NURSI NG ETHI CS AND I TS RELATI ON W I TH POW ER AND W ORK ORGANI ZATI ON
Valér ia Ler ch Lunar di1 Wilson Danilo Lunar di Filho1 Rosem ar y Silv a da Silv eir a2 Mar a Regina Sant os da Silva1 Jacqueline Sallet e Dei Sv aldi3 Michele Salum Bulhosa4
Lunar di VL, Lunar di Filho WD, Silv eir a RS, Silv a MRS, Sv aldi JSD, Bulhosa MS. Nur sing et hics and it s r elat ion w it h pow er and w or k or ganizat ion. Rev Lat ino- am Enfer m agem 2007 m aio- j unho; 15( 3) : 493- 7.
Difficult ies faced in t he nur sing r out ine, m ainly in hospit als, hav e been r epor t ed w it hout t he r esult ing et hical im plicat ions t o workers and especially t o client s, been sufficient ly quest ioned. The work organizat ion can be t he m ain source of suffering t o nursing workers, relat ed t o t he exercise of power of different act ors involved in t he healt h inst it ut ions, which can pot ent ially cause m ult iple problem s and dist ress of et hical order. This st udy aim s t o m ake a cr it ical r eflect ion about som e r elat ions bet w een t he nur sing w or k or ganizat ion, pow er r elat ions and it s et hical dim ension. St rat egies for an et hical perform ance of nurses and ot her nursing professionals in t he organizat ion of work in t he healt hcare inst it ut ions point t o t he need of t hese professionals exercise power in an et hical way.
DESCRI PTORS: et hics, nur sing; w or k ; pow er ( Psy chology ) ; pr ofessional aut onom y
A ÉTI CA NA ENFERMAGEM E SUA RELAÇÃO COM PODER E ORGANI ZAÇÃO DO TRABALHO
Dificuldades enfrent adas no cot idiano do t rabalho da enferm agem , principalm ent e no âm bit o hospit alar, t êm sid o d en u n ciad as, sem q u e as im p licações ét icas d ecor r en t es, t an t o p ar a os t r ab alh ad or es q u an t o, pr in cipalm en t e, par a os clien t es est ej am sen do focalizadas ou , n o m ín im o, su ficien t em en t e qu est ion adas. A organização do t rabalho pode const it uir- se em font e m aior de sofrim ent o para os t rabalhadores de enferm agem , est ando relacionada ao exercício de poder dos diferent es at ores envolvidos nas inst it uições de saúde, podendo pr ov ocar m últ iplos pr oblem as m or ais e sofr im ent o m or al. Com o pr esent e t ex t o, pr et ende- se ex plicit ar , por m eio de r eflex ão cr ít ica, algu m as r elações en t r e a or gan ização do t r abalh o da en fer m agem , as r elações de poder aí pr esen t es e a su a dim en são ét ica. Est r at égias par a u m a at u ação ét ica das en f er m eir as e dem ais pr ofissionais da equipe de enfer m agem , na or ganização do t r abalho nas inst it uições de saúde, apont am par a a necessidade de ex er cício de poder dessas pr ofissionais, m or alm ent e fundam ent adas.
DESCRI TORES: ét ica de enfer m agem ; t r abalho; poder ( Psicologia) ; aut onom ia pr ofissional
ETI CA EN ENFERMERÍ A Y SU RELACI ÓN CON EL PODER Y ORGANI ZACI ÓN DEL TRABAJO
Las dificult ades enfr ent adas en el cot idiano del t r abaj o de enfer m er ía, en especial en hospit ales han sido denunciadas, sin em bar go las im plicancias ét icas r esult ant es no est án siendo enfocadas o por lo m enos discut idas a nivel de los t r abaj ador es ni de los client es. La or ganización del t r abaj o puede const it uir se en una m ayor fuent e de sufrim ient o para los t rabaj adores de enferm ería, lo cual se relaciona al ej ercicio del poder de los difer ent es act or es inv olucr ados en las inst it uciones de salud, lo cual puede pr ov ocar m últ iples pr oblem as m or ales y sufr im ient o m or al. Con est e ar t ículo, se t iene la int ención de ex plicit ar por m edio de una r eflex ión cr ít ica, algunas r elaciones ent r e la or ganización del t r abaj o de enfer m er ía, las r elaciones de poder pr esent es y su dim en sión ét ica. Est r at egias par a el ej er cicio ét ico de en f er m er as y ot r os pr of esion ales del equ ipo de enfer m er ía, en la or ganización del t r abaj o de las inst it uciones de salud, nos indican sobr e la necesidad que est as pr ofesionales ej er zan su poder , el cual est á m or alm ent e fundam ent ado.
