Human connection in healthcare ethics: The nurse practitioner’s perspective
Every year, roughly 34.5 million people are admitted to U.S. hospitals. When we are sick in the hospital, we desire to be treated with dignity and compassion. We also innately yearn to create connections with those who care for us. We are, after all, in an isolated setting, outside the safety of our homes.
In my latest article published in the Journal of Nursing Ethics, I argue that nurse practitioners (NPs) – clinicians who begin as registered nurses (RNs) and then complete additional years of advanced graduate training – have special skills, attitudes and knowledge that allow them to forge these patient connections and make them valuable to ethics committees and ethics consultation services when they become clinical ethicists. Although most healthcare professions value relationships between patients and clinicians, nurse practitioners who also practice as ethicists care for patients from a unique perspective.
I remember when I first started my nursing career, I diligently studied to become an RN and build skills to care for my patients. I began seeing patients and developing deep human connections with those in the pediatric intensive care unit. This reminded me of why I wanted to become a nurse. My childhood friend died when I was 9 years old and received compassionate relational care from nurses. This became a model for how I wanted to serve my patients and their families: with compassion and by giving back. I wanted my patients to know that I am there for them and that I respect them as human beings, and I would never treat them as medical objects. 
Driven by this desire to serve patients, I then went back to school to become an NP, an advanced nursing role that blends clinical expertise with training in both nursing and medical ethics. NPs draw on their relational nursing roots and advanced clinical training to guide patients in making thoughtful, informed healthcare decisions.
Unlike RNs, who focus primarily on bedside care, NPs are additionally trained to diagnose, treat, prescribe and promote health while integrating both nursing ethics and medical ethics into their practice. When NPs pursue further ethics training (graduate education and/or clinical ethics fellowship), they offer a distinct perspective that blends hands-on patient care with ethical analysis. This differs from RNs with ethics training (nurse ethicists), whose contributions are rooted in bedside-centered ethics. In contrast, clinical ethicists with Ph.D.s or J.D.s often approach cases from academic, legal or philosophical frameworks. NP ethicists stand out by bridging these worlds with both ethical analysis and RN and NP lived experience caring for patients.
But how do NP ethicists with these unique skills and commitments help patients, ethics committees and ethics consultation services? First, they develop flourishing relationships with patients who desire not only healthcare but also relational care. Second, they are uniquely positioned to provide ethical recommendations in healthcare settings as ethicists and ethics committee members, distinct from nurse ethicists and non-clinically trained ethicists, due to their unique experience as NPs.
NP ethicists bring a unique and needed perspective to clinical ethics, combining the ability to rapidly connect with patients and a commitment to helping and healing relationships through advanced ethical training. It would behoove ethics teams, ethics committees and hospital administrators to ensure that each institution has a nurse practitioner ethicist available to care for and support the ill and their healthcare teams.
By Jesse Michael Kay, instructor of pediatrics, Division of Critical Care Medicine at Baylor College of Medicine, and intensive care nurse practitioner and group ethics consultant at Texas Children’s Hospital
