Ethics are an integral part of healthcare. Nurses, doctors, and anyone working with patients – directly or indirectly – is expected to adhere to certain ethical standards and practices throughout their day-to-day. This ensures that they follow good moral values, and that their work is both honest and honorable. Ethics also ensure that all patients are treated equally by practitioners, with care, respect, and empathy, no matter their background or what brought them there. Show If you are considering a career in nursing, you likely already have a strong moral compass and compassion for those around you. You likely know right from wrong, and want to do what is best for those you’re helping. But in your journey to become a nurse, this is just the beginning. Nurses work in life or death situations every day. Any decision they make can impact a patient’s health and well-being. With that in mind, the American Nurses Association (ANA) created a written, universal Code of Ethics for Nurses (The Code). This was developed as a guide for nurses both new and old, to help them understand and comply with a consistent set of ethical obligations as patient care providers. What is the Nursing Code of Ethics?The Code of Ethics for Nurses is a foundational, non-negotiable document for nursing professionals, set forth by the American Nurses Association (ANA). It serves as a guide for nurses in their duty to always analyze situations and make decisions in an ethical manner, and to provide the highest-quality care possible to their patients. This includes:
As noted above, nursing often involves life and death decisions. And sometimes, nurses cannot help but run into challenges when it comes to decision-making. For example, a nurse may carry a personal bias about a certain case or situation, or have a relationship with a patient that is within their care. Or, they may have to deliver a procedure against their own beliefs and religious ideals. When conflicts of interest or personal factors arise, the Nursing Code of Ethics becomes a source-of-truth. The goal of the Code is to standardize ethics in nursing. It outlines nine provisions that explicitly detail what nurses are responsible for, and will be held accountable for, in their professional career. It requires them to act in the best interests of their patients, to respect and protect all patients, and to promote positive change, morals, and justice in their workplace and beyond. The Nine Provisions in the Nursing Code of EthicsThe following nine provisions were defined by the American Nurses Association to shape, guide, and inform both current and future nurses. These conditions, as you will find, all revolve around moral values – and obliges nurses to always act for the good of their patients, their community, and the greater healthcare system. You can view the full Code of Ethics for Nurses at this link, or find an overview of its provisions below.
Becoming an Ethical NurseAs you plan to enter the nursing profession, it is important to understand how ethics, justice, and respect will factor into your role. The Code of Ethics for Nurses is a must on your reading list, either prior to or early in nursing school. These will ensure you are prepared to become a morally-sound and guided nurse, and that your patients will always be at the heart of what you do. It is also important to find a nursing school that recognizes these ethical standards, and that upholds similar values in their own curriculum. As detailed in our previous blog, The Core Values Every Nursing School Should Have, a great nursing program will emphasize the following skills in students:
A great nursing program will also encourage you to keep learning, in your education and career. This is also emphasized by the Nursing Code of Ethics, to keep on advancing through research and professional development. The fact is, the field is always changing. New medical treatment are being identified. New practices and technologies are being introduced. Even ethical standards and requirements are being evaluated each year, so it is important to stay up to date. This is all vital to remaining a trusted and competent nursing professional. This is the start of an extremely rewarding career, in which you have the unique ability to help people in need. To begin your career in nursing, or to advance your nursing education, please do not hesitate to contact Goodwin University. We offer nursing degrees at the associate, bachelor’s, and master’s level. Learn more by visiting us online, or calling 800-889-3282 today.  Goodwin University is a nonprofit institution of higher education and is accredited by the New England Commission of Higher Education (NECHE), formerly known as the New England Association of Schools and Colleges (NEASC). Goodwin University was founded in 1999, with the goal of serving a diverse student population with career-focused degree programs that lead to strong employment outcomes. Written By: Darby Faubion BSN, RN Ethical behavior is characterized by fairness, honesty, and equity in professional, academic, and interpersonal relationships. It is demonstrated by a respect for diversity, dignity, and rights of individuals and people. Nurses learn the importance of ethical behavior and how it applies to personal and professional behavior in nursing school and continue to add to the foundation of knowledge throughout their careers. If you are a nurse or nursing student, you may have asked, "What are the 9 Code of Ethics for nurses?” In this article, I will share information with you regarding the 9 provisions of the ANA Nursing Code of Ethics + interpretive statements every nurse must adhere to. You will learn the importance of ethics and how they apply to nursing practice and find out why it is important to have a moral and professional code of ethical behavior. "I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and as a 'missioner of health' I will dedicate myself to devoted service to human welfare.” (Nightingale Pledge, 1935) The formal Code of Ethics for nurses was developed by the American Nurses Association and adopted in 1950. Since its original publication, the ANA Code of Ethics for Nurses has undergone several modifications. According to the American Nurses Association, the Code of Ethics for Nurses is designed as a guide to help nurses carry out the responsibilities of their role in a manner consistent with the ethical obligations of the profession and quality nursing care. There are several reasons why the Code of Ethics for nurses is so important. Having a clear understanding of the benefit of the Code is essential. The following are ten reasons why the Code of Ethics is important to nursing. 