Why the Nursing Code of Ethics Matters

Nurses spend many years gaining the necessary education, licensure, experience, and certifications needed to deliver quality care to patients. While all those things work together to improve patient outcomes, it is the nursing code of ethics that guides all nursing professionals in how they must conduct themselves while on the job.

Among other things, nurses must commit to following good moral values to ensure all patients receive equal treatment from practitioners. The hallmarks of ethical nursing include care, empathy, and respect for all patients. Most nurses already have a strong moral compass and desire to help others, which is why they chose the profession. Realizing that every decision they make can impact the health and well-being of their patients is part of the purpose of the nursing code of ethics.

In this article, we will explore:

• History of the nursing code of ethics
• Four principles of ethics for nurses
• Nurse code of ethics interpretive statements
• Practicing nurse ethics

History of the nursing code of ethics

Originally called the “Nightingale Pledge,” the first nursing code of ethics was developed in the  1890s. Named after nursing pioneer Florence Nightingale, the earliest draft of these guiding principles was a modified version of the Hippocratic Oath for medical doctors. Nursing graduates would recite the Nightingale Pledge at their graduations to publicly express their commitment to following ethical nursing practices.

In 1950, the American Nurses Association (ANA) developed a more formal code of nursing ethics. This version originally contained four principles: autonomy, beneficence, justice, and nonmaleficence. In 2015, nine interpretive statements were added to the code to guide nurses more practically.

Many states include the nursing code of ethics as part of their practice statements. Nursing professionals must check with their licensing board to determine if their intended state of practice is one of them. Considering the importance of the code and its legal implications, nursing professionals can expect ongoing reviews and revisions as needed.

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Four principles of ethics for nurses

There are four main principles in the original nursing code of ethics. Every nurse must commit to practicing them. Most undergraduate nursing programs include these principles in their curriculum, though at times it can be confusing. Let’s break each one down clearly and concisely.

1.       Autonomy

Nurses often serve as advocates for their patients, ensuring the protection of their rights. To be effective, nurses must recognize every patient’s right to self-determination. They must present their patients with all relevant medical information and treatment options, offering education about anything the patient does not fully understand. Nurses should include the benefits, complications, and potential risks of any medical intervention so patients can make well-informed decisions. A final piece to the autonomy principle is for nurses to ensure that the entire medical team follows the wishes of the patient.

2.       Beneficence

This is just a fancy way of saying nurses should act with compassion to promote the welfare of others. In other words, nurses must always do what is best for their patients. This goes above and beyond the commitment to “do no harm.” Beneficence involves the active practice of removing patients from situations that can cause them harm and present them with options that will help them.

3.       Justice

Nurses must care for their patients with the same level of fairness, regardless of their financial situation, gender, race, religion, and sexual orientation.

4.       Nonmaleficence

Not to be confused with beneficence, nonmaleficence means “do no harm.” It is one of the main principles of nursing ethics and similar codes of conduct for most healthcare professionals. Nurses must choose medical interventions that will cause the least amount of harm to the patient in the pursuit of a beneficial outcome.

Nurse code of ethics interpretive statements

As previously mentioned, the original nurse code of ethics was amended in 1950 to include nine interpretive statements. The American Nurses Association added the provisions to clarify the original four principles. Each of the nine provisions revolves around moral values and encourages nurses to always act for the good of their patients. The nine provisions are:

• Nurses must practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

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

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

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

• 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.

• The nurse, through continual 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.

• 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.

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

• 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.

Practicing nursing ethics

Part of making ethical decisions as a nurse involves staying current on healthcare services and treatments. Many states require nurses to complete continuing education requirements to maintain their licensure. Nursing professionals can take advantage of Incredible Health’s free nursing CEU courses to keep their skills sharp and their patients at the heart of everything they do.  

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