Nursing Code of Ethics: A Student’s Guide

For the 20th straight year in a row, Gallup’s Honesty and Ethics poll has ranked nursing as the top most trusted profession by Americans. The poll revealed that nurses are viewed as being highly honest and ethical by an astounding 81% of Americans, eclipsing the second most trusted profession, doctors, by 14 points.

The actions of nurses are guided by universal rules of conduct to make difficult decisions and judgment calls, and to model integrity while remaining within the laws that govern their practice. Courses designed to instill an ethical foundation into students is central to any nursing core curriculum, but becoming a nurse is more than just knowing right from wrong. Nurses must possess an inner moral compass that dictates their professional actions and upholds the pledge they take “to do no harm.” If you’re feeling the calling to join the most trusted and ethical profession, you can and should start following the Nursing Code of Ethics the moment you begin your nursing education. It’s never too early to learn and implement the key ethical nursing principles to into your daily life as you prepare for your professional future.

The 9 Provisions of the Nursing Code of Ethics

The term ethics is derived from a Greek word “ethos,” which means character. As patient advocates, nurses must have strong ethical and moral principles to guide them. To help define the ethical behavior expected of nurses, the American Nurses Association has developed nine nursing code of ethics provisions. Whether you’re just starting your journey into nursing or are a seasoned professional, the expectations of moral and fundamental behavior remain the same. Explore the nine provisions and learn how they can be practiced by nursing students to prepare for a rewarding career in nursing.

Provision 1

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

Nurses must respect and maintain the autonomy and dignity of their patients and recognize that they are not defined by their illness, disability, or disease. Patients must be treated as the unique individual they are while being provided care. Information must be presented to patients honestly and with no ill intent, allowing them to make informed decisions about their health and the care they receive. This means that nurses must respect a patient’s choice, even if they do not agree with it. In addition to unbiased, respectful care, nurses must be able to resolve conflict and maintain professionalism with other members of the healthcare delivery team while committing to uphold what is best for the patient at all times.

Being compassionate and respecting the inherent dignity, worth, and unique attributes of every person is not just for licensed nurses. This social principle can be applied during regular interactions with people in everyday life. Take time to think about what makes you unique and the autonomous decisions you enjoy making every day. Then, consider other people and the characteristics that make them unique. While you’re a nursing student, you will start practicing this provision by recognizing that every person has a right to be independent and make their own choices, regardless of your own personal feelings towards those choices. This principle is essential to recognizing and promoting the welfare and dignity of others.

Provision 2

The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

The nurse’s main commitment must be to their patient. A nurse can also advocate for a family, group, community, or entire population. This means nurses should involve patients and their support system in their care while following a care plan that the patient agrees with and is willing to initiate. Conflicts will arise between patients, families, colleagues, or employers and can happen in any setting. The key is for nurse to identify conflicts that exist between their own personal values and those required by the profession.

Advocacy starts by being committed to your patients, even if you may not always agree with what your patients wants for themselves. You must start from a place of putting the patient first and then assisting family and friends if they request your insight. Be prepared to provide crucial information that is well founded and evidence based to your patients.. As a nursing student, practice this provision by collaborating with others, be willing to ask questions, admitting when you don’t know something, and be willing to find the answers to things you don’t know. Learning to speak up for yourself and others and use your knowledge while in nursing school will help provide a foundation for your nursing career.

Provision 3

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

Patient rights are granted to every patient and upheld by nurses. One of the most important patient rights nurses are responsible for is ensuring patient confidentiality and maintaining patient privacy. This not only means providing a therapeutic, private space for the patient while they receive care but also keeping patient information confidential and only sharing with other healthcare providers on a need-to-know basis such as being involved in the patient’s care. Nurses must also maintain performance standards of their profession such as completing required training, licensure, and being involved in policies designed to protect patients and minimize their risks. Promoting a culture of safety is not only beneficial for patients but also for coworkers and organizations to get the best outcomes.

Nursing students are held to high standards that continue after graduation as you enter the field as a newly licensed nurse. While this provision might seem specific to patient relationships, protecting the rights, health, and safety of others is important for personal relationships as well. Resisting the urge to spread rumors and gossip is very much related. Rumors tend to spread with rapid speed and harm others, often with no basis in fact. Be careful about what information you choose to share with others by asking if the information is relevant and necessary and what the result will be. Remember that words can have far-reaching consequences.

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.