1. The Nursing Code of Ethics establishes non-negotiable ethical standards for all nursing roles in all settings. 2. The provisions outlined in the Nursing Code of Ethics outlines broad expectations of nurses. 3. The ANA Code of Ethics for nurses helps guide nurses in daily practice as they navigate the complex healthcare system. 4. The Code of Ethics for nurses acts as a reminder to nurses of their commitment to society. 5. The Nursing Code of Ethics establishes guidelines that stress the importance of nurses participating in continuing education and evidence-based practice. 6. The Code of Ethics designates principles by which client care is determined and evaluated. 7. The ANA Code of Ethics provisions and interpretive statements address individual and collective nursing actions, intentions, and expectations, requiring all nurses to always act in a professional manner. 8. The Code of Ethics for nurses is an expression of a nurse’s understanding of her commitment to patients, the profession, and society. 9. The ANA Code of Ethics for Nurses clarifies roles and responsibilities within e nursing profession. 10. The Nursing Code of Ethics offers guidance to nurses for addressing common ethical situations or questions. The 7 ethical principles the Nursing Code of Ethics is based upon include beneficence, nonmaleficence, justice, accountability, autonomy, fidelity, and veracity. The following are brief descriptions of each of the ethical principles. Beneficence is the act of doing what is good and right for the patient. This ethical principle encompasses charity and kindness, which require actions by the nurse to benefit others. Nonmaleficence means doing no harm (intentional or unintentional). Nurses must provide care that reflects standards to avoid or minimize risk to the patient, healthcare team, or organization. Justice is fairness and impartiality. Nurses must make impartial, fair decisions regarding patient care without regard to a patient's race, age, sexual orientation, or economic status. Accountability means accepting responsibility for one’s personal actions. Autonomy is the ethical principle demonstrated when a nurse accepts the patient as a unique person with the right to his own opinions, values, beliefs, and right to make his own decisions. Fidelity is the practice of being faithful to a person, belief, or cause. It involves keeping one’s promises. In nursing, fidelity involves being true to the profession and honoring the responsibility of providing safe, competent, high-quality nursing care. Veracity is the principle of truth-telling. It requires nurses to be honest in their interactions with patients and colleagues. The 9 provisions of the ANA Code of Ethics for Nurses are a guide for carrying out nursing responsibilities consistent with high-quality nursing care and in alignment with the ethical obligations of the nursing profession. The following is a detailed explanation of the 9 provisions of the nursing code of ethics + interpretive statements every nurse needs to know about. The concept of practicing respect for human dignity is one of the most vital ethical issues related to professional nursing standards. Respect for human dignity means treating each patient as a unique being and having respect for the patient's individuality. Respecting human dignity means demonstrating an understanding of competence and respect for patients, allowing them to feel valued, and to grow, develop, trust, and value others. The Nursing Code of Ethics includes guidelines about the importance of establishing relationships with patients. The nurse must establish relationships with patients and deliver nursing care with respect for each person's individual needs and values, absent any prejudices. Nurses may not agree with or condone a client's individual choice or belief. However, it is the nurse's responsibility to respect the patient's rights and to consider the patient's lifestyle, religious beliefs, and value system when planning care for and with the patient. Nurses must extend respect to all patients regardless of the nature of their health problems, recognizing the worth of patients is not determined by disability, disease, functional status or ability, or the likelihood of death. Nurses act as leaders and advocates for the delivery of humane nursing care aimed at preserving human dignity. Respect for patients regarding the nature of health extends to any patient requiring nursing care for health promotion, disease prevention, health restoration, alleviation of suffering, and supportive care during the dying process. Ethical nurses actively assess patients and implement appropriate and responsible interventions to minimize patient suffering and unwanted or unneeded treatment. Demonstrating respect for human dignity requires nurses to recognize patient rights, especially the right of self-termination or autonomy. Self-determination is the basis upon which patients can engage in informed consent for healthcare services. Patients have a legal right to decide what treatments if any, will be performed on or for them. They have the right to accurate, understandable, and complete information that supports informed decision-making, allowing them to weigh the advantages and disadvantages of care. Nurses are obligated to be knowledgeable about the legal and moral rights of all patients to self-determination. Nurses must protect, preserve, and support their patient's interests by verifying their comprehension of the education or information provided and the implications associated with their decisions. Nurses should support the patient's right to accept, refuse, or stop treatment without undue influence, coercion, duress, or penalty. Support of self-determination includes recognizing cultural differences that may