Conflict of Commitment: Balancing Nurses’ Obligations to Patients and to Themselves

AbstractWorkplace violence remains a pervasive feature of contemporary nursing practice, especially in high-acuity environments. Nurses face verbal abuse, intimidation, and physical assaults at the bedside, often amid an unspoken understanding that such violence is "part of the job." The Revision of the Code of Ethics for Nurses underscores the nurse's ethical duty to promote safety in every encounter (Provision 2.4) and their obligation to safeguard their own health and safety (Provision 5.1). This tension is not new. The struggle between the duty to care and the obligation to personal safety has surfaced in a nearly cyclical fashion during times of community need and with developments in technology, like ECMO, which heightens nursing surveillance and the duty to care. Workplace violence remains a known problem in healthcare, with alarming statistics: 1 in 4 nurses report being assaulted, more than half report verbal abuse or bullying, and healthcare providers are 5 times more likely than other workers to be injured at work. In 2018, the Bureau of Labor Statistics reported that healthcare employee injuries accounted for 73 percent of all nonfatal injuries and illnesses due to workplace violence. As a profession, we ought to reaffirm that safety at the bedside is an essential condition for providing care, not an opposing priority. We offer practice tools and de-escalation skills based on a nurse's ethical obligations using case analyses. The goal is not to pit patients' interests against nurses' safety but to operationalize a dual duty to care and to maintain safety.