A Nurse Ethicist Explains Her Specialty

There are so many challenging decisions in nursing, and not all of the ethical issues are clear-cut. A nurse ethicist can be a resource in those difficult situations.

Nurse.com has an interview with a nurse ethicist who explains this little-known specialty. Lucia D. Wocial, RN, PhD, is a nurse ethicist with Indiana University Health, plus the Charles Warren Fairbanks Center for Medical Ethics, and then also an adjunct assistant professor at the Indiana University School of Nursing in Indianapolis, Indiana.

What exactly does a nurse ethicist do?

To start, this is not a black-and-white sort of job, where I come to work every day and know I will do XYZ. I present inservices related to ethics for nurses coming into IU Health. I talk about case examples and help them apply the abstract concept of ethics in their roles. With IU Health’s unit-based ethics program, I facilitate informal conversations regarding ethical issues. I help people learn to talk about and consider patient care issues in the context of ethics principals. I also serve on committees and do consultations.

But my role may differ from other nurse ethicists. When I went to graduate school, I wrote a job description for my ideal job as a nurse in ethics, and this is it. I spend about 40% of my time at the Fairbanks Center, 40% with the department of nursing at IU Health and 20% at the IU School of Nursing.

Do nurse ethicists review patient cases?

Yes. The most frequent reason for assistance on a patient care issue is concern about a patient’s or family’s request for nonbeneficial or futile treatment, trying to keep their loved one alive when the medical team does not think it is possible long-term or it is causing harm. That most commonly occurs in critical care or oncology.

Ethics is about more than death and dying, although issues surrounding end of life are the most ethically challenging. Because we are trained to help, it’s hard to cope with these issues. Sometimes, the patient will request a withdrawal of curative treatment before the healthcare team is ready for that.

Whatever the case, I will read the chart and talk with all of the stakeholders — the patient, the family, the nurses and physicians. I might mediate a discussion between patients and families and the healthcare team. I try to identify the language to use to help gain an understanding of each other’s perspectives. I will follow up informally with nurses involved with the care to help them with the ethical language and justify the approach taken. I help people think about the case beyond the emotional aspects and in the broader context.

What are your greatest contributions to the healthcare arena?

The greatest value I bring is as a resource on ethics when someone is grappling with the right thing to do. I can help them “unpack” their issues and separate them in a way that makes sense. Usually it’s an emotionally charged situation. Sometimes people need to set aside their emotions and think it through.

The benefit I provide is an ability to look at it through the lens of a nurse in clinical practice for more than 20 years. I know what it means to be a nurse taking care of patients. When I look at things with an ethicist’s eye, it is always through the lens of a nurse.