5.2 Ethical Principles
The American Nurses Association (ANA) designates Ethics as the first Standard of Professional Performance in Nursing: Scope and Standards of Practice, stating, “The registered nurse integrates ethics in all aspects of practice.”[1] See the following box for competencies associated with the ANA’s Ethics Standard of Professional Performance.
ANA’s Ethics Competencies[2]
The registered nurse:
- Uses the Code of Ethics for Nurses With Interpretive Statements as a moral foundation to guide nursing practice and decision-making.
- Demonstrates that every person is worthy of nursing care through the provision of respectful, person-centered, compassionate care, regardless of personal history or characteristics (Beneficence).
- Advocates for health care consumer perspectives, preferences, and rights to informed decision-making and self-determination (Respect for autonomy).
- Demonstrates a primary commitment to the recipients of nursing and health care services in all settings and situations (Fidelity).
- Maintains therapeutic relationships and professional boundaries.
- Safeguards sensitive information within ethical, legal, and regulatory parameters (Nonmaleficence).
- Identifies ethics resources within the practice setting to assist and collaborate in addressing ethical issues.
- Integrates principles of social justice in all aspects of nursing practice (Justice).
- Refines ethical competence through continued professional education and personal self-development activities.
- Depicts one’s professional nursing identity through demonstrated values and ethics, knowledge, leadership, and professional comportment.
- Engages in self-care and self-reflection practices to support and preserve personal health, well-being, and integrity.
- Contributes to the establishment and maintenance of an ethical environment that is conducive to safe, quality health care.
- Collaborates with other health professionals and the public to protect human rights, promote health diplomacy, enhance cultural sensitivity and congruence, and reduce health disparities.
- Represents the nursing perspective in clinic, institutional, community, or professional association ethics discussions.
American Nurse Association Code of Ethics
The American Nurses Association Code of Ethics for Nurses With Interpretive Statements is an ethical standard that guides nursing practice and ethical decision-making. It states, “Individuals who become nurses are expected to adhere to the ideals and moral norms of the profession and also to embrace them as a part of what it means to be a nurse. The ethical tradition of nursing is self-reflective, enduring, and distinctive. A code of ethics makes explicit the primary goals, values, and obligations of the profession.”[3]
The Code of Ethics for Nurses contains nine provisions. Each provision contains several clarifying or “interpretive” statements. Read a summary of the nine provisions in the following box.
Nine Provisions of the ANA’s Code of Ethics for Nurses[4]
Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
Provision 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.
Provision 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.
Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
Provision 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.
Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
Provision 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.
Read the free, online, full version of the Code of Ethics for Nurses With Interpretive Statements.
Ethical Principles
Ethical principles are used to define right from wrong action. Although there are many ethical principles that guide nursing practice, foundational ethical principles include respect for autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), and veracity (tell the truth).
Autonomy
The ethical principle of autonomy recognizes each individual’s right to self-determination and decision-making based on their unique values, beliefs, and preferences. The American Nurses Association (ANA) defines autonomy as, “the capacity to determine one’s own actions through independent choice, including demonstration of competence.”[5] The nurse’s primary ethical obligation is client autonomy.[6] Based on autonomy, clients have the right to refuse nursing care and medical treatment.
Beneficence
Beneficence is defined by the ANA as, “the bioethical principle of benefiting others by preventing harm, removing harmful conditions, or affirmatively acting to benefit another or others, often going beyond what is required by law.”[7] When caring for clients with mental health disorders, nurses implement beneficence when advocating for evidence-based treatment for clients’ mental health.
Nonmaleficence
Nonmaleficence is defined by the ANA as, “the bioethical principle that specifies a duty to do no harm and balances avoidable harm with benefits of good achieved.”[8] A classic example of doing no harm in nursing practice is reflected by nurses checking medication rights three times before administering medications. In this manner, medication errors can be avoided, and the duty to do no harm is met. An example of nurses implementing nonmaleficence in mental health care is ensuring that clients are not harmed by adverse effects of psychotropic medications (such as lithium toxicity or tardive dyskinesia).
Justice
Justice is defined by the ANA as, “a moral obligation to act on the basis of equality and equity and a standard linked to fairness for all in society.”[9] The principle of justice requires health care to be provided in a fair and equitable way. Nurses provide quality care for all individuals with the same level of fairness despite their personalities or characteristics, such as financial status, cultural beliefs, religion, gender, or sexual orientation. Nurses have a social contract to “provide compassionate care that addresses the individual’s needs for protection, advocacy, empowerment, optimization of health, prevention of illness and injury, alleviation of suffering, comfort, and well-being.”[10] An example of a nurse using the principle of justice in mental health care settings is ensuring that quality care is provided to all clients, even those who do not have the cognitive ability to communicate their needs.
Fidelity
Role fidelity is defined as being responsible for providing competent nursing care. An example of role fidelity in nursing is remaining up-to-date with evidence-based practice and implementing effective mental health interventions.
Veracity
Veracity means telling the truth. An example of veracity in health care is informed consent. Nurses ensure that clients have a good understanding of the benefits and risks of a prescribed procedure or psychotropic medication.
Role of Caring
Nurses use a client-centered, care-based, ethical approach to nursing care that focuses on the specific circumstances of each situation. This approach aligns with the foundational nursing concepts of holism and caring in a nurse-client relationship rooted in dignity, respect, kindness, and compassion.[11]
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- Legal Information Institute. (n.d.). Welcome to LII. Cornell Law School. https://www.law.cornell.edu ↵
The capacity to determine one’s own actions through independent choice, including demonstration of competence.
The bioethical principle of benefiting others by preventing harm, removing harmful conditions, or affirmatively acting to benefit another or others, often going beyond what is required by law.
The bioethical principle that specifies a duty to do no harm and balances avoidable harm with benefits of good achieved.
A moral obligation to act on the basis of equality and equity and a standard linked to fairness for all in society.
Being responsible for providing competent nursing care.
Telling the truth.
