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The 9 Nursing Code of Ethics (Provisions + Interpretive Statements) – Every Nurse Must Adhere To


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.


What Exactly Is The Nursing Code Of Ethics?


The Nursing Code of Ethics is a tool for nurses at all levels of practice. The Code establishes and reiterates the fundamental commitments and values of nurses. It identifies the boundaries of professional nursing practice and loyalties and outlines the duties of nurses extending beyond individual patient encounters. According to the American Nurses Association, the Code of Ethics for Nurses is the “Social contract that nurses have with the United States public. It exemplifies our profession's promise to provide and advocate for safe, quality care for all patients and communities. It binds nurses to support each other so all nurses can fulfill their ethical and professional obligations.”


When And By Whom Was The First Nursing Code Of Ethics Established?


The origins of the Code of Ethics for Nurses with Interpretive Statements date back to the late 1800s. The founder of modern nursing, Florence Nightingale, established the foundation of ethics in nursing practice. The foundation of ethics she laid included preparing the groundwork for today's modern ethical standards. In 1893, the Nightingale Pledge was created by a committee led by Lystra Gretter, Principal of the Farrand Training School for Nurses in Detroit, Michigan, at the Harper Hospital. The Nightingale Pledge was revised in 1935.

The following is the Nightingale Pledge which, to this day, is still recited by nursing students during graduation and other nursing ceremonies.

"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)


When And By Whom Was The Modern Nursing Code Of Ethics Established?


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.


10 Reasons Why Code Of Ethics Is So Important In Nursing


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.


What Are The 7 Ethical Principles On Which The Nursing Code Of Ethics Is Based?


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.

1. Beneficence:

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.

2. Nonmaleficence:

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.

3. Justice:

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.

4. Accountability:

Accountability means accepting responsibility for one’s personal actions.

5. Autonomy:

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.

6. Fidelity:

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.

7. Veracity:

Veracity is the principle of truth-telling. It requires nurses to be honest in their interactions with patients and colleagues.



WHAT ARE THE 9 CODE OF ETHICS FOR NURSES?


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.

1. “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”


1.1 Respect For Human Dignity:

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.

1.2 Relationships With Patients:

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.

1.3 The Nature Of Health:

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.

1.4 The Right To Self-Determination:

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.

1.5 Relationships With Colleagues And Others:

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.


2. “The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.”


2.1 Primacy Of The Patient's Interests:

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.

2.2 Conflict Of Interest For Nurses:

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.

2.3 Collaboration:

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.

2.4 Professional Boundaries:

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.


3. “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”


3.1 Protection Of The Rights Of Privacy And Confidentiality:

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.

3.2 Protection Of Human Participants In Research:

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.

3.3 Performance Standards And Review Mechanisms:

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.

3.4 Professional Responsibility In Promoting A Culture Of Safety:

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.

3.5 Protection Of Patient Health And Safety By Acting On Questionable Practice:

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.

3.6 Patient Protection And Impaired Practice:

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.


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.”


4.1 Authority, Accountability, And Responsibility:

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.

4.2 Accountability For Nursing Judgments, Decisions, And Actions:

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.

4.3 Responsibility For Nursing Judgments, Decisions, And Actions:

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.

4.4 Assignment And Delegation Of Nursing Activities Or Tasks:

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.


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.”


5.1 Duties To Self And Others:

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.

5.2 Promotion Of Personal Health, Safety, And Well-Being:

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."

5.3 Preservation Of Wholeness Of Character:

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.

5.4 Preservation Of Integrity:

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.

5.5 Maintenance Of Competence And Continuation Of Professional Growth:

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.

5.6 Continuation Of Personal Growth:

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.


6. “The nurse, through individual and collective efforts, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.”


6.1 The Environment And Moral Virtue:

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.

6.2 The Environment And Ethical Obligation:

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.

6.3 Responsibility For The Healthcare Environment:

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.


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.”


7.1 Contributions Through Research And Scholarly Inquiry:

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.

7.2 Contributions Through Developing, Maintaining, And Implementing Professional Practice Standards:

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.

7.3 Contributions Through Nursing And Health Policy Development:

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.


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


8.1 Health Is An Universal Right:

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.

8.2 Collaboration For Health, Human Rights, And Health Diplomacy:

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.

8.3 Obligation To Advance Health And Human Rights And Reduce Disparities:

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.

8.4 Collaboration For Human Rights In Complex, Extreme, Or Extraordinary Practice Settings:

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.


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.”


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.

9.1 Articulation And Assertion Of Values:

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.

9.2 Integrity Of The Profession:

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.

9.3 Integrating Social Justice:

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.

9.4 Social Justice In Nursing And Health Policy:

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.



10 Most Common Violations Of The Nursing Code Of Ethics


1. Violations of Patient Privacy (Violation of ANA Code of Ethics Provision 3.1):

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.

2. Failure to Promote a Safe Healthcare Environment

(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.

3. Ethical dilemmas regarding informed consent are common

(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.

4. Lack of professional growth

(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.

5. Allowing Personal Biases and/or Beliefs to Interfere with Patient Care

(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.

6. Failure to Report Suspected Impairment of a Coworker/Peer

(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.

7. Withholding Important Information from Patients About Their Health

(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.

8. Avoiding Action Against Questionable Practices

(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.

9. Not Accepting Responsibility for One’s Judgment and Nursing Actions

(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.

10. Delegating Assignments to the Appropriate Person

(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.


What Should You Do If You Have Violated 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.


7 Consequences Of Violating The Nursing Code Of Ethics


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.

1. Disciplinary Action from Employer:

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.

2. Loss of Job:

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.

3. Disciplinary Action from the State Board of Nursing:

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.

4. Loss of Nursing License:

In some cases, especially if previous disciplinary action did not correct behavior, nurses can face loss of their nursing license following ethical violations.

5. May be Subject to a Civil Personal Injury Claim:

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.

6. Criminal Prosecution:

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.

7. Loss of Professional Relationships:

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.


Useful Resources For Learning More About The Code Of Ethics For Nurses


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.


My Final Thoughts


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.


FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT


1. What Was The First Code Of Ethics For Nurses Called?

The first Code of Ethics for Nurses was called the Nightingale Pledge.


2. What Is Provision Number In The ANA Code Of Ethics?

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.


3. What Is The ICN Code Of Ethics For Nurses?

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.


4. Can I Contact Someone About The ANA Code Of Ethics?

If you have questions about the ANA Code of Ethics for nurses, you may contact the Center of Ethics and Human Rights at ethics@ana.org.


5. Where Can I Find Nursing Code Of Ethics?

The American Nurses Association developed the ANA Code of Ethics for Nurses. The Code with interpretive statements can be found on the ANA website.


6. Is It Hard For Nurses To Adhere To The ANA Code Of Ethics?

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.


7. How Do I Cite The ANA Code Of Ethics?

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.


8. Does The ANA Code Of Ethics Apply To All Types Of Nurses?

The ANA Code of Ethics applies to every person who enters the nursing profession, regardless of their level of degree or licensure.


9. Does The Code Of Ethics Apply To Nursing Students?

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.


10. How Do Nursing Schools Teach The 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.


11. How Will Understanding The ANA Code Of Ethics Help Me As A Nursing Student?

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.


Darby Faubion BSN, RN
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).