DESCRI PTORES: ét ica de enfer m er ía; t r abaj o; poder ( Psicología) ; aut onom ía pr ofesional
1
RN, PhD in Nursing, Professor, e- m ail: vlunardi@t erra.com .br, lunardifilho@t erra.com .br, m ara@vet orial.net ; 2 RN, Doct oral St udent in Nursing, Professor, e- m ail: anacarol@m ikrus.com .br; 3 RN, M. Sc. in Nursing, Professor, e- m ail: j svaldi@m ikrus.com .br; 4 RN at t he Municipal Healt h Secret ary of Rio Grande, RS, Mast er St udent , e- m ail: m ichelebulhosa@yahoo.com .br. Fundação Federal Universit y of Rio Grande Depart m ent of Nursing
I NTRODUCTI ON
D
ue t o it s nat ure and charact erist ics, nursing w or k it self com m only inv olv es coping w it h sit uat ionsof su f f er in g b y clien t s, r elat ed t o losses, d isease,
fr ust r at ion and deat h, w hich can const it ut e a sour ce
o f su f f er i n g f o r t h e w o r k er s w h o p er f o r m i t . Th e
sit u at ion of clien t s w h o n eed h ealt h p r of ession als’
k now ledge, can com m only r epr esent suffer ing, pain,
am ong ot her feeling, st r engt hening t he pr ofessionals’
ur gent com m it m ent t o r espect t he client s’ r ight s and
t h e p e r m a n e n t n e e d t o r e c o g n i z e t h e i r h u m a n
condit ion. How ever, cont radict or ily, nur sing w or k can
be per ceiv ed as ex t r em ely pleasur able, w hen it can
be r ealized, depending on t he obt ained r esult s and,
also, because it at t ends t o nursing workers’ needs of
feeling useful and want ing t o help( 1). I n t his sense, it
seem s r elev ant t o highlight t hat “ feeling useful” and
“ w an t i n g t o h el p ” can co n st i t u t e a n ecessar y b u t
insufficient condit ion t o w or k in healt h/ nur sing.
The or ganizat ion of healt h/ nur sing w or k , on
t h e ot h er h an d, con sider ed as “ in a w ay, t h e ot h er
per son’s w ill”( 2), can be a gr eat er sour ce of suffer ing
for nur sing w or k er s and is r elat ed t o t he ex er cise of
p o w e r b y t h e m u l t i p l e a ct o r s i n v o l v e d i n h e a l t h
in st it u t ion s. Th er ef or e, t alk in g ab ou t p ow er m ean s
t alking about t he exercise of power, about Power in a
r elat ion al con cep t ion , w h ose ex ist en ce d ep en d s on
m ult iple resist ance point s( 3). I t is relevant t o highlight
t hat a pow er r elat ion needs t o be under st ood as an
act ion not on t he ot hers, but as an act ion on t he ot hers’
act ion, w het her t hese ar e r eal or possible. Hence, a
power relat ion aim s neit her for t he ot her’s dest ruct ion
n or h is/ h er an n u lm en t , as all r elat ion al possibilit ies
would be closed off, but t he ot her ’s survival as a subj ect
of act ion is fundam ent al for t he pow er relat ion t o be
su st a i n e d a n d m a i n t a i n e d , a l l o w i n g f o r a n sw e r s,
r eact ions, const r uct ions( 3 ).
