Nursing Code of Ethics: Explained

What is the Nursing Code of Ethics?

The Code of Ethics for Nurses with Interpretive Statements (The Code) was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. In this we are going to discuss Both ICN Code of Ethics & ANA Code of Ethics

International Council for Nurses- Code of Ethics

The ICN Code of Ethics for Nurses is a statement of the ethical values, responsibilities and professional accountabilities of nurses and nursing students1 that defines and guides ethical nursing practice within the different roles nurses assume. It is not a code of conduct but can serve as a framework for ethical nursing practice and decision-making to meet professional standards set by regulatory bodies.

1. Nurses & Patients or Other People Requiring Care or Services

1. Nurses’ primary professional responsibility is to people requiring nursing care and services now or in the future, whether individuals, families, communities or populations (hereinafter referred to as either ‘patients’ or ‘people requiring care’).
2. Nurses promote an environment in which the human rights, values, customs, religious and spiritual beliefs of the individual, families and communities are acknowledged and respected by everyone. Nurses’ rights are included under human rights and should be upheld and protected.
3. Nurses ensure that the individual and family receive understandable, accurate, sufficient and timely information in a manner appropriate to the patient’s culture, linguistic, cognitive and physical needs, and psychological state on which to base consent for care and related treatment.
4. Nurses hold in confidence personal information and respect the privacy, confidentiality and interests of patients in the lawful collection, use, access, transmission, storage and disclosure of personal information.
5. Nurses respect the privacy and confidentiality of colleagues and people requiring care and uphold the integrity of the nursing profession in person and in all media, including social media.
6. Nurses share with society the responsibility for initiating and supporting action to meet the health and social needs of all people.
7. Nurses advocate for equity and social justice in resource allocation, access to health care and other social and economic services.
8. Nurses demonstrate professional values such as respect, justice, responsiveness, caring, compassion, empathy, trustworthiness and integrity. They support and respect the dignity and universal rights of all people, including patients, colleagues and families.
9. Nurses facilitate a culture of safety in health care environments, recognising and addressing threats to people and safe care in health practices, services and settings.
10. Nurses provide evidence-informed, person-centred care, recognising and using the values and principles of primary health care and health promotion across the lifespan.
11. Nurses ensure that the use of technology and scientific advances are compatible with the safety, dignity and rights of people. In the case of artificial intelligence or devices, such as care robots or drones, nurses ensure that care remains person-centred and that such devices support and do not replace human relationships.

2. Nurses & Practice

1. Nurses carry personal responsibility and accountability for ethical nursing practice, and for maintaining competence by engaging in continuous professional development and lifelong learning.
2. Nurses maintain fitness to practice so as not to compromise their ability to provide quality, safe care.
3. Nurses practise within the limits of their individual competence and regulated or authorised scope of practice and use professional judgement when accepting and delegating responsibility.
4. Nurses value their own dignity, well-being and health. To achieve this requires positive practice environments, characterised by professional recognition, education, reflection, support structures, adequate resourcing, sound management practices and occupational health and safety.
5. Nurses maintain standards of personal conduct at all times. They reflect well on the profession and enhance its image and public confidence. In their professional role, nurses recognise and maintain personal relationship boundaries.
6. Nurses share their knowledge and expertise and provide feedback, mentoring and supporting the professional development of student nurses, novice nurses, colleagues and other health care providers.
7. Nurses are patient advocates, and they maintain a practice culture that promotes ethical behaviour and open dialogue.
8. Nurses may conscientiously object to participating in particular procedures or nursing or health-related research but must facilitate respectful and timely action to ensure that people receive care appropriate to their individual needs.
9. Nurses maintain a person’s right to give and withdraw consent to access their personal, health and genetic information. They protect the use, privacy and confidentiality of genetic information and human genome technologies.
10. Nurses take appropriate actions to safeguard individuals, families, communities and populations when their health is endangered by a co-worker, any other person, policy, practice or misuse of technology.
11. Nurses are active participants in the promotion of patient safety. They promote ethical conduct when errors or near misses occur, speak up when patient safety is threatened, advocate for transparency, and work with others to reduce the potential of errors.
12. Nurses are accountable for data integrity to support and facilitate ethical standards of care.

3. Nurses & the Profession

1. Nurses assume the major leadership role in determining and implementing evidence-informed, acceptable standards of clinical nursing practice, management, research and education.
2. Nurses and nursing scholars are active in expanding research-based, current professional knowledge that supports evidence-informed practice.
3. Nurses are active in developing and sustaining a core of professional values
4. Nurses, through their professional organisations, participate in creating a positive and constructive practice environment where practice encompasses clinical care, education, research, management and leadership. This includes environments which facilitate a nurse’s ability to practice to their optimal scope of practice and to deliver safe, effective and timely health care, in working conditions which are safe as well as socially and economically equitable for nurses.
5. Nurses contribute to positive and ethical organisational environments and challenge unethical practices and settings. Nurses collaborate with nursing colleagues, other (health) disciplines and relevant communities to engage in the ethical creation, conduct and dissemination of peer reviewed and ethically responsible research and practice development as they relate to patient care, nursing and health.
6. Nurses engage in the creation, dissemination and application of research that improves outcomes for individuals, families and communities.
7. Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics, pandemics, social crises and conditions of scarce resources. The safety of those who receive care and services is a responsibility shared by individual nurses and the leaders of health systems and organisations. This involves assessing risks and developing, implementing and resourcing plans to mitigate these

American Nurses Association (ANA)- Code of Ethics

According to ANA the nursing code of ethics is a guide for “carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.”

