The Code of Ethics for Nurses

The Code of Ethics for Nurses

The Code of Ethics for Nurses with Interpretive Statements (the Code) establishes the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making. The Code is nonnegotiable in any setting. It may be revised or amended only by formal processes established by the American Nurses Association (ANA). The Code arises from the long, distinguished, and enduring moral tradition of modem nursing in the United States. It is foundational to nursing theory, practice, and praxis in its expression of the values, virtues, and obligations that shape, guide, and inform nursing as a profession.

Nursing encompasses the protection, promotion, and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering, in the care of individuals, families, groups, communities, and populations. All of this is reflected, in part, in nursing’s persisting commitment both to the welfare of the sick, injured, and vulnerable in society and to social justice. Nurses act to change those aspects of social structures that detract from health and well-being. The Code of Ethics for Nurses

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Individuals who become nurses, as well as the professional organizations that represent them, are expected not only to adhere to the values, moral norms, and ideals or the profession but 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 for the nursing profession makes explicit the primary obligations, values, and ideals of the profession. In fact, it informs every aspect of the nurse’s life.

The Code of Ethics for Nurses with Interpretive Statements serves the following purposes:

•  It is a succinct statement of the ethical values, obligations, duties, and professional ideals of nurses individually and collectively.

Source: American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author.

•  It is the profession’s non-negotiable ethical standard.

•  It is an expression of nursing’s own understanding of its commitment to society.

Statements that describe activities and attributes of nurses in this code of ethics and its interpretive statements are to be understood as normative or prescriptive statements expressing expectations of ethical behavior. The Code also expresses the ethical ideals of the nursing profession and is, thus, both normative and aspirational. Although this Code articulates the ethical obligations of all nurses, it does not predetermine how those obligations must be met. In some instances nurses meet those obligations individually; in other instances a nurse will support other nurses in their execution of those obligations; at other times those obligations can only and will only be met collectively. ANA’s Code of Ethics for Nurses with Interpretive Statements addresses individual as well as collective nursing intentions and actions; it requires each nurse to demonstrate ethical competence in professional life. The Code of Ethics for Nurses

Society recognizes that nurses serve those seeking health as well as those responding to illness. Nurses educate students, staff, and others in healthcare facilities. They also educate within communities, organizations, and broader populations. The term practice refers to the actions of the nurse in any role or setting, whether paid or as a volunteer, including direct care provider, advanced practice registered nurse, care coordinator, educator, administrator, researcher, policy developer, or other forms of nursing practice. Thus, the values and obligations expressed in this edition of the Code apply to nurses in all roles, in all forms of practice, and in all settings.

ANA’s Code of Ethics for Nurses with Interpretive Statements is a dynamic document. As nursing and its social context change, the Code must also change. The Code consists of two components: the provisions and the accompanying interpretive statements. The provisions themselves are broad and noncontextual statements of the obligations of nurses. The interpretive statements provide additional, more specific, guidance in the application of this obligation to current nursing practice. Consequently, the interpretive statements are subject to more frequent revision than are the provisions—approximately every decade—while the provisions may endure for much longer without substantive revision.

Additional ethical guidance and details can be found in the position and policy statements of the ANA or its constituent member associations and affiliate organizations that address clinical, research, administrative, educational, public policy, or global and environmental health issues. The Code of Ethics for Nurses

The origins of the Code of Ethics for Nurses with Interpretive Statements reach back to the late 1800s in the foundation of ANA, the early ethics literature of modem nursing, and the first nursing code of ethics, which was formally adopted by ANA in 1950. In the 65 years since the adoption of that first professional ethics code, nursing has developed as its art, science, and practice have evolved, as society itself has changed, and as awareness of the nature and determinants of global health has grown. The Code of Ethics for Nurses with Interpretive Statements is a reflection of the proud ethical heritage of nursing and a guide for all nurses now and into the future.

Introduction

In any work that serves the whole of the profession, choices of terminology must be made that are intelligible to the whole community, are as inclusive as possible, and yet remain as concise as possible. For the profession of nursing, the first such choice is the term patient versus client. The term patient has ancient roots in suffering; for millennia the term has also connoted one who undergoes medical treatment. Yet, not all who are recipients of nursing care are either suffering or receiving medical treatment The root of client implies one who listens, leans upon, or follows another. It connotes a more advisory relationship, often associated with consultation or business.

Thus, nursing serves both patients and clients. Additionally, the patients and clients can be individuals, families, communities, or populations. Recently, following a consumerist movement in the United States, some have preferred consumer to either patient or client. In this revision of the American Nurses Association’s (ANA’s) Code of Ethics for Nurses with Interpretive Statements (the Code), as in the past revision, ANA decided to retain the more common, recognized, and historic term patient as representative of the category of all who are recipients of nursing care. Thus, the term patient refers to clients or consumers of health care as well as to individuals or groups.

