In 2015, nurses in the Netherlands received a new professional code. This was a breakthrough. No longer were there four separate codes but only a single ethical point of departure on the basis of which care could be administrated. All nurses can recognise themselves in it. This is our profession, and this is the way we perform it. One might ask why it took so long.

Ethical indications
Around 1900, there was also a kind of professional code in force. It was called ethical indications for the nurse, based on the fundamental principles as formulated by Florence Nightingale in her “Notes on Nursing” from 1859. The first Dutch handbooks were written by physicians and always started with ethical rules. Physicians knew perfectly well what should be demanded of nurses. Obedience was first and foremost here. From 1910 on, when the first clinical nurse managers started to write handbooks themselves, they also devoted ample attention to ethics in nursing. In the 1930s, the 10 commandments by nurse educator Melk were popular. Even today, they are well worth reading. Obviously, their wording is old-fashioned, but the essence is the same: good and civilised nursing, through the use of heart, head and hands. After 1930, when nursing was gradually divided through the pillarisation of Dutch society, protestant and catholic leaders each wrote their own professional codes, based on the Christian faith and intended for their own circles.

Disobedient
But what is the advantage of a national professional code for the nurses themselves? I wish we would have had such a professional code in the 1970s. As a nurse fresh from school, I worked at the psychiatric ward of a medium-sized hospital. Without any knowledge of psychiatric nursing, I was scheduled to assist a psychiatrist in the weekly electroshock treatments. Every Tuesday morning, some 10 patients came in to undergo this treatment. After one morning of this duty, it was clear to me that it was an inhuman treatment. Without any form of sedation or compassion, electrodes were placed on the temples of depressed patients, who were then subjected to a degrading epileptic seizure. I was shocked. When I was again scheduled to perform this duty, I refused. The serving psychiatrist was beside himself over such disobedience. He assured me that my refusal to assist him meant my dismissal. I was obviously taken aback by that, but decided to pay no heed to the threat. ‘Doctor, I refuse to do this,’ was my reaction. I was not dismissed and there even was an adjustment of the procedure surrounding the electroshock treatment.

Professional code

What a support it would have been if I had been able to appeal to a universal professional code. If I had been able to say that I refused because it was my duty as a nurse “not to endanger the health and safety of the patient”, as the code states. How great it is that such a universal professional code is now in place and that nurses can appeal to it.

Nannie Wiegman
Directeur
Florence Nightingale Instituut

Doctor, I refuse to do this