Nurses must make decisions and take actions swiftly. Sometimes, these high-pressure situations can result in taking the easy road or having a lapse in judgment. Nurses are responsible for the actions they take and can be held liable for them, which is why it is crucial to always exercise within the scope of practice and take responsibility your actions. These responsibilities include accepting patient assignments that are appropriate, delegating the right tasks to assistive personnel, and being accountable for decisions made. If a mistake is made, address it immediately to ensure harm to your patient is minimized as much as possible.

Nursing school is full of challenges and judgment calls. Having integrity and honesty in academia is not only expected but required. The nursing profession is no different. Taking on the responsibility of helping vulnerable populations in their time of need will require honesty and integrity. Mistakes can and do happen. Addressing these mistakes, learning from them, and helping to teach others is something that will be required of you well before graduation day comes. Take this time to learn as much as you can and ask questions of the seasoned nurses who’ve faced challenging situations.

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.

This provision emphasizes the needs for self-care and health promotion. Nursing is a strenuous job that can also take an emotional toll. To combat this and prevent burnout, nurses must develop a self-care routine where they can eat well, exercise, and partake in personal interests to be able to care for others. Establishing a circle of friends who understand and can be there for each other during stressful times is beneficial. Nursing is unique in that its personal and professional requirements are not mutually exclusive but instead blended due to the high ethical and moral requirements of the work.

Nursing school can also be a busy time where juggling school, work, and family obligations is difficult. Consider implementing a wellness routine to carve out time for yourself. Getting into a routine can take some time, so you may need to experiment with different activities to see what works best for you. There are many ways to do this, including journaling, long walks, exercise, meditation, or just setting aside dedicated time for a personal activity that makes a positive impact in your life. To care for others, we must first be able to take care of ourselves.

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.

Taking an active part in the work environment helps nurses professionally but also gives them input into making policies and decisions that directly impact their patients and each other. Nurses have a professional duty to create an environment that is supportive of moral values so they can fulfill ethical obligations. Taking part in health and safety initiatives, committees, and other organizational structures helps influence the direction of healthcare. Being kind, welcoming, and supportive of new staff, offering knowledge when able, and being a role model of leadership and integrity is expected as you continue to grow in your professional role as a nurse.

In nursing school, there are many opportunities for involvement and professional development. These can be an excellent launching point for the professional development that’s expected of you once you are a licensed nurse. Take advantage of student body government, clubs, and chapters that align with your ethics and goals. Become involved in your school and help incoming students who have questions and concerns. Working to create a more inclusive environment can be a great way to gain experience with leadership and advocacy, both of which are key requirements of the licensed nurse.

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.

Nurses are responsible for knowing and remaining within their scope of practice while performing job duties. Implementing care must be appropriate within the scope of practice, align with the nurse’s professional experience, and follow current evidence-based guidelines. Nurses are expected to be continuous learners and take time to update themselves on continually evolving healthcare practices by asking questions, completing required training, and completing continuing education courses required for license renewal. Nurses are also strongly encouraged to engage at the organizational, community, state, or national level to engage initiatives related to the profession and the entire scope of healthcare.

While you’re in nursing school, learning is at the forefront, but lifelong learning is an ongoing process. Take advantage of your time in school to learn and grow while you gain an understanding of the research process. Research consists of more than formulating PICOT questions and whipping out that essay over the weekend. Healthcare is such a complex, multifaceted specialty that it requires constant monitoring for practice updates as well as a willingness to approach something differently than has been done in the past.

Provision 8

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

Health is a universal human right. As such, nurses must maintain and promote universal access to healthcare, sanitation, and education to help individuals understand, treat, and control any health problems they may have. Nurses must not impose their own culture and values on others, but they need to have compassion and provide culturally competent care across a wide demographic of people. Affirming human rights and providing unbiased care is essential to the duties required of a nurse. Nurses are expected to model health and wellness in their communities and to create collaborative partnerships to help relieve healthcare disparities.

Begin implementing this provision in nursing school by getting to know your local community, its population, and what health disparities affect it the most. Becoming familiar with those around you and the issues they face can help you recognize disparities and see how they influence each community differently. Consider volunteering at a charity clinic or with the public health department. Learning about different cultures and opening dialogues with people who come from different backgrounds can help you expand your knowledge which will be very beneficial once you begin to practice as a nurse.

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.

It is the responsibility of nurses and the organizations that represent them to address health-related sociocultural issues such as homelessness, violence, hunger, illness, and human rights violations. Professional nursing associations must educate and inform their members on expected nursing values, including those that are vital to social change and enhanced health. Nursing organizations also have a responsibility to promote respect, care, and fairness while ensuring workforce sustainability, promoting higher education for all nurses, and facilitating evidence-based practices. Communicating nursing values to the public helps ensure the integrity of the profession remains intact.

