generally, ethics and professional issues are often perceived as part of the ‘softer’ set of
subjects and many students seem to consider these subjects as optional. But there is
nothing soft about ethical and professional matters; indeed such matters go to the heart
of the purposes of nursing. The nature of nursing work brings human vulnerability into
sharp relief and with it a whole range of questions about which nursing actions best
meet the needs of patients; questions that are among the most difficult to answer
precisely because they deal with essential problems of human frailty. As a consequence
ethical and professional issues remain of central concern to the enterprise of nursing and
this is made explicit in the professional requirement that pre-registration nursing
students Ieam to engage in ethical practice (NMC 2004a). It follows that there must be
some form of ethics content in programmes of study leading to professional nurse
registration, and this is often taken to mean that the teaching of ethics to nurses should
be a subject in its own right. But before exploring what this means for nurse education,
a brief historical detour might provide some useful contextual information.
The tradition of ethics in nursing during most of the 20th century owes much to Florence
Nightingale, although as I have argued elsewhere (Sellman 1997) much of that which is
generally regarded as reactionary in Nightingale stems from some rather narrow
interpretations and over-simplified sound bites. Nevertheless, the generally accepted
wisdom is that Nightingale’s legacy left ethics for nurses in a sorry state and even as far
into the 20th century as the early 1970s there is material published that might be best
described as etiquette rather than as ethics for nurses. The following extract is of a not
uncommon tenor.
Ward routine has a certain pattern to encourage respect for the doctor: he is
always accompanied by the sister, the ward is quiet, he is never contradicted;
and by various means he is shown to be a person of pre-eminent skill and
wisdom.
(Wray 1962, reprinted 1971 p. 22).
Thus, the teaching of ethics as other than etiquette to nurses is of relatively recent
origin. The emergence of the current sense of ethics and professional issues as necessary
for the professional practice of nursing can be located within the debates about
accountability of the late 1970s and early 1980s which preceded the introduction of the
first UK code of conduct for nurses (UKCC 1983). The explicit requirement for the
inclusion of ethics in the pre-registration nursing curricula was formalised as part of the
‘Project 2000’ revision of nursing education from the late 1980s (UKCC 1986) and
introduced at a time when nurse education was beginning the move from hospital-based
17