Caring in the Context of Risk

Moving Beyond Duty

Abstract

Hospital-based nurses face many occupational risks. In the early days of the coronavirus disease-2019 (COVID-19) pandemic, questions were raised regarding nurses' responsibilities to provide care in the context of risk of exposure to this infectious disease. In the United States, these questions were answered relatively swiftly using a deontological framework. If nurses did not have access to appropriate personal protective equipment, they were not duty bound to provide nursing care to patients with a known infection. Another occupational risk hospital-based nurses face is exposure to patient violence. Questions about nurses' responsibilities to provide care in the context of this occupational risk have not been addressed. The purpose of this article is to examine these 2 occupational risks and ethical decision-making frameworks that can be used to answer questions about the provision of nursing care in the face of personal risk. While useful in the context of COVID-19, a duty-based framework seems insufficient to capture the contextual nuances and moral complexity of providing nursing care to hospitalized patients who exhibit violent behavior. Professional duties are explored as are other ethical frameworks. Ethics of the everyday, virtue ethics, and care ethics are introduced as additional perspectives that can help inform nurses' decision-making and actions when they are exposed to occupational risks such as patient violence and COVID-19.