A decision was also made about the words ethical and moral. Both are neutral and categorical. That is—similar to physical, financial, or historical—they refer to a category, a type of reflection, or a behavior. They do not connote a rightness or goodness of that behavior. The Code of Ethics for Nurses

Within the field of ethics, a technical distinction is made between ethics and morality. Morality is used to refer to what would be called personal values, character, or conduct of individuals or groups within communities and societies. Ethics refers to the formal study of that morality from a wide range of perspectives including semantic, logical, analytic, epistemological, and normative. Thus, ethics is a branch of philosophy or theology in which one reflects on morality. For this reason, the study of ethics is often called moral philosophy or moral theology. Fundamentally, ethics is a theoretical and reflective domain of human knowledge that addresses issues and questions about morality in human choices, actions, character, and ends.

As a field of study, ethics is often divided into metaethics, normative ethics, and applied ethics. Metaethics is the domain that studies the nature of ethics and moral reasoning. It would ask questions such as “Is there always an element of self-interest in moral behavior?”and “Why be good?” Normative ethics addresses the questions of the ought, the four fundamental terms of which are right and wrong, good and evil. That is, normative ethics addresses what is right and wrong in human action (what we ought to do); what is good and evil in human character (what we ought to be); and good or evil in the ends that we ought to seek.

Applied ethics wrestles with questions of right, wrong, good, and evil in a specific realm of human action, such as nursing, business, or law. It would ask questions such as “Is it ever morally right to deceive a research subject?”or “What is a ‘good nurse’ in a moral sense?” or “Are health, dignity, and well-being intrinsic or instrumental ends that nursing seeks?”All of these aspects of ethics are found in the nursing literature. However, the fundamental concern of a code of ethics for nursing is to provide normative, applied moral guidance for nurses in terms of what they ought to do, be, and seek.

Some terms used in ethics are ancient such as virtue and evil, yet they remain in common use today within the field of ethics. Other terms, such as ethics and morality, are often—even among professional ethicists—used imprecisely or interchangeably because they are commonly understood or because common linguistic use prevails. For example, one might speak of a person as lacking a “moral compass” or as having “low morals.” Another example is the broader public use of the term ethical. Ethics is a category that refers to ethical or nonethical behavior: either a behavior is relevant to the category of ethics, or it is not. Here, the term unethical has no meaning, although it is commonly used in lectures and discussions—even by professional ethicists—to mean morally blameworthy, that is, wrong. The terms should and must are often substituted for the more precise normative ethical term ought. Ought indicates a moral imperative. Must expresses an obligation, duty, necessity, or compulsion, although not an intrinsically moral one. Likewise, should expresses an obligation or expediency that is not necessarily a moral imperative.

The English language continues to evolve, and the once firm and clearly understood distinctions between may and can; will and shall; and ought, should, and must have faded in daily language and have come to be used interchangeably in both speech or writing, except in rare instances in which the nuance is essential to an argument. To aid the reader in understanding the terms used, this revision of ANA’s Code of Ethics for Nurses with Interpretive Statements will, for the first time, include a glossary of terms that are found within the Code.

This revision also includes another innovation: links to foundational and supplemental documents. The links to this material are available on ANA’s Ethics webpage. These documents are limited to works judged by the Steering Committee as having both timely and timeless value. Nursing’s ethics holds many values and obligations in common with international nursing and health communities. For example, the Millennium Development Goals of the United Nations, the World Medical Association’s Declaration of Helsinki about research involving human subjects, and the International Council of Nurses’ Code of Ethics for Nurses are documents that are both historically and contemporaneously important to U.S. nurses and nursing’s ethics.

The afterword from the 2001 Code has been included and updated to reflect the 2010–2014 revision process. This Introduction, another new component of this revision, was added to provide a general orientation to the terminology and the structure of this document. The Code of Ethics for Nurses

The nine provisions of the 2001 Code have been retained with some minor revisions that amplify their inclusivity of nursing’s roles, settings, and concerns. Together, the nine provisions contain an intrinsic relational motif: nurse-to-patient, nurse-to-nurse, nurse-to-self, nurse-to-others, nurse-to-profession, nurse-to-society, and nursing-to-society, relations that are both national and global. The first three provisions describe the most fundamental values and commitments of the nurse; the next three address boundaries of duty and loyalty; the final three address aspects of duties beyond individual patient encounters. This revision also retains, for each provision, interpretive statements that provide more specific guidance for practice, are responsive to the contemporary context of nursing, and recognize the larger scope of nursing’s concern in relation to health.

It was the intent of the Steering Committee to revise the Code in response to the complexities of modern nursing, to simplify and more clearly articulate the content, to anticipate advances in health care, and to incorporate aids that would make it richer, more accessible, and easier to use.

—Steering Committee for the Revision of the Code of Ethics for Nurses with Interpretive Statements, September 2014