affect the patient's decisions about care. The nurse's compassion and respect for others extend to all people they interact with, including colleagues, members of the interdisciplinary team, and others. The Nursing Code of Ethics encourages nurses to demonstrate commitment to integrity-preserving compromise, conflict resolution, and fear treatment of all individuals. Nurses work in various roles, and in each, the nurse must treat peers, assistants, employees, and students with compassion and respect. Relationships with colleagues and others should value the contribution of individuals and groups and include collaboration to provide high-quality nursing care. All prejudicial actions, harassment, threatening behavior, or disregard for others should be avoided in their entirety. Primacy is defined as the fact of being primary, preeminent, or more important. Primacy of the Patient's Interests means the nurse's main commitment is to the recipient of nursing care, the patient. The recipient may be an individual, family, group, or community. Nurses should strive to provide patients with opportunities to be involved in planning their care, assuring the patient believes the care plan is acceptable and supports the initiation of the plan. The nurse's commitment to the patient should remain steadfast when conflict occurs or persists. It is not uncommon for nurses to be faced with a conflict related to expectations from patients, families, colleagues, or the organizations for who they work. It is crucial that nurses examine conflicts between their own professional and personal values, the interests and values of interdisciplinary team members, patient families, and patients. Conflicts of interest for nurses may occur in any area of nursing practice including clinical settings, administrative positions, research, and education. Whether a conflict is actual or perceived, nurses must disclose the conflict of interest to all relevant parties, including employers, colleagues, and patients. The American Nurses Association Code of Ethics urges nurses to withdraw from participation in any activity that creates a conflict of interest. However, nurses must understand that personal dislikes or discrimination against a person, group, or culture are not grounds for withdrawal from patient care. When nurses and other members of the healthcare team cooperate to achieve a shared goal in patient care, this is known as collaboration. Professional collaboration in nursing is fundamental to addressing the healthcare needs of patients and the public. Effective patient care occurs through the interdisciplinary collaboration of nurses in various roles who work together to teach skills, set standards, manage the healthcare environment, and expand nursing knowledge. Collaboration requires recognition, respect among healthcare team members, mutual trust, open dialogue among all parties, and shared decision-making about patient care. According to the Nursing Code of Ethics, nurses should actively promote collaborative multidisciplinary planning to ensure the availability and accessibility of high-quality healthcare services to everyone in need. One of the most critical aspects of nursing ethics is recognizing and honoring professional boundaries. Nursing care is intimate in nature, which sometimes causes the line of limitation within professional relationships to blur. However, nurses must recognize and maintain appropriate boundaries within relationships. Nurse-patient and nurse-colleague relationships should have a foundation based on alleviating suffering, promoting, protecting, restoring patient health, and preventing illness. If professional boundaries are jeopardized, the nurse's responsibility is to seek guidance from supervisors and/or take steps to remove themselves from the situation. The nurse must safeguard the patient's right to privacy and maintain the confidentiality of all patient information. Advocating for patient privacy and confidentiality involves promoting an environment that provides physical privacy as well as auditory privacy to allow for personal discussions or consultations. It includes enacting policies and practices to protect the confidentiality of patient information. A patient's well-being, safety, and rights should be the primary factors when using professional judgment concerning confidential information about or from a patient, no matter the method of delivery (written, verbal, electronic). The best way to protect a patient's right to confidentiality is to apply the "need to know" rule. In other words, it is the nurse's obligation to provide quality care and share relevant data only with the healthcare team members who need that knowledge to carry out their duties regarding patient care. The patient's right to self-determination includes the right to choose whether to participate in any type of research. Before patients participate in research, it is crucial that the patient or their legal representative receives enough information to make an informed decision about the research. The nurse must ensure the patient or authorized party comprehends the information before giving consent and that they understand they may discontinue participation in research without fear of penalty. Nurses should be aware of concerns raised by research involving vulnerable participant groups such as the elderly, the poor, students, children, and prisoners. It is the nurse's responsibility to be informed about the subject's and the nurse's rights and obligations related to the study and research in general. If a nurse feels any research is morally questionable, it is her duty to question and, if necessary, refuse to participate in the research. Nurses are responsible for implementing and maintaining standards of professional practice. These standards of professional nursing practice include being involved in the development of policies and assessing review mechanisms designed to reduce the risk associated with errors, promote patient safety, and address factors that present an increased risk to all patients. The Nursing Code of Ethics is clear that nurses should never participate in or attempt to hide errors or punitive responses that serve to fix blame instead of correcting the