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Whether you are already working in the nursing field or aspire to become a nurse in the future, one of the most important things you will need to learn is the American Nurses Association Code of Ethics.


In nursing practice, this code of ethics provides critical guidance for carrying out the duties and responsibilities of the nursing profession in a manner that ensures quality, consistent care. The code of ethics for nurses also aims to provide nurses with guidance in adhering to the ethical obligations of this challenging yet rewarding profession.

So, why is the nursing code of ethics so important in nursing practice—and what are some of the key principles aspiring and practicing nurses should know? We will be covering this and more, including details about the history of the nursing code of ethics, below.

The Importance of the Nursing Code of Ethics

There are many reasons why the nursing code of ethics is so important for all nursing professionals to learn. From upholding a sense of professional integrity to ensuring consistency and quality in patient care, the code of ethics serves an important purpose in the nursing profession.

Upholding Professional Integrity

Integrity is crucial to nursing practice, as all nurses need to maintain strong moral principles. The code of ethics in nursing offers a universal set of guidelines designed to uphold professional integrity throughout the field. With all nurses following the same code of ethics, everyone can adhere to the same standards and be held to the same expectations. Widespread upholding of a level of integrity by each individual nurse helps maintain the overall integrity of the field.

Ensuring Quality Care

The nursing code of ethics also helps ensure quality and consistent care from one patient to the next because the code of ethics guides everyday practice to maintain and improve the patient care environment. When nurses follow the code of ethics in their everyday decision-making, they can take consistent action and make decisions that lead to optimal patient care.

The Evolution of the Nursing Code of Ethics

Believe it or not, following a code of ethics in nursing is still a relatively new concept. By understanding the historical context of the code of ethics and today’s modern adaptations of it, you can get a better feel for how nursing practice has changed over the years.

Historical Context

It is believed that the first inklings of a code of ethics started back in the late 1800s when nurses coined “the Nightingale Pledge” after modern nursing founder Florence Nightingale. This pledge was essentially a slight modification of the Hippocratic Oath geared specifically toward nursing professionals.

Modern Adaptations

In the 1950s the American Nurses Association (ANA) officially developed its own code of ethics. Since then, the nursing code has changed considerably. As recently as 2015, nine new interpretive statements were added to the code—and small revisions to the code regularly occur.

Core Ethical Principles in Nursing

All nursing professionals are expected to follow four core ethical principles within the nursing code of ethics: autonomy, beneficence, justice, and nonmaleficence.

Principle of Autonomy

The principle of autonomy recognizes that each patient has the right to make their own decisions regarding their health and wellness. Nurses must serve as patient advocates by supporting patients’ decisions, including when they may not agree with a patient’s choice.

Principle of Beneficence

The principle of beneficence means that every decision a nurse makes should be guided by compassion, kindness, and charity toward all people.

Principle of Justice

The principle of justice means nurses should be fair in all medical and nursing decisions. Patients are entitled to receive the same quality of care and compassion, regardless of their race, gender, religion, or background.

Principle of Nonmaleficence

Last but certainly not least, the nursing principle of nonmaleficence means that nurses should always resolve to “do no harm.” Nurses should make decisions and choose interventions that will yield the best possible outcomes for patients with the least risk of harm.

Interpretive Statements and Provisions of the Nursing Code of Ethics

In 2015, nine provisions or statements were added to the American Nurses Association Code of Ethics.

Understanding the Provisions

You can read the ANA nine provisions in detail online at the National Institutes of Health website. However, nurses and aspiring nurses should understand that these provisions were added to help nurses make more ethical and informed decisions throughout their careers in ways that the original code could not. Topics covered by the nine provisions are broad and range from guidance on scholarly inquiry and professional standards to patient advocacy.

Applying the Provisions in Practice

Nurses apply the code of ethics provisions in their work every day—often without even realizing it. For example, a nurse may choose to advocate for a patient who wants to stop chemotherapy treatment for cancer and begin hospice care instead. Even if the nurse wants the patient to keep fighting, the code of ethics and its provisions guide nurses toward respecting patient decisions and always advocating for their autonomy.

The Role of Ethics in Nursing Decisions

Making ethical decisions is something nursing professionals do many times each day. It is not uncommon for a nurse to incorporate all four ethical principles and many of the nine provisions in a single shift. Still, this does not necessarily make the decisions any easier on the nurse.

Balancing Personal and Professional Ethics

Nurses often struggle to balance their personal ethics with the code of ethics they have sworn to. For example, a nurse may struggle to accept a patient deciding to sign out of the hospital against medical advice. At the same time, the code of ethics maintains that nurses must allow patients to maintain their autonomy. Nurses must work to follow the code of ethics no matter what—even when its principles go against their personal beliefs.

Case Studies on Ethical Dilemmas

Over the years, there have been many case studies done on common ethical dilemmas in the nursing field. Among the most common dilemmas nurses face is that of confidentiality versus the duty to warn, which involves the difficult decision to breach patient confidentiality to keep the patient (or others) safe.

This is most often the case when a patient has a history of violent behavior or has made comments about their intent to hurt themselves or others. In these instances, nurses face the difficult task of evaluating the severity of the threat, seeking consultation from other team members, and following all legal and ethical guidelines to reach a decision.

Other common ethical dilemmas that nurses often face on the job are related to:

  • End-of-life care
  • Informed consent
  • Patient autonomy versus beneficence

Ready to Deepen Your Understanding of the Nursing Field?

Without the American Nurses Association Code of Ethics, nursing professionals would not have a universally accepted ethical guide for carrying out their work. Typically, this code is taught as part of a comprehensive nursing education program (such as a nursing degree program)—but even after being introduced to the code of ethics in school, nurses should be proactive about staying familiar with the code in their everyday work.

If you are still looking for the right nursing program for your interests, Post University has options for you to consider, including an  RN-to-BS in Nursing and a Master of Science in Nursing (MSN). You can learn more about our nursing degree programs by getting in touch with our team—or take the next step and complete your online application today.


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