A new econom y of pow er r elat ions r equir es
t he use of form s of resist ance against t he use of power
f o r m s. I n a Fo u cau l t i an p er sp ect i v e, t h en , p o w er
r elat ion s can on ly occu r bet w een fr ee su bj ect s w h o
are capable of resist ing, of exercising opposit e forces
a s, i n t h e a b se n ce o f t h i s f r e e d o m , r e l a t i o n s o f
d om in at ion in st ead of p ow er w ou ld occu r( 3 ). Th u s,
t alking about power necessarily requires t alking about
f or m s of r esist an ce, as “ pow er n eeds r esist an ce as
one of it s fundam ent al operat ional condit ions”. I t is
t hrough t he art iculat ion of resist ance point s t hat power
spr eads in t he social spher e. How ever, it is t hr ough
r esist ance t hat pow er is br ok en. Resist ance is at t he
sam e t im e an elem ent of t he power’s funct ioning and
a sour ce of per pet ual disor der. I n t his sense, if w or k
organizat ion in a way corresponds t o t he ot her’s will,
su bm it t in g t o t h e w ay w or k is or gan ized can m ean
subm it t ing t o t he ot her’s power exercise, t o t he ot her’s
w ill, accept ing, not r esist ing( 3).
Hence, it is im por t ant t o under line t hat t he
w ay n u r si n g an d h eal t h w o r k i s o r g an i zed en t ai l s
im plicat ions for t he w or k er s and for t he client s w ho
a r e a t t e n d e d a n d r e ce i v e ca r e , i n t e r m s o f t h e
suffer ing t hat could and needs t o be av oided( 4- 6). I n
Brazil, difficult ies nurses face in t heir daily work have
been den ou n ced, u sin g dif f er en t appr oach es. Th ese
ar e r epr esen t ed by low w ages, Dou ble em ploy m en t
w it h long w or k day s, inappr opr iat e w or k condit ions,
p r ecar i o u s m at er i al r eso u r ces, i n su f f i ci en t h u m an
r esou r ces, disr espect f u l r elat ion s in t h e h ealt h an d
n u r s i n g t e a m , a m o n g o t h e r s , r e l a t e d t o t h e
or ganizat ion of w or k( 1, 7- 9), w it hout focusing on or at
l e a st su f f i ci e n t l y st u d y i n g t h e co n se q u e n t m o r a l
suffer ing and et hical im plicat ions for t he w or k er s as
well as for t he client s.
Hen ce, w e pr esen t t h is r eflect ion , aim ed at
m ak in g ex plicit r elat ion s am on g t h e or gan izat ion of
n u r sin g w or k , especially in t h e h ospit al sph er e, t h e
p o w e r r e l a t i o n s p r e s e n t t h e r e a n d t h e i r e t h i c a l
dim ension. I nit ially, w e appoint ev idence of feelings
of m oral suffering in nursing workers, associat ed wit h
t h e w a y n u r s i n g w o r k i s b e i n g o r g a n i z e d a n d
im plem ent ed in differ ent spaces, and t he consequent
sit uat ions of disrespect t hat are experienced, whet her
b y t h e w or k er s t h em selv es as su b j ect s, or b y t h e
clien t s t h ey at t en d, du e t o t h e disr espect f or t h eir
right s. Thus, t he m oral dim ension of nursing pract ice
is addressed, associat ed w it h t he possibilit y of pow er
ex er cise b y it s w or k er s, in or d er t o cop e w it h t h e
m ult iple m or al pr oblem s ex per ienced in daily w or k .