condition that led to an error. Further, nurses should promote the inclusion of any appropriate person in all deliberations related to patient care. Nurses must participate in the development, implementation, adherence to, and review of policies that promote patient safety and well-being, reduce errors, and establish a culture of safety. Nurses can improve workplace safety by collaborating with team members to promote patient health and safety. Although the goal is to avoid errors or accidents, when nurses create a culture of safety, they become more aware of risk factors to safety and more easily identify errors if they occur. If an event occurs that threatens the safety culture, nurses can then be sure they are investigated and appropriately handled, including creating a plan of correction to prevent repeated events. The primary commitment of all nurses is to the well-being, safety, and health of patients across the lifespan in all settings where healthcare needs are identified and addressed. A nurse must recognize and take action to address any instances of unethical, illegal, incompetent, or impaired practice by any healthcare team member or others that place the patient in jeopardy. The nurse should first express concern to the person carrying out the questionable practice, including why the practice could be detrimental to the patient's well-being or impact the integrity of nursing. It is necessary for nurses to understand the proper chain of command and follow it when reporting any questionable practices. In some circumstances, nurses may need to report issues to external authorities, such as law enforcement. The role of nurses as advocates includes being dedicated to protecting the patient, the public, and the nursing profession from the potential harm that could occur when a colleague is impaired. When impairment of a colleague is suspected, the nurse is obligated to take action to protect patients and ensure the impaired person receives help to recover. The ANA Code of Ethics for Nurses states that “Nurses in all roles should advocate for colleagues whose job performance may be impaired to ensure they receive appropriate assistance, treatment, and access to fair institutional and legal processes.” At times, advocacy can feel difficult. Nurses are encouraged to follow their organization’s policies for reporting without fear of negative consequences for reporting. Nursing practice includes any activity that involves direct patient care, delegation of nursing responsibilities, research, teaching, and management. Nurses are responsible for the care their patients receive and are independently accountable for the actions they take when providing or delegating care. Changing patterns in healthcare delivery and the complexity with which care is delivered requires nurses to demonstrate sound judgment when delegating tasks, accepting nursing assignments, and consulting with others. Nurses must remain responsible and accountable for their actions, the quality of nursing care, and standards of care, including exercising authority outlined in their scope of practice. Accountability in nursing means taking responsibility for and being answerable for one's actions. Nurses are expected to consistently perform with a code of ethical conduct. The American Nurses Association Code of Ethics outlines acceptable nursing behavior regarding accountability for nursing judgment, decisions, and actions. Nurses must demonstrate accountability for decisions made in nursing practice and any nursing interventions they implement. The Code of conduct by which nurses must perform is grounded in the principles of respect for the worth, dignity, and autonomy of patients and moral principles. Being responsible for nursing judgment, decisions, and actions involves exercising liability or accountability associated with the performance of the nurse's duties. The nurse's responsibility is to know their scope of practice and accept or reject assignments based upon their knowledge, experience, competence, and education. Nurses in management positions must be careful not to delegate responsibilities to others outside that person's scope of practice. Ethical nurses assess their own competence and recognize when patient needs exceed their education, qualifications, or experience. When a patient's needs are greater than the competencies of the nurse, the nurse must seek collaboration and consultation from the interdisciplinary team and/or other appropriate sources. Nurses in leadership or supervisory roles often delegate tasks to other nurses or members of the healthcare team in their charge. Nurses who delegate nursing tasks or activities are accountable for the care provided. Therefore, the delegating nurse must assess the competence of staff to whom they delegate responsibility. The nurse is responsible for overseeing and monitoring the care provided. Nurses in management roles must provide an environment conducive to appropriate delegation, including assisting nurses in developing skills and competencies, providing orientation to staff, and establishing policies to protect patients and nurses from the inappropriate delegation of nursing tasks. This ANA Code of Ethics for nurses interpretive statement is a brief introduction to the fifth provision of the Code. To be effective in their roles, nurses must take time to take care of themselves with the same level of care as they provide to others. Nurses can foster their own well-being by maintaining their competence, preserving integrity, and committing to personal and professional growth. All other interpretive statements in the fifth provision explain how nurses can meet the ethical demand requiring a duty to self and others. Nurses need to understand the importance of self-care and learn how to promote personal physical and mental well-being, good heal, and safety in personal and professional practices. Creating a healthy work-life balance is essential to physical and mental wellness. Nurses should ensure personal well-being by eating a well-balanced diet, exercising, and getting sufficient rest. It is also necessary to recognize compassion fatigue or burnout symptoms and seek help or relief when needed. Further, nurses must follow safety