What is the nursing code of ethics?
Whether you practice at the bedside, in the community or over a webcam as a telehealth nurse, your nursing judgments and decisions are held to a set of universal ethical principles that reflect the primary goals and values of the nursing profession. Formally known as the “Code of Ethics for Nurses with Interpretive Statements” (the Code), these guidelines serve as a blueprint for executing nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
Developed by the American Nurses Association (ANA), the Code applies universally to all nurses in all roles and all settings. “Professional ethics are rules that guide the behavior of a particular profession. With our Code of Ethics for Nurses, our purpose is to outline the ethical values, obligations, duties and professional ideals for nurses, not just individually, but collectively as a profession. We want to be able to set that ethical standard—that really is the purpose of the Code. In addition, it’s an expression of our own understanding of the nursing profession’s commitment to society,” says ANA Senior Policy & Ethics Advisor, Kara Curry, MA, RN, HEC-C.
In This Article
History of the Nursing Code of Ethics
The foundation for a nursing code of ethics dates back to the late 1800s when the ANA was founded. The organization adopted the first formal ethics code for nurses, “The Code for Professional Nurses,” in 1950. Since then, the Code has been revised to reflect changes in the art, science and practice of nursing, as well as developments in global health and society in general.
The Code is regarded as a living document designed to guide nurses now and in the future. The current code was updated in 2015. A revised version is scheduled for release in 2025. “Every 10 years, the Code is reviewed and rewritten by an American Nurses Association (ANA) Ethics Committee to reflect the changing roles and responsibilities of nurses and the ever-evolving dynamics of the healthcare system,” says Curry.
How the Code is used
While the Code is intended as a guide for ethical decision-making at all levels of nursing, the extent to which you are held to these standards can vary by state. There is no nationwide requirement that nurses pledge to the Code in the same way that physicians take the Hippocratic Oath. While the Code is not legally binding as a separate document, it can have legal implications for some nurses.
While the Code is intended as a guide for ethical decision-making at all levels of nursing, the extent to which you are held to these standards can vary by state.
“Some states do have the Code of Ethics incorporated into their practice act, so it can potentially be legally binding for some nurses. It all depends on the circumstance and how it’s being used,” says Curry. “Most ethics codes indicate that the content is written for guidance and not law. That is true for the Nursing Code of Ethics, though it could be legally binding, depending on the state in which you practice. That’s why we educate nurses to be very familiar with different practice acts and knowing the regulations of their board of nursing.”
Ideally, the Code is introduced as an integral concept in nursing education. “Our main goal is to push the idea in education to consider this as a crucial part of the nursing curricula. It does show up in everything we do. It doesn’t matter where we practice or what stage we are in our career, it’s our ethical duty to embody this code,” says Curry.
“The goal of the Code is to set an ethical standard to which we do expect nurses to adhere, but in adherence, it really reflects who we are as individuals and who we are as a profession,” says Curry.
Deciphering the Code of Ethics for Nurses
The Code of Ethics for Nurses with Interpretive Statements includes nine provisions. These provisions address ethics at the bedside and beyond in the following ways:
Each provision is accompanied by interpretive statements that provide more specific guidance for the application of the provision in practice. Members and non-members of the ANA can view the Code of Ethics for Nurses in its entirety on the ANA website. The nine provisions of the Code include the following:
Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person.
Key concepts of interpretive statements:
- Nurses respect the inherent dignity, worth, uniqueness and human rights of everyone they encounter, whether they are a patient, a member of a patient’s family or colleague.
- The dignity and human rights of all patients are prioritized regardless of the factors that contribute to a patient’s health status.
- Nurses support the moral and legal rights of patients, including their right to self-determination. This gives patients the right to receive complete and understandable information about their treatments and to determine what is done to and with their bodies.
- Nurses respect a patient’s choices within the professional guidelines of care and communication even if the nurse does not agree with the patient’s decisions. However, nurses have an obligation to address risky or self-destructive behavior by offering opportunities and resources for change.
Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population.
Key concepts of interpretive statements:
- The patient and their interests are the primary concerns in all aspects of nursing and care practices.
- Any conflict of interest that arises, whether related to a patient’s family, the nurse’s employer, external healthcare organizations or the nurse’s habits or ideals, should be disclosed and addressed to ensure that patient care is not affected.
- Providing the best possible patient care requires professional collaboration with internal and external parties.
- Nurses strive to maintain personal relationship boundaries with patients and colleagues to ensure that they do not cross the boundaries of professionalism or compromise patient care.
