By Laurie Davies
The Code of Ethics for Nurses establishes ethical principles in nursing. Far more than just words on paper, the code is nursing’s north star. It governs how nurses behave during the vulnerable moments when patients place their trust, their care and perhaps even life and death decisions into their hands.
Established by the American Nurses Association (ANA), the Code of Ethics for Nurses “informs every aspect of the nurse’s life.” As such, the ANA Code of Ethics for Nurses is the profession’s non-negotiable standard.
It’s also a dynamic document, and one that has responded over time to healthcare, technological and social changes.
The origins of nursing ethics reach back to the late 1800s — a far different era when nurses weren’t viewed as valued members of a healthcare team as they are today. And concepts like justice in nursing? Well, let’s just say that wasn’t a thing back then.
Times have changed.
Formally adopted by the ANA in 1950, the Code of Ethics is revised approximately every decade to keep pace with advances in healthcare and technology, greater awareness of global health, greater inclusivity and the expansion of nursing into advanced practice roles, such as the family nurse practitioner. Today, there are four principles of nursing ethics and nine provisions that guide practice.
Nurses make ethical decisions daily. In fact, nurses often walk a line between advocating for patients while also adhering to ethical nursing principles.
The four principles of ethics for nurses guide this sacred charge. These principles are autonomy, beneficence, justice and nonmaleficence.
Autonomy in nursing means that each patient has the right to make their own decisions based on their beliefs and values. According to an article published by the National Center for Biotechnology Information, this means a patient has the right to refuse medications, treatment, surgery or other medical interventions. The nurse must respect this choice.
Beneficence in nursing is not as intimidating as it sounds. The ANA defines it as “actions guided by compassion.” Examples of beneficence include helping a heart patient shower, keeping side rails up to prevent falls or providing medication in a timely manner.
Justice in nursing ethics implies that patients have a right to fair and impartial treatment. This means no matter what a patient’s insurance status or financial resources may be, or what gender identification, age or ethnicity they are, they have the right to fairness in nursing decisions.
What is nonmaleficence in nursing? It simply means “do no harm.” In other words, nonmaleficence in nursing requires that nurses select interventions that can be beneficial without causing harm.
It’s not difficult to imagine that sometimes these principles of ethics can collide. For example, a nurse may find doing no harm is in conflict with a patient’s exercise of autonomy in refusing a lifesaving medication.
The ongoing realities of caring for patients during COVID-19 has also stretched nurses to the limits of autonomy, justice and compassion. However, according to an article in the American Journal of Nursing, an August 2020 survey of 4,000 people (1,000 of whom were nurses) revealed that “the crisis has resulted in some progress within the profession, accelerating changes in attitudes and expectations regarding nurses.”
Specifically, leadership opportunities, professional advancement and influence into decision-making seemed to be higher among those who spent more than half their time caring for COVID-19 patients than those who spent less than half their time caring for COVID-19 patients.
In addition to the high-level ethical principles in nursing described above, nurses must abide by a Code of Ethics.
From patient dignity and confidentiality to a safe environment and work setting, nurses are to abide by the nine provisions of the Nursing Code of Ethics, according to the American Nurses Association.
The Code of Ethics for Nurses PDF, published by the American Nurses Association, provides greater detail about the provisions.
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