protocol to reduce the risk of injury or exposure to illness-causing pathogens. The best way to sum up this interpretive statement is to say, "It is impossible to provide high-quality, effective care to others if you do not care for yourself." Although nurses have professional and personal identities, neither is entirely independent nor entirely merged with the other. Instead, the nurse’s personal and professional identities are integrated, which means the nurse embraces professional values and incorporates them with personal values. Wholeness of character includes the nurse’s relationship with patients and colleagues alike. It is necessary for nurses to maintain personal and professional boundaries. While it is okay for a nurse to express a personal opinion, when solicited, the wholeness of character requires the nurse to ensure their opinion does not violate a patient’s self-determination with undue influence. Integrity is defined as the quality of being honest and having strong moral principles. It is crucial for nurses to protect their personal and professional integrity. It is not uncommon for threats to integrity to occur when nurses are asked to perform in a way that violates the values or ethics of the nursing profession, especially those requests that violate the Nursing Code of Ethics. While some circumstances require nurses to compromise, nurses should never agree to anything that does not honor and uphold integrity in personal and professional practices. If placed in a situation of compromise that involves violations of moral personal or nursing standards, nurses are within their rights to express their objection to participation. Nurses are trusted with the responsibility of providing high-quality nursing care to patients. As the healthcare industry continually grows and expands, adding advanced technology and evolving knowledge, it is crucial for nurses to keep up with the pace. Professional growth and maintenance of competence go hand-in-hand. Nurses should not only complete formal training but actively engage in continuing professional development to ensure the maintenance of competence in nursing practice. The nurse should be committed to lifelong learning. Performing self-assessments and participating in continuing education helps the nurse remain aware of current trends in healthcare, including new concepts, healthcare concerns, and treatments. The ANA Code of ethics recognizes the integration of the nurse's personal and professional self and, as such, feels the things that cause professional growth also affect personal growth. The continuation of personal growth is impacted by any measure to maintain competence and continue professional growth, making the wholeness of the nurse come full circle resulting in an integrated person representing worth and dignity. Nurses can complement their professional growth by implementing recreational activities, personal study, and social advocacy. Virtues are habits or behaviors of character that predispose one to meet moral obligations. People with high moral virtue possess attributes such as courage, compassion, honesty, and patience. In nursing, moral virtues are habits that confirm and promote the values of well-being, health, human dignity, respect, and autonomy. Some research indicates that the physical environment has a role in an individual's moral virtue and judgment, either supporting the growth of virtues or causing growth to be thwarted or diminished. According to the American Nurses Association Code of Ethics, all nurses are responsible for creating, maintaining, and contributing to environments supportive of the growth of moral virtues, which enables nurses to fulfill ethical obligations. Practice environments include working conditions and policies and procedures which outline the expectations of nurses. Role descriptions, organizational structures, ethics committees, disciplinary procedures, health and safety initiatives, and compensation systems contribute to the nurse's work environment. These contributing factors can foster professional fulfillment and ethical practices or create barriers to the same. When nurses feel their work environment is fair and that high standards of care are supported, they are more likely to realize the values of the nursing profession and act according to sound nursing practices. Nurses play a vital role in the healthcare environment. The nurse is responsible for contributions that create an environment of support for patients and peers and respect among colleagues. It is crucial for nurses to understand that accepting inappropriate or unsafe nursing practices is the same as condoning the practice, even if that nurse is not participating in the questionable practice. Nurses in leadership roles should advocate for fair treatment of the nurses on their teams. Any nurse employed at a facility that violates patient or nurse rights or asks the nurse to compromise personal or professional morals should not remain employed at that facility. It is the position of the American Nurses Association that all nurses should participate in the advancement of the nursing profession through knowledge development, dissemination, evaluation, and application to practice. Knowledge development relies upon research and scholarly inquiry. Scholarly inquiry helps expand the body of knowledge that forms and advances the practice and theory of the nursing discipline on all levels. Nurses engage in scholarly activities by using evidence-based practices. Nurse researchers are responsible for making active contributions supportive of advancing the nursing profession, testing existing nursing knowledge, and generating new knowledge. The American Nurses Association Code of Ethics encourages nurses to be involved in the development of professional guidelines and standards. Standards and guidelines are designed to reflect the practice of nursing that supports a broad body of knowledge and ethical commitments. The Code clearly states it is the nurse's responsibility to know their own scope of practice and to adhere to that Code. Nurse educators must promote and maintain high-quality standards of nursing education to ensure students possess the skills and knowledge needed to graduate