As a student nurse, consider some of the ways health and social factors have affected your community in the past. Think about how the needs of people in your community may be different from your needs and how you would address them. Consider how you portray yourself on social media platforms. Be careful of what you post and consider how it could be interpreted from different perspectives. Whether you’re a student nurse or a nursing professional, your social media accounts may be strictly monitored by employers, your leadership, and even nursing organizations in order to maintain integrity and safety of patients.

The 4 Principles of Ethics for Nurses

It is not at all uncommon for ethical dilemmas to arise for nurses as they provide care for patients. Sometimes, these dilemmas may conflict with the Nursing Code of Ethics or with the nurse’s personal values. This can cause nurses to walk a fine line between patient care and their ethics. The American Nurses Association has developed the principles of nursing ethics which include autonomy, beneficence, justice, and non-maleficence. Because society and healthcare changes, updates are made to the nursing ethic principles every decade The principles of ethics for nurses include the nine provisions previously discussed, but take a look at the bigger picture and see how you can apply these principles while you’re a nursing student.

Principle One: Autonomy

Autonomy is recognizing that patients have the right to make their own decisions based on their own beliefs and values. Sometimes, patients may choose to refuse or decline a medical intervention, regardless of the benefit. Patients have the right to refuse medications, treatment, surgery, or other medical interventions. While it can be difficult to understand for nurses, patients do have the right to refuse and the nurse must respect their choice, regardless of what they feel is best. This can create conflict when care suggestions do not align with the patient choice, but it is their autonomous right to do so.

Think about some personal choices you enjoy the freedom in making such as your hair color, who you live with, or diet choices. Then, consider someone you know who feels or lives differently. While you each have your own personal positions, neither of you has a right to override the other’s choice. Respecting others’ decisions, even when they do not align with your own, is the most basic principle of autonomy, and it is important to bring this respect to your nursing education and practice. Take the time to get to know others while remaining respectful of their decisions. This will help you to be more accepting and considerate of the differences of others when you enter a professional nursing practice.

Principle Two: Beneficence

The duty to refrain from maltreatment, minimize harm, and promote good towards patients is known as beneficence. Every action you take as a nurse is based on the perceived benefit versus risk to the patient. It is routine practice for nurses to enact safety measures as a way of providing beneficent care such. This care could be placing non-skid socks on a patient prior to helping them walk, helping a patient eat their meal, and making sure you check in on your patients at the right times. These examples display perceived benefit over risk and improve the likelihood of the patient remaining safe.

Every day, you make choices based on perceived risk versus benefit such as driving a car, meeting a friend at a public park, or putting on a jacket. Beneficence is using a calculated thought process to decide which actions should be taken based on the benefit outweighing the risk. You can implement this today by evaluating your personal behaviors and choices such as don’t drink and drive, exercise for an extra 10 minutes, and swap out the white rice for brown rice in a favorite dish. These decisions will not result in harm to you, but instead will help you. Make sound choices and avoid risky behaviors that could affect you or someone else in a negative way.

Principle Three: Justice

The nursing ethic of justice implies that patients have a right to fair and impartial treatment. Nurses have an ethical responsibility to treat all patients fairly and with equality regardless of their ability to pay for services, gender identification, age, or ethnicity. Justice has been a hot topic for years in healthcare, with primary arguments centering around universal health coverage and access to healthcare availability in rural areas compared to metropolitan ones.

Treat others as you would like to be treated. It sounds so simple but can be much more challenging when it comes to implementation. Justice aligns well with autonomy because in respecting the decisions of others, nurses must also advocate for those with identifiable healthcare disparities. You can begin implementing justice now by being a voice for people with less fortunate circumstances, volunteering to help underserved populations, and learning all you can about some of the issues the modern healthcare system faces. This will prepare you for the working world and give you confidence to speak up and advocate for patients in your care.

Principle Four: Non-maleficence

Non-maleficence is the patient’s right to receive no harm. For the nurse, this is often the most challenging ethical principle to uphold because it can easily conflict with other nursing principles. For example, what if a patient refuses to take medication or have a procedure performed that could save their life? This puts the nurse in a difficult position because they know that what is best for the patient is in violation of the patient’s autonomous right to decline. In these instances, the nurse can only provide information and facts to the patient, but it is ultimately the patient’s decision and must be respected.