RELATI NG W ORK ORGANI ZATI ON, POW ER
AND ETHI CS I N NURSI NG
I n ex am in in g t h e cr eat ion of p leasu r e an d
su f f er in g in n u r sin g w or k , as a con t r ib u t ion t o it s
or gan izat ion , t h e ex pr ession of f eelin gs of pleasu r e
w as obser ved, associat ed w it h dem onst r at ions of t he
valuat ion of nursing work, as well as wit h professional
l i f e i n a h ar m on i ou s w or k en v i r on m en t , b ased on
relat ionship. Feelings of suffering, on t he ot her hand,
were associat ed wit h anger in t he face of assessm ent s
of t heir w ork, w it hout considering t he condit ions it is
realized in; wit h t he perm anent search of bet t er work
condit ions; w it h t he need t o com ply w it h w hat t hey
acknow ledge t o be adm inist r at ive incoher encies, w it h
r espect t o r ou t in es, st an dar ds an d pu n ish m en t s; t o
im pot ence, guilt and fear, in view of t he im possibilit y
t o car r y out w hat t hey believ e t o be cor r ect and of
m a n i f e s t i n g m o v e m e n t s o f e x p l i c i t r e s i s t a n c e ,
con sider in g t h e r isk of pu n ish m en t ; t o an gu ish an d
concern about using broke equipm ent and apparat us;
t o t he lack of r espect by phy sicians, ex acer bat ed in
e m e r g e n c y s i t u a t i o n s , l e a d i n g t o a c l i m a t e o f
r est lessness and fr ight , am ong ot her s( 1).
I n t he at t em pt t o get t o know how pat ient s’
r igh t s ar e bein g r espect ed at a h ospit al in st it u t ion ,
feelings of guilt were evidenced in t he nurses, due t o
care act ions t hat were not realized. I n t he face of t he
in ap p r op r iat e w or k con d it ion s f aced in d aily w or k ,
t hese professionals’ defense of t he inst it ut ion seem ed
t o be m or e ev ident t han clar ificat ions t o t he client s.
I n shor t , w e could v er ify t hat t he nur ses denied t he
pat ient s’ right t o inform at ion, out of fear of ret aliat ions
and punishm ent s by t he heads and adm inist rat ion ( 9).
The “ cult ur e of silence” in nur sing w or k , on
t h e o t h e r h a n d , w a s d e n o u n c e d a s c r e a t i n g a n
a p p a r e n t h a r m o n y a n d a p o l i t i c a l l y c o r r e c t
environm ent , favoring t he workers’ daily cont act wit h
e r r o r a n d n e g l i g e n c e , w i t h f e e l i n g s o f f e a r a n d
i m p o t e n c e w h e n a c k n o w l e d g i n g t h e n e e d f o r
denouncem ent s. “ Super ficial and cur r ent negligence”,
including pat ient s’ ex posur e t o r isk s, associat ed w it h
t he adm inist rat ion of wrong m edicat ion doses because
of unr eadable handw r it ing on t he pr escr ipt ion; and/
o r w r o n g m e d i ca t i o n co n ce n t r a t i o n s se n t b y t h e
pharm acy, am ong ot hers, which denot e lack of respect
for t he client as w ell as for nur sing, w hich seem s t o
choose a role of “ prot ect ing” t he inst it ut ion and ot her
pr ofessionals, w it hout defending it s ow n r ight s( 8).
Feelings of suffering and guilt derive from t heir
per cept ion of con n iv an ce becau se t h ey do n ot offer
t he basic and essent ial care t o a deat h considered as
dignified. I n view of pat ient s’ pain m anifest at ions, t he
f e a r o f t h e p h y s i c i a n ’ s p o s s i b l e r e a c t i o n t o t h e
quest ioning of his m edicat ion pr escr ipt ion cont r ibut es
t o n u r si n g w o r k er s’ r et r a ct i n g a n d g i v i n g u p a n y
int ervent ion and m ovem ent of react ion and resist ance,
a feeling t hat seem s t o be ov er com e in sit uat ions of
risk for t he pat ient ’s life( 8).
These sit uat ions( 1,8- 9) show evidence not only
of suffer ing, but of m or al suffer ing by nur sing t eam
professionals, caused by disrespect of and even denial
of t heir condit ion of subj ect s, due t o t he need t o deny
and om it t heir values, beliefs and knowledge, as well
as by t he pot ent ial disrespect and denial of t he client s
at t ended by t hese t eam s and t heir right s as cit izens.
