Nursing Code of Ethics Explained

Gayle Morris, MSN
Updated September 25, 2023
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The Code of Ethics is a foundation for complex decision-making necessary in today's healthcare climate. Knowing the code can help protect nurses.
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  • The American Nurses Association Code of Ethics for Nurses provides a foundation for ethical decision-making at the bedside.
  • Nursing has held the top spot as the most trusted and ethical profession in a list of diverse professions for more than 20 years.
  • With each passing year, nurses are confronted with more complex health-related decisions, which require a strong code of ethics as a foundation for care.

When faced with a professional ethical dilemma, where do you turn? The Code of Ethics for Nurses outlines nursing responsibilities and provides a foundation for the profession.

These codes help nurses fulfill their professional obligations and support their practice. Let’s explore the provisions within the Code, how you can use them, and how they shape your nursing practice.

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The Need for a Nursing Code of Ethics

To practice with integrity, nurses must follow key elements that guide the profession. This includes a rigorous system for licensure, accreditation for education, and a code of ethics relevant to current practice.

A foundational code of ethics helps practicing nurses remember that patients have unique backgrounds with different cultural needs, which requires withholding judgment to ensure all patients receive quality care. Key examples of how ethics impacts nurses daily include confidentiality, holistic treatment, advocacy, accountability, and equality.

Initially, there was no formalized code of ethics, and most nurses relied on Gretter’s Nightingale Pledge, which is similar to the Hippocratic Oath used in medicine. In 1926, the American Nurses Association (ANA) suggested an outline of ethical behavior framed in terms of relationships between colleagues, patients, and medicine.

A Tentative Code was published in 1940, and the first formal code was adopted in 1950. In 1968 the code was revised to help nurses interpret the provisions, which were also reduced from 17 to 10. In the following years, the code has been revised and expanded as the profession has become more independent, using advanced technology and expanding into advanced practice roles.

What Is the Code of Ethics for Nurses?

The ANA Code of Ethics for Nurses has nine provisions and support statements. It addresses four main principles of ethics: autonomy, justice, beneficence, and nonmaleficence. The provisions assert the ethical and moral foundation of the nursing profession.

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    Provision 1

    The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
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    Provision 2

    The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
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    Provision 3

    The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
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    Provision 4

    The nurse has authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to promote health and to provide optimal care.
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    Provision 5

    The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
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    Provision 6

    The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that support safe, quality healthcare.
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    Provision 7

    The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the initiation of both nursing and health policy.
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    Provision 8

    The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
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    Provision 9

    The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

How Nurses Use the Nursing Code of Ethics

The ANA’s Code of Ethics for Nurses is designed to guide decision-making and assist clinical nurses in their roles within the healthcare system. The Code of Ethics is not a legal requirement mandated by law, but healthcare facilities and institutions typically incorporate its principles into their policies and procedures. Nurses are expected to follow these principles as a matter of professional integrity and commitment to patient well-being.

Patients have the right to make health-related decisions based on their beliefs and values, practicing an autonomy that could conflict with care guidelines or recommendations that healthcare professionals believe are best. So, if a patient chooses not to receive treatment, healthcare professionals must respect this decision, and nurses must advocate on their patient’s behalf.

Nurses must clearly understand the ethical principles that guide their profession and recognize their own moral and ethical foundation. There can be situations where nurses may perceive a conflict between the Code of Ethics and the practical realities of patient care. In such situations, nurses are encouraged to make the best ethical decision for patient well-being.

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