Non-maleficence is an ethical principle unique to the healthcare profession. The best way to implement this principle today is by talking with experienced individuals and learning about how these delicate situations were handled. Ask what went well and what could have been different. Place yourself in the patient’s and healthcare professional’s shoes to think about where each side is coming from. Also, consider looking at some of your local organizations and see if they offer an ethics committee or advisor. These options can be beneficial to staff and patients alike when ethical situations arise.

Limitations of the Code of Ethics for Nurses

A patient refusing a therapeutic medication, removing life support from a patient, or determining a person’s cognitive ability to sign a complex consent form are just a few examples of ethical dilemmas nurses can find themselves in. Nurses must make difficult decisions daily, and the code of ethics helps drive these decisions. Still, there are inevitable situations that arise that will call ethical principles into question and lead the nurse to doubt what the best course of action is. Ethics are ever evolving and are called into question, so take a look at some of the more common scenarios where ethics are more likely to be broken, and what you should do if these situations occur.

Patient Needs vs. Personal Beliefs

What a patient may need medically can conflict with their personal beliefs. During these difficult scenarios, patients will often ask their nurse for advice or what they would do if they were in the same shoes. Patients are looking for reassurance and may ask for the nurse’s opinion to help them make a decision. In these situations, the nurse should not express their personal beliefs or opinions to the patient but should facilitate care coordination and offer facts to the patient so they can make an informed decision.

Resource Allocation

It is more common than you might think that nurses are the ones who decide which patients need supplies or treatment more than others. Recent supply chain issues and an aging population have placed significant strain on the U.S. healthcare system, requiring nurses to ration and allocate resources. When this occurs, nurses must use their triage skills to decide who is in the most need. They must also facilitate communication with providers to have orders changed or edited if there is another option that could work in the interim.

Withholding Information

Nobody likes being the bearer of bad news. Since doctors order and review test results, it is expected that they inform the patient. Unfortunately, there are many times where the nurse is placed in a difficult position because the physician did not tell the patient or left out important details. In these difficult situations, it is best for the nurse to answer the patient’s questions carefully and factually. It is not wrong for the nurse to feel uncomfortable in doing this and it would be fine to ask that a supervisor or physician speaks with the patient.

End-of-Life Decision Making

End-of-life decision making is a major ethical issue in nursing. Nurses can quickly find themselves in a difficult position between honoring patients’ wishes and managing others who may be at odds with the patient such as family members or other healthcare professionals. If a patient is of sound mind and judgment, they are well within their rights to choose end-of-life care or continued treatment. A nurse’s primary responsibility is to the patient and supporting their autonomy and their decision in these instances.

Peer Incompetence/Violation of Ethics

The type of work nurses do day in and day out leads to the development of tight bonds with peers and coworkers. This can place nurses in a difficult position when a fellow nurse is not performing their duties as assigned. Reporting errors can be difficult, but the nurse is ultimately responsible for providing safe and competent care to all patients. At a minimum, concerns of nursing judgment, ability, or potential ethical violations should be reported to a first line supervisor for follow up.

While these are only five examples, be aware that there are infinite situations that may call a nurse’s ethics into question. Nurses have a professional obligation to always default to the code of ethics and live accordingly. Personal beliefs should not influence patient interactions if they will cause a violation of the code of ethics. Your personal ethics as a nursing student and later on as a nurse create a deep-seeded moral compass that will evolve with time. The best time to learn and practice these ethical principles is now while you’re still in school.

Further Reading: Nursing Code of Ethics Resources

The Code of Ethics for Nurses is complex and multifaceted. Taking time to familiarize yourself with the principles as a nursing student can best prepare you for your future as a licensed nurse. If you would like to learn more about the Nursing Code of Ethics, explore the following resources.

• ANA Code of Ethics for Nurses: The American Nurses Association provides easy access and transparency to the Code of Ethics for Nurses to maintain quality in nursing care.
• Emergency Nurses Association Student Membership: As a nursing student, if you’re interested in emergency nursing, you can become a student member of the ENA, where you’ll receive many benefits including advocacy and education on ethics and patient care.
• Legal Issues All Nurses Need to Be Aware Of: The University of South Carolina Aiken offers this resource for nurses on understanding legal issues and the ramifications behind violations to help nurses be more aware and protect themselves from legal and ethical pitfalls.
• National Student Nurses’ Association: The NSNA has a large, comprehensive section dedicated to the code of ethics for nursing programs, which align and expand upon with the Nursing Code of Ethics.
• Nursing Essentials Ethical & Legal Issues NCLEX-RN: Try your luck at some of these practice NCLEX-RN questions centered around ethical and legal issues in nursing, including testing strategy and rationale for correct answers.