5.2 Ethical Principles

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.

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.

Autonomy Case Application

Sarah, an experienced registered nurse, is caring for Mr. Thompson, a 68-year-old man recently diagnosed with early-stage lung cancer. His oncologist has recommended surgery followed by chemotherapy, explaining that this approach offers the best chance of remission. However, after discussing the options with Sarah and his family, Mr. Thompson decides to decline aggressive treatment in favor of palliative care, prioritizing his quality of life over prolonged treatment.

Although Sarah personally believes that pursuing treatment might extend his life, she respects Mr. Thompson’s decision. She ensures that he fully understands the risks and benefits of his choice, answers his questions, and advocates for his wishes with the healthcare team. She arranges for a palliative care consultation and works to provide comfort-focused care, demonstrating her commitment to the ethical principle of autonomy

Beneficence Case Application

Emily, a psychiatric nurse, is caring for Jake, a 25-year-old patient admitted for severe depression and suicidal ideation. After assessing Jake’s condition, she notices that he is hesitant to engage in therapy and has refused his prescribed antidepressant medication due to fears of side effects.

Understanding the importance of evidence-based treatment, Emily takes extra time to educate Jake about his medication options, explaining the benefits and potential side effects in a way that eases his concerns. She also collaborates with the healthcare team to explore alternative treatments, such as therapy and lifestyle modifications, that align with his comfort level.

Beyond her basic duties, Emily advocates for Jake by arranging a meeting with his psychiatrist to discuss adjusting his treatment plan to better suit his needs. She also encourages the implementation of cognitive behavioral therapy, recognizing its proven effectiveness in treating depression. By proactively seeking the best care for Jake and ensuring he receives appropriate, individualized treatment, Emily exemplifies the ethical principle of beneficence.

Nonmaleficence Case Application

Michael, a psychiatric nurse, is caring for Lisa, a 40-year-old patient diagnosed with bipolar disorder who has been taking lithium for mood stabilization. During his routine assessment, Michael notices that Lisa is experiencing symptoms of nausea, hand tremors, and mild confusion—potential early signs of lithium toxicity.

Recognizing the risk, Michael immediately reviews Lisa’s most recent lab results and finds that her lithium level is approaching a toxic range. Acting quickly, he notifies the prescribing provider and ensures that Lisa’s medication is adjusted to prevent further harm. He also educates Lisa about the importance of staying hydrated and recognizing signs of toxicity so she can report symptoms early in the future.

By proactively identifying and addressing a potential medication-related harm, Michael upholds the ethical principle of nonmaleficence, ensuring that Lisa’s treatment remains both safe and effective.

Justice Case Application

Sophia, a nurse working in a busy emergency department, is caring for two patients who arrived at the same time—one is a well-dressed businessman with private insurance, and the other is an unhoused individual experiencing a mental health crisis. Despite their differing backgrounds, Sophia treats both patients with the same level of care, professionalism, and respect.

The unhoused patient is disoriented and unable to clearly communicate his needs. Sophia takes the time to assess him thoroughly, advocating for a psychiatric evaluation and ensuring he receives appropriate care, including food, clean clothing, and social work support for housing resources. She also educates both patients about their treatment options and ensures they have follow-up care in place before discharge.

By providing equitable and compassionate care to both patients—regardless of their socioeconomic status—Sophia upholds the ethical principle of justice, ensuring that healthcare is delivered fairly and without bias.

Fidelity Case Application

James, a registered nurse on a medical-surgical unit, is caring for Mr. Thompson, a postoperative patient recovering from abdominal surgery. During the night shift, Mr. Thompson confides in James that he is in more pain than he initially reported but asks him not to document it because he's afraid it might delay his discharge.

James listens carefully and reassures Mr. Thompson that his concerns are valid. He gently explains that accurate documentation is essential—not only for managing his pain appropriately but also to maintain transparency and continuity of care. James advocates for the patient by contacting the provider to reassess the pain management plan, while also clearly documenting the patient’s condition in the medical record, following hospital policy.

Though tempted to withhold the full truth out of empathy for Mr. Thompson’s desire to go home, James remains loyal to his professional obligation and the trust placed in him by both the patient and the healthcare team. His honest, compassionate communication and commitment to ethical documentation reflect the principle of fidelity—keeping promises, honoring professional responsibilities, and maintaining trust in the nurse-patient relationship.

Veracity Case Application

Emily, a preoperative nurse, is preparing Mr. Jackson, a 55-year-old patient, for an elective colonoscopy. As she reviews his chart, she notices that he has not yet signed the informed consent form. When she asks him about it, Mr. Jackson admits that he doesn’t fully understand the risks and benefits of the procedure.

Emily notifies the physician, who answers his remaining concerns. Once he feels confident in his decision, Mr. Jackson signs the consent form. By ensuring that he receives complete and truthful information before making a decision, Emily upholds the ethical principle of veracity.

Role of Caring Case Application

Elena, a nurse on an oncology unit, is caring for Mrs. Rivera, a patient undergoing chemotherapy who is experiencing significant fatigue, hair loss, and emotional distress. During morning rounds, Elena notices that Mrs. Rivera is unusually quiet and tearful.

Instead of simply focusing on clinical tasks, Elena pulls up a chair, holds Mrs. Rivera’s hand, and asks how she’s truly feeling. Mrs. Rivera opens up about her fears, body image concerns, and feelings of isolation. Elena listens with empathy, validates her emotions, and offers support by involving the hospital counselor and arranging a visit from a volunteer who also underwent cancer treatment.

Later that day, Elena brings in a soft headscarf gifted by a local support group and helps Mrs. Rivera feel more comfortable and cared for. She checks in regularly—not just to assess physical symptoms, but to ensure emotional and spiritual needs are met.

By going beyond physical care to foster connection, compassion, and comfort, Elena exemplifies the role of caring in nursing, nurturing a healing environment that supports the whole person, not just the illness.