Thus, it can also be confirm ed t hat healt h care pract ice
is a m oral act iv it y, as t he way pr ofessionals per for m
t heir role ent ails m oral im plicat ions( 10) for t he m ult iple
subj ect s involved, m ainly due t o t he different relat ions
o f f o r ce s, o f p o w e r, o f m u l t i p l e so ci a l , cu l t u r a l ,
l a n g u a g e , k n o w l e d g e i n e q u a l i t i e s p r e se n t t h e r e ,
am on g ot h er s.
Hence, w hen nur sing pr ofessionals accept t o
w o r k i n p r e ca r i o u s co n d i t i o n s, i n o r g a n i z a t i o n a l
con dit ion s in w h ich t h ey can n ot per f or m w h at t h ey
h av e l ear n ed t o b el i ev e an d v al u e an d / o r d o n o t
perform w hat t hey can and should, t hey are denying
t h em selv es t h e oppor t u n it y of gu ar an t eein g r espect
for t hem selves and t heir profession and, m ainly, failing
t o guarant ee t he necessary respect and care for t heir
pat ient s. Thus, it can be quest ioned: what im pact does
t his sit uat ion ex er t on t he pr ofessional nur se- pat ient
r el at i o n ? D o p at i en t s k n o w t h a t t h ei r ca r e i s n o t
a d e q u a t e ? D o t h e y k n o w t h a t t h e y a r e b e i n g
d i sr esp ect ed ? Ar e t h e p r o f essi o n a l s a w a r e o f t h e
r elat ion bet w een t he w ay nur sing and healt h w or k is
o r g a n i z e d a n d t h e i r p a r t i c i p a t i o n o r n o t i n t h i s
o r g a n i z a t i o n , t h e d e n i a l o f t h e m se l v e s, o f t h e i r
co n d i t i o n a s su b j e ct s a n d , m a i n l y, t h e d e n i a l o f
pat ient s’ right s? Finally, who benefit s from t hese power
r elat ions? How hav e t hese pr ofessionals been t ak ing
car e of t heir client s?
The look at daily nursing work can represent
an ex t r em ely r ich sour ce of pr oblem s and quest ions,
coping wit h which requires t he perm anent const ruct ion
of part nerships bet ween professionals wit h a st ronger
p r esen ce in t h e acad em y an d t h ose p r ed om in an t ly
working in healt h inst it ut ions, in an at t em pt t o search
and const r uct st r at egies t hat fav or t he achiev em ent
a n d o v er co m i n g o f a n sw er s. Th i s l o o k co m m o n l y
se e m s t o f o cu s o n n u r si n g w o r k , w h e t h e r i n i t s
organizat ional or et hical dim ension, wit hout sufficient ly
expressing t he possible relat ions present bet ween t he
w ay nur sing w or k has been or ganized in t he healt h
con t ex t , t h e pow er r elat ion s pr esen t t h er e an d t h e
et hical dim ension of t his w or k : What ar e t he et hical
im plicat ions of nursing work organizat ion? Do nursing
i s b e i n g o r g a n i z e d e n t a i l s m o r a l a n d e t h i c a l
im plicat ions, t hat is, t hat t heir pr ofessional pr act ice
ent ails perm anent et hical im plicat ions? Do t he nursing
t eam an d n u r ses u n der st an d t h at t h eir ex er cise or
non- ex er cise of pow er can ent ail et hical im plicat ions
for t hem selves as w ell as for t he client s t hey deliver
car e t o?
Th e r e l a t i o n s p r e s e n t b e t w e e n t h e
organizat ional environm ent of work and nurses’ et hical
act ion ar e in cr easin g ly em p h asized : “ Nu r sin g is a
n oble pr ofession , bu t also fr equ en t ly a t er r ible j ob.