from nursing programs. Nurse managers and administrators must establish and maintain employment conditions that allow nurses to practice within the guidelines and standards of nursing practice and which promote improved patient outcomes. Per guidelines established by the ANA Code of Ethics, nurses can, and should, seek ways to advance their profession by contributing to activities, leadership, and the viability of professional nursing organizations. Some ways nurses can help advance the nursing profession are to serve as leaders or mentors or to become committee members where they are employed. Participation in healthcare-related civil activities, demonstrating professional integrity, and promoting professional and civic values are a few ways to contribute to nursing. Nurses are encouraged to participate in local, state, national, and/or international initiatives related to nursing and healthcare. According to the World Health Administration, “the highest attainable standard of health is a fundamental right of every human being." The statement, "Health is a universal right," creates an obligation for nurses to help advance health and human rights on all levels. The universal right to health includes access to healthcare services, including preventive, emergency, and trauma care, basic sanitation, and education concerning the prevention, treatment, and control of common health problems. It also includes having the right to food security, injury prevention, immunizations, prevention and/or control of endemic diseases, potable water, reproductive health, and public health regarding health promotion and maintenance. This American Nurses Association Code of Ethics interpretive statement explains the importance of all nurses being committed to advancing the welfare, health, and safety of all people. If health is a universal human right, health disparity creates a human rights issue. The nurse must focus on achieving and sustaining health for the common good so individuals and communities can experience their fullest potential and live with dignity. Some ways nurses can participate in collaboration for health, human rights, and health diplomacy include writing letters to legislators, promoting healthy lifestyles within their communities, and creating and helping maintain culturally sensitive healthcare environments to address diverse cultural perspectives. Nurses should also consider joining professional organizations that lobby Congress for equitable healthcare policies. Several factors impact human rights and create disparities. Nurses have an obligation to help advance the health and human rights of patients and the public and contribute to efforts to reduce disparities. When providing care, nurses should avoid imposing their own cultural values upon others. Instead, the nurse can advance human rights by affirming human dignity and showing respect for the personal values and practices of patients from other cultures. Social determinants of health that must be addressed include poor sanitation, hunger, violence, homelessness, and limited education. The nurse can help address these by creating collaborative partnerships to impact legislation, healthcare policies, and relief efforts to relieve these disparities and help populations flourish. Nurses have a responsibility to know about the health status of their community and to recognize existing threats to safety and health. It is vital for nurses to participate in active collaboration with other healthcare professionals, including participating in and supporting community groups and organizations. Nurses can assist in efforts to educate the public, identify conditions that increase the risk of illness and disease, promote informed decision-making, encourage healthy lifestyles, and participate in legislative and institutional efforts to promote health and wellness. The American Nurses Association Code of Ethics interpretative statements in this section deal with professional nursing organizations and their roles in the delivery of professional nursing care. The nursing profession is represented by associations and its members. It is the responsibility of professional nursing associations to affirm and communicate nursing values to their members. The ANA Code of Ethics for nurses supports the necessity for professional organizations to encourage the support of critical evaluation and self-reflection within the nursing profession. Professional organizations share and articulate mutual values with the nursing profession, colleagues, and the public. The Code states that professional nursing organizations should communicate to the public values that nursing considers vital to social change and enhanced health. Professional nursing organizations are responsible for designating and expressing the ethics and values of the profession and for encouraging their members to act in compliance with those ethics and values. In fact, one of the most essential responsibilities of professional nursing organizations is to advocate for awareness of and adherence to the Nursing Code of Ethics. Nursing organizations help promote the integrity of the profession by encouraging respect, care, and fairness in all areas of nursing, ensuring nursing workforce sustainability, advancing nursing science, promoting higher education for nurses, and facilitating evidence-informed practices. Nurses are in a unique position to work both as independent citizens and as part of a professional group using political actions focused on bringing about social change. The ANA Code of Ethics establishes a position that professional nursing associations have a responsibility to speak on behalf of nurses collectively in efforts to shape and/or reshape healthcare, promoting and integrating social justice. This includes lobbying for legislation that affects the quality, accessibility, and cost of healthcare services. The integration of social justice in nursing involves the belief that health is more than delivery and reimbursement systems. It is understood that sociocultural issues such as homelessness, violation of human rights, violence, the stigma of illness, and hunger have health-related impacts. Pursuing social justice in nursing means demonstrating