Ethics, in general, are the moral principles that dictate how a person will conduct themselves. Ethical values are essential for ALL healthcare workers, but ethical principles in nursing are particularly important given their role as caregivers.

4 Ethical Principles in Nursing According to ANA

1. Autonomy 

Autonomy in nursing is recognizing each individual patient’s right to self-determination and decision-making. As patient advocates, it is imperative that nurses ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions. 

Once the patient has all the relevant information, the medical and nursing team can make a plan of care in compliance with the medical wishes of the patient. 

It is important that nurses support the patient in their medical wishes and ensure that the medical team is remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the wishes being verbalized because the medical team might not agree with those wishes.

Many factors may influence a patient’s acceptance or refusal of medical treatment, such as culture, age, gender, sexual orientation, general health, and social support system.

2. Beneficence

Beneficence in nursing is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as “actions guided by compassion.”

3. Justice

Justice is that there should be an element of fairness in all medical and nursing decisions and care. Nurses must care for all patients with the same level of fairness despite the individual’s financial abilities, race, religion, gender, and/or sexual orientation. 

An example of this is when working at a free flu clinic or diabetes screening clinic. These are open to all individuals in the community regardless of the previously mentioned factors.

4. Nonmaleficence 

Nonmaleficence is to do no harm. This is the most well-known of the main principles of nursing ethics. More specifically, it is selecting interventions and care that will cause the least amount of harm to achieve a beneficial outcome

The principle of nonmaleficence ensures the safety of the patient and community in all care delivery. Nurses are also responsible for reporting treatment options that are causing significant harm to a patient, which may include suicidal or homicidal ideations. 

Provisions:

1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks.
5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety.
6. The nurse participates in establishing, maintaining, and improving healthcare environments.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

Consequences of Violating the Nursing Code of Ethics

Violations of the ANA Nursing Code of Ethics for nurses can have dire consequences. It is vital for nurses to be aware of the possible consequences of violating the Code and make every effort to avoid violations. The following are examples of consequences associated with Code of Ethics violations for nurses.

1. Disciplinary Action from Employer:

 Nurses who violate ethical codes of conduct can expect to face disciplinary action from their employers. Depending on the violation and whether the nurse has a history of previous misconduct, the nurse could face a verbal or written reprimand or suspension.

2. Loss of Job:

 When violations of the Nursing Code of Ethics are repeated, the nurse could face termination. It is the nurse and healthcare organization’s responsibility to hold patient safety, privacy, and care in the highest regard. If a nurse fails to follow the provisions outlined by the Code of Ethics, it can result in loss of job.

3. Disciplinary Action from the State Board of Nursing:

 Any action that constitutes violation of the Nursing Code of Ethics may be reported to the Board of Nursing that holds jurisdiction over the nurse’s license. As such, it is the discretion of the Board to determine what action, if any, will be taken against the nurse.

4. Loss of Nursing License:

 In some cases, especially if previous disciplinary action did not correct behavior, nurses can face loss of their nursing license following ethical violations.

5. May be Subject to a Civil Personal Injury Claim:

 When nurses violate the Code of Ethics, they open themselves up for risk of facing civil litigation. Patients or their designated representatives may make a claim in civil court based on the nature of the violation. If the case is ruled in favor of the plaintiff, the nurse could face far-reaching financial, social, and psychological effects.

6. Criminal Prosecution:

 While many breaches of the ANA Code of Ethics for nurses are considered civil matters, some violations can result in criminal prosecution and penalties. For example, some HIPAA violations carry criminal penalties.

7. Loss of Professional Relationships:

 As if disciplinary actions, loss of job or license, and the risk of legal action were not enough, nurses who violate ethical codes of contact are at risk of losing professional relationships. Professional peers may personally like another nurse but often find it in their best interest to step away from relationships with unethical nurses to protect their own reputations.

Nursing Ethics Education:

Importance:

1. Prepares nurses to address complex ethical issues
2. Develops critical thinking and decision-making skills
3. Enhances patient care and safety
4. Supports professional development and growth
5. Fosters a culture of ethical practice

Curriculum Components:

1. Nursing ethics theories and principles
2. Code of Ethics and professional standards
3. Ethical decision-making models
4. Cultural competence and diversity
5. Patient rights and autonomy
6. Confidentiality and privacy
7. Informed consent and refusal
8. End-of-life care and palliative care
9. Research ethics and evidence-based practice
10. Interdisciplinary collaboration

Teaching Strategies:

1. Case studies and scenarios
2. Group discussions and debates
3. Role-playing and simulation
4. Reflective journaling and self-assessment
5. Guest lectures and expert panels
6. Online modules and webinars
7. Small group workshops and seminars

Assessment and Evaluation:

1. Written exams and quizzes
2. Case study analyses and presentations
3. Group projects and presentations
4. Reflective journaling and self-assessment
5. Clinical evaluations and observations

REFERENCES

1. Institute of Business Ethics (2019). The Ethical Challenges and Opportunities of Social Media Use. Business Ethics Briefing. 2 May 2019. Retrieved from: https://www.ibe.org.uk/ resource/the-ethical-challenges-and-opportunities-of-social-media-use.html
2. International Council of Nurses (1987). Definition of a nurse. Available at: https://www.icn.ch/nursing-policy/nursing-definitions
3. Office of the High Commissioner for Human Rights (n.d.). What are human rights? Retrieved from: https://www.ohchr.org/en/issues/pages/whatarehumanrights.aspx
4. United Kingdom Nursing & Midwifery Council (2021). What is fitness to practice? Retrieved from: https://www.nmc.org.uk/concerns-nurses-midwives/dealing-concerns/what-is-fitness-to-practise
5. American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring, MD: Author. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of Ethics-For-Nurses.html

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