patients with osteosarcoma, Wilms tumor, neuroblastoma, short gut syndrome, biliary atresia, failure to thrive, and other diseases, and it tested one's capabilities on a daily basis. It was also the first time that I came face-to-face with the death of children for whom I was their primary care nurse and with the grief and suffering of families that ensued. The loss of a child brings tears to all those involved; there is no exception for nurses or others who also hope for positive outcomes. This work as a pediatric nurse was both demanding and fulfilling. I became part of the fabric of an institution committed to caring for those who were the most vulnerable, and it often evoked a mix of moral emotions. Indeed, there were days when I questioned what was in the best interest of my patients and whether it was within the realm of my position to question.

As I moved on from the surgical unit, I was offered an opportunity to gain didactic and experiential training as an Operating Room (OR) nurse. The technological nature of the OR and the ability to understand the intricate nature of pediatric diseases was remarkable, and interdisciplinary teamwork was paramount. I held many different roles within this practice environment, and every day there was something new to absorb. But then again, as Atul Gawande (2014) reflects in his beautifully written exposition of his life as a physician: "Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve" (8).

In fact, I was able to safely monitor sterile surgical fields, circulate and scrub complex cases while standing for long periods of time and authenticating sponge, needle, and instrument counts, manage multiple stakeholder needs as a clinical manager, and be at the ready for any traumatic injury that might come through the OR doors at any time of the day or night. Nevertheless, ethical questions lingered in my mind. I often wondered how to help myself and my nurse colleagues during difficult times: times when one was alone with a child who died on the OR table and was anxiously waiting for the family in a perioperative room; times when staffing needs were stretched and allocation priorities were questioned; times when interdisciplinary team communication was disruptive; times when parents said their emotional goodbyes to their children as they were whisked off to OR suites hoping, for example, that the tumor was not cancerous or some...