vigilance in efforts to influence people in power to address unjust healthcare systems and underlying determinants of health, improve health and healthcare, and redress wrongs. Social justice in nursing and health policy involves extending activities to address health-related sociocultural issues, including homelessness, violence, hunger, the stigma of illness, and violations of human rights. One of the most common violations of the Nursing Code of Ethics is the violation of a patient's right to privacy. Violation of a patient's privacy can occur in several ways. To prevent this type of Code of Ethics violation, nurses must be careful to discuss patient information only with the people providing care for the patient and anyone else the patient or his legal representative approves. Conversations regarding a patient should occur away from the public and in areas designated for care. (Violation of ANA Code of Ethics Provision 6.3): Nurses are responsible for knowing which acts or behavior constitute unsafe nursing practices. Further, the ANA Nursing Code of Ethics encourages nurses to avoid any behavior that jeopardizes patient or nursing safety and well-being. Any time nurses feel the need to question any behavior and its ethicality, they should be able to do so without fear of negative consequences. However, even in the face of unfavorable consequences, the nurse should always err on the side of provisions outlined in the Nursing Code of Ethics. (Violation of ANA Code of Ethics Provision 1.4): Healthcare providers must explain treatment options and procedures and obtain consent from the patient or her legal representative before care is administered. Before patients or their representatives can submit informed consent, the nurse's responsibility is to make sure they understand all aspects of the proposed treatment. If a patient does not fully understand a proposed treatment and is afraid to ask questions, the nurse may assume he understands and proceed with care, creating a violation of the Code of Ethics which protects the patient's right to make informed decisions for himself. (Violation of ANA Code of Ethics 5.2): Healthcare is ever-growing and expanding. New medications are developed daily. According to the American Nurses Association Code of Ethics, nurses must evaluate their own performance and competencies and strive for personal and professional growth. Professional growth in nursing requires a lifelong commitment to learning. When nurses do not pursue avenues to expand their knowledge and develop new skills, their disinterest can result in the delivery of patient care that is not up to date with current standards. (Violation of ANA Code of Ethics Provision 2.1): There are instances when nurses have the right to refuse to participate in certain activities or assignments. One example of when it is appropriate to decline participation in the care of a patient is if the type of care being provided conflicts with the nurse's religious beliefs. While it is sometimes acceptable for nurses to refuse to participate in a type of care, it is never appropriate to refuse care based on the nurse's personal dislike for or discrimination against a person. For example, it is inappropriate for a nurse to refuse patient care when the patient is a prison inmate because the nurse disagrees with the inmate's illegal behavior. (Violation of ANA Code of Ethics Provision 3.6): Understandably, nurses may feel apprehensive about reporting suspected impaired behavior of a coworker. However, the Nursing Code of Ethics is clear about the importance of protecting patients and the profession by addressing impaired practice. (Violation of ANA Code of Ethics Provision 1.4): At times, nurses are faced with the ethical dilemma of being asked to withhold the seriousness of a diagnosis from their patients. It is not uncommon for family members to want to spare their loved ones the anguish of knowing how dire their health situation is. However, if the patient is of sound mind, it is his right to make decisions about his care, including deciding who else can know about his illness, disease, or prognosis. (Violation of ANA Code of Ethics 3.5): A nurse’s primary focus should be the health, safety, and well-being of patients. If a nurse suspects inappropriate or unethical practices regarding the provision or denial of care, their concerns should be expressed. Failure to address questionable practices put the patient, healthcare team, and the profession at risk for harm. Therefore, the nurse must always address concerns with the person carrying out the practice and, if appropriate, escalate the concern to a higher authority. (Violation of ANA Code of Ethics 4.3): Even the best nurses have bad days and make mistakes. One of the most professional characteristics a nurse can demonstrate is the willingness to be accountable and responsible for his own actions. Being ethical means being accountable for one’s nursing judgment and actions, even if it means owning up to a mistake or a misunderstanding. (Violation of ANA Code of Ethics 4.4): Charge nurses, nurse supervisors, and administrative nurses assign nursing staff to care for patients and perform specific procedures or treatments. While the nurse may have authority to delegate, the nurse also has the responsibility to make decisions based upon the knowledge and skills of the nurse to whom assignments are delegated. Nurses who delegate assignments to personnel who are not adequately trained or comfortable providing that type of care violate the patient's right to safe care and the Nursing Code of Ethics. The ANA Code of Ethics for Nurses is not legally binding. However, state Boards of Nursing have the authority to discipline nurses for unprofessional conduct resulting from a violation of the Code of Ethics. It is crucial for nurses to be honest with their supervisors. Some cases may require the nurse to self-disclose or report a violation of the Nursing Code of Ethics to their Board of Nursing. Violations of the ANA Nursing Code of Ethics for nurses can have dire consequences. It is vital for nurses to be aware of the possible consequences of violating the Code and make every effort to avoid violations. The following are examples of consequences