( . . . ) Lack of t im e, su p p or t , r esou r ces, r esp ect ar e
m ent ioned again and again ( ...) I n m any nurses’ daily
life, t here is t he const ant conflict bet ween what nursing
could be at it s best – t he ideal – and what it act ually is
aft erwards - realit y. For m any nurses, t hat t ension is
int oler able” ( 11).
Th e f r u st r at i o n an d d i sap p o i n t m en t m an y
n u r ses ex p er i en ce, i n d ep en d en t l y o f t h ei r so u r ce,
frequent ly are not perceived in t heir m oral dim ension:
“ Th e r e i s n o w a y o f b e i n g a n e t h i c a l n u r s e i n
environm ent s where ot her powerful act ors block what
n u r ses ack n ow led g e as t h eir m or al ob lig at ion s”, as
“ et hical problem s in healt h care are inseparable from
t he social and organizat ional environm ent t hey em erge
in ”( 1 1 ). Man y au t h or s h av e ack n ow l ed g ed t h at t h e
o r g a n i z a t i o n a n d e n v i r o n m e n t o f n u r s i n g w o r k
influence et hical pract ice m ore t han values and et hical
con cer n s.
Mor al pr oblem s can be concept ualized as “ a
sit uat ion in which a problem or dilem m a is experienced
bet w een one’s ow n v alues and st andar ds and t hose
of ot her people: a sit uat ion t hat one perceives as being
incorrect or t hat should not occur”( 12). These problem s
reveal t o be m ore evident when nursing professionals
appoint feelings of “ lack of power” wit h respect t o t he
pat ient s’ w ell- being.
Resist an ce, h ow ev er, as a m an if est at ion of
t h e n u r ses’ pow er ex er cise, does n ot seem t o be a
st im ulat ed pract ice yet , neit her in t eaching nor in care,
d esp it e t h e p ossib le et h ical im p licat ion s an d m or al
p r ob lem s d er iv in g f r om t h e lack of cou n t er - p ow er
act ion s in t h e p ow er r elat ion s w e ar e p er m an en t ly
im m er sed in . How ev er, “ t h er e ar e m om en t s in lif e
when t he quest ion of knowing whet her one can t hink
d i f f e r e n t l y f r o m w h a t i s t h o u g h t , a n d p e r c e i v e
different ly from what is seen, is essent ial t o keep on
look ing or r eflect ing”( 13).
Thus, conflict s can occur w hen differences in
t h e w ay a cer t ain sit u at ion is p er ceiv ed can n ot b e
ad eq u at ely com m u n icat ed , u n d er st ood an d solv ed ,
w h ich can cau se m or al su f f er in g. Nu r ses an d ot h er
professionals from t he nursing t eam can present m oral
suffering when t hey are able t o m ake a m oral j udgm ent
of w hat t hey ar e exper iencing and know w hat act ion
would be m orally necessary, but t heir decision m aking
is const r ained, w het her by t he inst it ut ional st r uct ur e
or ot her workers( 14), “ associat ed wit h feelings of anger,
fr ust r at ion and lack of pow er ”( 15).
These conflict s can det er m ine a sit uat ion of
et hical dilem m a on how t o m ak e a decision/ per for m
an act ion( 16). Thus, m or al suffer ing pr ovokes a m or al
d i l e m m a . I n a m o r a l d i l e m m a , t h e p r o f e ssi o n a l
acknowledges t hat different , but im port ant values are
in con f lict in m ak in g a decision ; h ow ev er, ch oosin g
o n e o p t i o n m e a n s e x cl u d i n g a n o t h e r, w h i ch a l so
pr ov ok es m or al su f f er in g.
Possible et hical im plicat ions associat ed w it h
t h e n u r ses’ su bm ission an d t h eir appar en t difficu lt y
t o ex er cise pow er in t he m ult iple r elat ions of for ces
t hey insert t hem selves or are insert ed in, in t he healt h
i n st i t u t i o n s t h ey w o r k a t , h a v e b een f o cu sed o n .
