The first principle, nonmaleficence, or do no harm, is directly tied to the nurse's duty to protect the patient's safety. Born out of the Hippocratic Oath, this principle dictates that we do not cause injury to our patients.
How do interstate practice and nonmaleficence interrelate? With interstate practice, it may not seem self-evident how nurses can injure patients with whom they have no physical contact. Consider the interstate nurse, however, who does not return a phone call to a patient who is considered a malingerer. In refusing to return the call, perhaps the patient suffers needless physical or emotional trauma. Therefore, a way that harm can occur to patients is through communication failures. These failures can be intentional as just described or as a result of electronic or human error. Failing to convey accurate information, giving wrong messages, and breaking down of equipment, can cause harm to patients. This harm could be life-threatening such as in cases of strokes and heart attacks.
Some of these communication problems may certainly occur whether a patient is at a neighborhood clinic or 500 miles away, but distance and high reliance on electronic medium make close examination of communication and ethical issues vital. Examples of questions that need further investigation include: Should nurse call lines operate 24 hours a day instead of fewer hours? What back-up mechanisms exist for equipment failure? What phone work can and cannot be delegated? What quality assurance mechanisms are in place?
The principle of nonmaleficence is considered before new treatment approaches are tried on patients. We ask ourselves, and then patients and families ask us, "Can this harm the patient?" Should we not ask this same question before we initiate new models for professional practice such as interstate practice? While legal and financial issues are routinely discussed in relation to interstate practice, ethical issues are not. Unless open discussion of ethical issues occurs, the harm to patients may not be clear until nurses are practicing.