associated with Code of Ethics violations for nurses. Nurses who violate ethical codes of conduct can expect to face disciplinary action from their employers. Depending on the violation and whether the nurse has a history of previous misconduct, the nurse could face a verbal or written reprimand or suspension. When violations of the Nursing Code of Ethics are repeated, the nurse could face termination. It is the nurse and healthcare organization's responsibility to hold patient safety, privacy, and care in the highest regard. If a nurse fails to follow the provisions outlined by the Code of Ethics, it can result in loss of job. Any action that constitutes violation of the Nursing Code of Ethics may be reported to the Board of Nursing that holds jurisdiction over the nurse’s license. As such, it is the discretion of the Board to determine what action, if any, will be taken against the nurse. In some cases, especially if previous disciplinary action did not correct behavior, nurses can face loss of their nursing license following ethical violations. When nurses violate the Code of Ethics, they open themselves up for risk of facing civil litigation. Patients or their designated representatives may make a claim in civil court based on the nature of the violation. If the case is ruled in favor of the plaintiff, the nurse could face far-reaching financial, social, and psychological effects. While many breaches of the ANA Code of Ethics for nurses are considered civil matters, some violations can result in criminal prosecution and penalties. For example, some HIPAA violations carry criminal penalties. As if disciplinary actions, loss of job or license, and the risk of legal action were not enough, nurses who violate ethical codes of contact are at risk of losing professional relationships. Professional peers may personally like another nurse, but often find it in their best interest to step away from relationships with unethical nurses to protect their own reputations. There are several resources to find information about the ANA Code of Ethics for nurses. The following are some books, YouTube videos and websites where nurses can find Code of Ethics information. • Code of Ethics for Nurses with Interpretive Statements: This book offers a framework for decision-making and ethical analysis for registered nurses in all practice levels, settings, and roles. The Code of Ethics for Nurses is useful in healthcare today as it emphasizes the fundamental commitments and values of nurses, describes duties of the nurse beyond patient care, and identifies the lines between personal and professional boundaries. • Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application: In this in-depth book, readers will find key ethical principles as they relate to nursing. Each chapter is devoted to a single Code provision and includes key ethical concepts related to that provision. • Nursing Ethics: Understanding Ethics in Nursing- Anne and George Bunting, Professors of Clinical Ethics are joined by Cynda Rushton to explain the importance of understanding ethics in nursing. • What is the Code of Ethics for Nurses? In less than seven minutes, this YouTube video defines what the Code of Ethics for Nurses is and explains the principles that make up the Code. • The American Nurses Association: The ANA developed the Nursing Code of Ethics with Interpretive Statements and is an excellent resource for information about the Code as well as other things relevant to nursing practices. One of the most important questions nursing students and nurses can ask is, "What are the 9 Code of Ethics for nurses?” Nurses concerned with delivering high-quality, ethical nursing practices learn the Code and implement it in daily practice. The 9 provisions of the ANA Nursing Code of Ethics + interpretive statements every nurse must adhere to featured in this article offer nurses insight into the type of behavior expected of nurses in patient care. By demonstrating ethical behaviors as outlined in the Code of Ethics, nurses protect patients, themselves, and the profession.The first Code of Ethics for Nurses was called the Nightingale Pledge. Provisions are codes for specific standards of behavior and performance expectations. The provision number in the ANA Code of Ethics for nurses represents one of nine provisions. Each provision has interpretive statements which explain the provision in greater detail. The ICN Code of Ethics for Nurses is the International Council of Nurses Code of Ethics for Nurses. The ICN Code of Ethics for Nurses is a statement of ethical values, professional accountabilities, and responsibilities of nurses and nursing students. It defines and guides ethical practice with various nursing roles. If you have questions about the ANA Code of Ethics for nurses, you may contact the Center of Ethics and Human Rights at . The American Nurses Association developed the ANA Code of Ethics for Nurses. The Code with interpretive statements can be found on the ANA website. Nurses who are dedicated to high-quality patient care, desiring to promote the profession typically find it easy to adhere to the ANA Code of Ethics for nurses. There are several ways to use citations in writing. One way to cite the ANA Code of Ethics is to use the MLA citation as follows: American Nurses Association. Code of Ethics for Nurses. American Nurses Publishing, 2015. The ANA Code of Ethics applies to every person who enters the nursing profession, regardless of their level of degree or licensure. Because nursing is based on a commitment to promote the well-being of patients and the profession, nursing students should be committed to learning and accepting the ANA Code of Ethics. Nursing schools teach ethics and the law to nursing students early in the nursing curriculum. As nursing students learn the principles of the ANA code of ethics, they develop a foundation of sound nursing practice based upon morals and integrity. The ANA Code of ethics helps guide everyday nursing practices. Understanding the Code helps nursing students navigate the complexities of nursing as they develop the knowledge and skillset necessary to provide high-quality, ethical nursing care.
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