Translational Research Emphasis for the last thirty years has been on shifting nursing curricula out of hospitals to universities. The education of nurses is now increasingly leaning towards theory. This has led to an obvious gap between what is experienced in the practical healthcare settings by nurses and what is taught in lecture halls (Saifan, AbuRuz, & Masa'deh, 2015).

Nursing practice is just one of the areas of healthcare that is experiencing increased pressure from the dynamic healthcare environment. Each year, as changes in the medical environment become increasingly dynamic, prospects become harder to forecast, and in order to experience success, partnering with other stakeholders becomes essential. The speed of changes in practical nursing is inevitable and will continually increase, as the level of dynamism and interdependence in the practice continues to grow (Jooste, 2011).

Nursing Practice Which Needs Change; Nursing Ethics

Nursing is practiced by people who have been licensed and registered under the Nursing Act, as it is one of the regulated professions that are part of a multifaceted health care system. Its practice encompasses scientific knowledge, expertise and wisdom within an environment that is caring, and preserves the coordination and continuity in the provision of healthcare. Nurses have a two-fold accountability: one is to clients in terms of character and the quality of practice; and second, is indulging in a safe and competent practice to society through license laws (Jooste, 2011). It is considered that the professional duty of nurses, either directly or through referrals, is to provide non-discriminatory attention to all patients. Nurses are obliged professionally to give excellent, unbiased care to those under their care emergencies, in spite of their personal beliefs. Any approaches and convictions that would interrupt important functions of the job must be communicated to employers at the pint of employment by nurses, as a professional obligation (AWHONN, 2009).

It is generally considered difficult, in the health care profession, to acknowledge the fact that sometimes, the actions nurses take, are not in favor of the patient (Moore, 2012). For example, many times nurses take action to save patients' lives, when they may be better off dead. Nurses are sometimes, in life and death situations, in which life is saved, but with regrets later on. Ethics in nursing, thus, comes into play (Moore, 2012).

The area of nursing ethics is one that clearly needs change. In order for the health care professionals to provide improved and enhanced services to patients, the ethical codes must evolve at the same pace as the rapidly evolving nursing practice.

For human development, care is vital and it is aimed first at the physical needs of man. In order for infants to survive, care at the nurturing stage is needed in the same way as in the case of a dependent patient at the end of his life. The nursing ethics arise from the notion that care is a basic requirement for humans to exist. Care ties people together into a web of relationships. Choosing to join the nursing practice is accepting a moral duty to tend to all patients. This is not, and should not, be a light decision as reflected in the nurses' code of ethics (Lachman, 2012).

The American Nursing Association (2001) states that irrespective of the type of health problem in question, nurses should respect the value, and esteem rights of all human beings (Nursing World, 2015).

A nurse, for instance, is required to give care to a patient, whose current health condition is, as a result of, refusing to follow a treatment plan aimed at managing his diabetes and alcoholism. However, for a nurse to set aside his/her personal prejudice against such a case and follow the four stages of care is very difficult. Accordingly, adhering to the four dimensions requires the nurse to go beyond his/her good intention. Good care requires a combination of activities, attitudes and knowledge of the situation at hand (Lachman, 2012).

Nursing can either be considered to be just like any other duty within the ethics bracket, and hence a difficult task to accomplish, or, a calling and passion to be enthusiastically involved in the patient's needs (Lachman, 2012).

In providing care to others, there comes a time when the patient and his/her family members, the doctor and the nurse in charge, do not agree. Despite such a situation coming up, none of them can be wrong as their focus is the same, only the solution is not obvious (Bedrosian, 2015).

Nurses undergo conflicts about ethical challenges every single day, in all departments of various health care organizations. They rarely form part of any discussions in the course of any care provision...

However, if disregarded, healthcare facilities do not just end up with burned out results, but the nurses, sometimes, even quit. This has dire consequences for the future of healthcare as the demand for nurses is rapidly increasing (Bedrosian, 2015).
Nurses have been determined to face unique challenges when it comes to medical work ethics, even though it affects all health care workers. Because of the time they spend with their patients, they are in a better position to understand and know what the patient and his/her family feel and want. They are commonly present when a patient and their family are faced with important yet often uncomfortable decisions. In most cases, they are the ones who are aware when either the patient or his/her family is uncomfortable with an ongoing treatment. Nurses have extended contact and interaction with their patients and their families. They share the experience and the frustrations that come with receiving treatment, as they are more connected with the prevailing situation. They are practically in the midst of the fray, and this can greatly impact ethics. This gets particularly complicated, when the nurse's own beliefs and ethics are in collision with those of the patients' families, hospitals or even other care giver ethics (Bedrosian, 2015).

Nurses should receive training so as to readily recognize and discuss the ethical dilemmas that they encounter each day in their practice.

Key Stakeholders Who Are Part of the Current Nursing Practice

The interested parties in nursing practice include: nurses, doctors, hospital management, educational institutions and regulators of the healthcare industry. They are the ones responsible for drafting the ethical codes.

Role of Educational Institutions

Educational institutions have a vital role to play in ethical education. One of these roles is to encourage discussions on ethics and create awareness about it, by providing forums in which students can openly speak on issues surrounding ethics. One of the institutions that have done this is the Johns Hopkins, which has introduced ethical rounds, which are meetings in which teams are given the space to discuss ethical issues emerging from patient care (Bedrosian, 2015). To adopt such a measure is a conscious decision by this institution to bring this topic out into the open. These meetings may include the patients and their relatives. Some of the things discussed in these forums provided by the institution are how the healthcare team feels about the course of treatment that they are currently giving, how the family feels about it, what the family members feel the patient would have preferred if he/she was able to express him/herself and whether the patient has expressed his preferences before or not (Bedrosian, 2015). Awareness on ethics is thus created among all who are involved in patient care and the topic is demystified. Therefore, this institution has helped to not only promote ethical discussions, but also create awareness of it amongst everyone that is involved.

Role of Doctors

Doctors make decisions regarding patient care and consult with nurses and other medical professionals in order to ensure that their instructions are carried out (Browne, n.d.).Since doctors are always in close contact with the nurses, it also becomes their responsibility to make sure ethics is talked about and they support their peers and colleagues in making the right ethical decision. McKay and Narasimhan (2012) delineated the roles of doctors and nurses. According to them, doctors should be professional by maintaining high personal ethical standards and should also provide leadership and management in the organization they are working in. By being a leader, doctors can help nurses develop their ethical sixth sense and monitor behavior for red flags (McKay & Narasimhan, 2012).

Role of Hospitals

Hospitals also have major functions to fulfill in changing nursing practice. Some of these functions are designing appropriate safety guidelines and specific codes of conduct. The elements captured in a code of conduct that embraces this change are respect for cultural traditions, confidentiality and patient autonomy. This is part of the code of conduct for the Johns Hopkins hospital. The code of conduct should also specifically state how it relates to everyday regular activities of a hospital, such as vaccinations, admissions, administering drugs, allocation of scarce supplies, staff allocations and even distribution of space. John Hopkins, for example, has set up a specific code of conduct that highlights all these. Some safety guidelines are for the protection of the emotional health of the nurses. For example, the John Hopkins hospital has support systems for nurses…