Besi d es t h e q u est i o n i n g o f t h i s ap p ar en t “ l ack o f
p o w e r ” , t h e r e i s t h e a r g u m e n t t h a t n u r s e s
u n d er est im at e or d o n ot ack n ow led g e t h eir p ow er
ex er cise. On t he ot her hand, w hen nur ses and ot her
nur sing pr ofessionals, in t heir pr ofessional ex er cise,
r ef u se t o r esist again st ot h er people’s act ion , t h ey
m ay also be r efusing t he best possible car e for t heir
p a t i e n t s ( 1 7 ), a s “ p o w e r i s a c r i t i c a l v a r i a b l e i n
det er m ining w hat w ill be ack now ledged as an et hical
pr oblem and how public a debat e and a solut ion w ill
becom e”( 1 1 ).
Th u s, p r o f essi o n a l s l i k e n u r ses ca n a v o i d
responsibilit ies and “ can delegat e” : a process t hrough
w h i ch t h e y ca n a v o i d m a k i n g e t h i ca l d e ci si o n s,
i n v o k i n g t h e a u t h o r i t y o f p h y si ci a n s ( a n d o t h e r s
r epr esent ing pow er at t he inst it ut ions) as a base for
t heir decision m ak ing( 18).
CONCLUSI ONS
By d em a n d i n g b et t er o r g a n i za t i o n a l w o r k
condit ions, nurses indirect ly advocat e for t he pat ient s,
ex plicit ly claim ing t hat t heir v alues, as w ell as t heir
et hical and professional responsibilit ies, be support ed.
The adv ocacy could be m ade easier if nur ses had a
gr eat er sense of confidence, w hich r esult s fr om t heir
Un for t u n at ely, w h en n u r ses in t en t ion ally do
n o t ex er ci se p o w er t o w ar d s a g i v en p r o f essi o n al /
et hical agenda, t o a cer t ain ex t ent , t hey par t icipat e
in t h eir ow n op p r ession an d ar e m or ally g u ilt y f or
accept ing t his st at us quo. Nur ses and ot her nur sing
pr of ession als n eed t o con sider w h at r espon sibilit ies
r ealist ically ar e t heir s. These pr ofessionals com m only
t al k am o n g t h em sel v es an d i n si d e t h e p r o f essi o n
ab o u t i n eq u al i t i es, b u t r ar el y t ak e t h ei r co n cer n s
b e y o n d n u r s i n g , d e s p i t e t h e m u l t i p l e d i f f e r e n t
possibilit ies besides r esigning, y elling, pr ay ing or not
doing anyt hing, depending on t he sit uat ion ( 14).
Thus, w e consider t hat st r at egies for et hical
a c t i o n s b y n u r s e s a n d o t h e r n u r s i n g t e a m
p r o f e s s i o n a l s , i n w o r k o r g a n i z a t i o n a t h e a l t h
i n s t i t u t i o n s , p o i n t t o w a r d s t h e n e e d f o r t h e s e
pr ofessionals t o exer cise pow er, in t heir r elat ion w it h
t hem selves, wit h t heir desires, aspirat ions, as well as
i n t h e i r r e l a t i o n w i t h o t h e r s , c l i e n t s , h e a l t h
pr ofessionals, inst it ut ion m anager s, am ong ot her s.
Hence, one of t he w ay s t o ident ify ev idences
o f t h e s e p r o f e s s i o n a l s ’ p o w e r e x e r c i s e i n t h e
i n st i t u t i o n a l a n d o r g a n i za t i o n a l sp a ce s t h e y a r e
act iv e in, is t hr ough t he analy sis of t he m ov em ent s
of r esist an ce t h ey h av e b een con st r u ct in g in t h eir
daily w or k . How ev er, fr om an et hical per spect iv e, it
i s n o t en o u g h j u st t o ex er ci se r esi st an ce ag ai n st
t h e ex er cise of p ow er, b u t t h is r esist an ce, as w ell
as ot h er act ion s, n eed s t o b e m or ally f ou n d ed f or
i t s ex er ci se.
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