By Kasee Wiesen DNP, APRN, FNP-C

According to the most recent Gallup Honesty and Ethical Survey, 85% of people find nurses honest and ethical—ranking nurses the most trusted profession for more than 20 years. 

Based on this fact, it should not come as a surprise that the standards of practice for a nurse follow a code of ethics. Nursing ethics dates back over 100 years with multiple revisions as nursing practice and health care changes have occurred. The code includes four principles and nine provisions that guide all nurses throughout their practice. 

Where did nursing ethics come from?

The code determines nursing ethics by providing the ethical standards that all nurses must follow during their careers. But when was it first implemented?

The nursing code of ethics development dates back to 1893, to the Nightingale Pledge. The pledge was named after Florence Nightingale, who is considered the founder of modern nursing, and based on the Hippocratic Oath for physicians laying the foundation of ethics in nursing practice. The Nightingale Pledge has had multiple revisions over the last century and is still recited today at nursing pinning ceremonies across the United States. 

In 1950, the American Nurses Association (ANA) adopted a formal code of ethics in nursing, and has revised several times over the last 72 years to remain current with the changes in nursing practice. The most recent revision in 2015 defined four principles and nine provisions for ethical practice.

What is the nursing code of ethics?

Ethics are the morals and values that form the actions of right and wrong for a person. They are the standards of doing right. The code of ethics in nursing is precisely that for nurses—it is the standards or guidelines to ensure they practice consistently through delivering high-quality care. 

The ANA established the code that guides nurses in their daily tasks and decision-making. The code is firm, and only the ANA can make revisions. The code of nursing ethics applies not only to today’s nurses but to future nurses, too. 

The following statements describe the purpose of the code:

• It is a concise statement of nurses’ ethical values, obligations, duties, and professional ideals, individually and collectively.
• It is the profession’s non-negotiable ethical standard.
• It is a statement of the nurse’s responsibility and devotion to society.

There are four principles of ethical nursing as defined by the code of nursing: Autonomy, Beneficence, Nonmaleficence, and Justice.

• Autonomy is the patient’s right to make their own medical decisions. In other words, the nurse should provide the patient with all the necessary information, options, and education for the patient to make an informed decision regarding their health.
• Beneficence is doing good or what is right for the patient, family, organization, etc. It includes preventing harm, removing harmful situations, and consciously acting to do good for others.
• Nonmaleficence is the duty not to inflict harm. It balances unavoidable harm with the benefits of good achieved. This principle also includes completing interventions that will result in the least harm to the patient.
• Justice states that nurses shall treat everyone equally regardless of their differences. Therefore, nurses must treat all people equally and fairly irrespective of their background, including race, ethnicity, religion, gender, and financial status.  

The current code of nursing ethics contains nine provisions that will guide the nurse in making ethical decisions and providing ethical care to patients.

Learn more about RUO's MSN in Nursing Leadership Program

In their practice, nurses are compassionate, respecting their patients' dignity, worth, and unique attributes.

1. The nurse’s responsibility is to the patient, including a person, group of people, family, or even community.   
2. The nurse will stand up for their patient by advocating for them and preserving their rights, health, and safety. 
3. The nurse must practice with the commitment to provide the highest quality and safest care to patients. In addition, nurses practice with authority and take accountability and responsibility for their decisions and nursing practice.
4. The nurse must care for themself and emphasize professional development by nurturing their own health and safety and maintaining ethical practices in their professional and personal life. Nurses should continue to grow professionally to demonstrate competence in practice.  
5. The nurse works towards improving the ethical environment of their workplace. They may do this individually or collectively with a group of nurses or other health care professionals. The goal of enhancing ethics is to ensure safe work environments to deliver high-quality health care. 
6. The nurse will promote evidence-based practice in all roles and settings to help advance the nursing profession through research, professional development, and health policy.
7. The nurse will work with the interdisciplinary team to promote health and reduce health disparities in their communities. 
8. The nurse will work with other nurses as a professional organization to promote ethical practice. The nurse must state the nursing values and further the four principles of nursing (autonomy, justice, beneficence, and nonmaleficence) in nursing and health policy. 

How are nurses responsible for adhering to these ethics?

The nursing code is the standard for nursing practice and applies to all nursing specialties, including registered nurses (RNs), nurse educators, nurse leaders, and nurse practitioners. The code lays the foundation for the ethics of nursing by ensuring nurses practice ethically and morally and that their values and ideals align with the profession.

Nurses are responsible for adhering to these ethics, and nurse leaders are responsible to ensure their nursing staff follow these practices daily. For example, nurses are example to do the following:

• Have the patient sign an informed consent form before a surgical procedure
  • The patient can choose or refuse medical treatment, including surgical procedures, medications, and life-saving measures. 
  • The patient may choose or decline life-saving measures, such as blood transfusion, or even elect DNR (“do not resuscitate”), based on their personal or religious beliefs.
• Maintain confidentiality 
• Listen to their patient and advocate for them when needed; for example, asking for a consult with physical therapy for a weak patient, palliative care for a patient overwhelmed with their new chronic diagnosis, and home health for an elderly patient discharged after a hospitalization 
• Administer pain medication to the post-operative patient, acetaminophen to the patient with a fever, or oxygen to the patient who is short of breath 
• Tell the patient the truth, including when the information they provide is difficult to share

Nurses are known for their excellence, compassion, and genuine care. The code of ethics helps ensure this type of care is universal, and the patient’s autonomy is always honored.

How can I be an ethical nurse leader? 

Rockhurst University offers an online Master of Science in Nursing–Leadership (MSN-Leadership) for aspiring nurse leaders. The MSN-Leadership program will help further develop the skills to become a transformational nurse leader capable of leading in organizational and clinical settings. 

The MSN-Leadership program can be completed in as few as four semesters if attended full-time or six semesters if attended part-time. Three common themes create the foundation for the program’s curriculum: leadership and management, evidence-informed quality improvement, and health care systems and policy.

Learn more about RUO's MSN-Leadership Program