Provision 3: The nurse promotes, advocates for and protects the rights, health and safety of the patient.
Key concepts of interpretive statements:
- Nurses help protect a patient’s right to privacy. They help prevent unnecessary intrusion into a patient’s life by protecting all confidential information.
- Relevant data is only shared with the appropriate healthcare professionals through approved channels that are based on established protocols.
- A nurse understands the institutional standards set in place to review their performance and maintains standards of competence to meet these performance standards.
- Nurses work together to establish and enact policies that prioritize the health and safety of patients. If a nurse observes or recognizes errors, they are reported and fully investigated so they can be appropriately handled to protect patient safety.
- Nurses protect the patient, the public and the profession from receiving impaired nursing care. The nurse has a duty to take action to protect patients and ensure that the impaired colleague receives the necessary assistance.
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.
Key concepts of interpretive statements:
- Nurses have primary responsibility and accountability for all aspects of care. Responsible decision-making and good judgment should be primary when assuming responsibilities, obtaining consultation and delegating nursing functions.
- Accountability involves adherence to the scope and standards of nursing practice. It also requires following a code of ethical conduct with adherence to moral principles.
- Nurses support each other at the direct-care, managerial and educational levels. They assist each other in addressing challenging issues and maintaining access to the resources they need to assess, preserve and grow their professional competence.
- Nurses are accountable and responsible for the delegation of nursing activities. Assigning nursing responsibilities must be done within the standards of state practice acts, organizational policy, nursing standards of practice and levels of individual competence.
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.
Key concepts of interpretive statements:
- Nurses have an obligation to demonstrate care for themselves as well as others in order to provide professional care. This involves promoting health and safety, preserving character and integrity and continuing personal and professional growth.
- Having a health knowledge helps nurses work to preserve their safety and well-being. They acknowledge the need for medical treatment and ways to remain healthy to protect their performance and personal life.
- Nurses work to treat all patients with compassionate care. They help others identify their own values and make educated decisions.
- A nurse’s integrity does not tolerate any type of abuse. They conscientiously object when they recognize moral violations.
- Nurses maintain a commitment to lifelong learning and continuing education to maintain a high level of competence.
- Nurses complement their continued education with social advocacy, personal study and the pursuit of leisure and recreational pursuits.
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 are conducive to safe, quality health care.
Key concepts of interpretive statements:
- Nurses’ virtues are more extensive than those that society expects of all citizens, such as integrity, respect and moderation. In addition, nurses are expected to have attributes of skill, knowledge, patience, honesty, compassion, courage and altruism.
- Nurses work to establish and preserve morally sound environments by acting on their virtues and prioritizing what is most appropriate for their patients and workplaces.
- Nurses support excellence in nursing practice by promoting environments that support the fair and equitable treatment of everyone to enable safe, quality care and the best possible outcomes.
Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development and the generation of both nursing and health policy.
Key concepts of interpretive statements:
- All nurses can help advance the profession by adding to the body of nursing knowledge. They can do this by contributing scholarly research and supporting and participating in human research that is soundly constructed within ethical standards. Nurses can also help develop and support workplace structures that promote and disseminate scholarly work.
- Through roles in direct patient care, management or education, every nurse can contribute to health policy and the maintenance of professional standards.
- Nurses lead, serve and mentor on institutional or health agency committees in the practice setting to promote a balance of patient-nurse interests.
Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy and reduce health disparities.
Key concepts of interpretive statements:
- Nurses adhere to the belief that health is a universal right and therefore the need for nursing is universal.
- Nurses work to protect and promote the health of all people around the world. They lead and/or support projects, policies and programs that promote and restore health, prevent illness and alleviate suffering.
- Through community groups and organizations, nurses work with other groups to improve unfair structures and other factors that interfere with the provision of health.
- Nurses can bring attention to human rights violations in all settings and contexts. Nurses stress the protection of human rights with particular attention to vulnerable groups such as the homeless, the poor, the elderly, the mentally ill, women, children and all socially stigmatized groups.
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.
Key concepts of interpretive statements:
- Nurses are collectively represented by their professional associations and organizations. These organizations provide a united voice for nurses to communicate and promote the shared values and ethics of nursing within the profession and to the public.
- Professional organizations maintain the integrity of the nursing profession. These groups advocate for nurses and help to improve health and healthcare by promoting social justice for all populations.
- Nurses and professional organizations can target social justice issues by becoming involved in the political process and focusing on health-related regulatory and legislative issues. The emphasis on social justice extends to environmental influences and challenges that impact health.
