Nursing Code of Ethics Principles

Why This Matters

The ANA Code of Ethics isn't just a document you memorize for exams—it's the foundation that shapes every clinical decision you'll make as a nurse. You're being tested on your ability to apply these principles to real-world scenarios, recognize ethical dilemmas, and understand how individual provisions connect to broader concepts like patient autonomy, beneficence, nonmaleficence, justice, and professional accountability. Exam questions often present situations where multiple principles seem to conflict, and you'll need to prioritize appropriately.

These nine provisions (plus the interpretive statements) demonstrate how nursing ethics differ from general bioethics by centering the nurse-patient relationship while also addressing obligations to self, the profession, and society. Don't just memorize what each principle says—know which principle applies when a patient refuses treatment, when you witness unsafe practice, or when resources are limited. Understanding the "why" behind each provision will serve you far better than rote recall.

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Patient-Centered Obligations

These principles establish the nurse's primary commitment to the individual receiving care. The therapeutic relationship forms the ethical core of nursing practice, distinguishing it from other healthcare professions.

Respect for Human Dignity

• Inherent worth—every patient deserves equal respect regardless of diagnosis, lifestyle choices, socioeconomic status, or personal characteristics
• Cultural humility requires recognizing and honoring patients' values, beliefs, and practices without imposing your own judgments
• Compassionate presence means treating each encounter as meaningful, fostering trust through empathy and genuine concern

Commitment to the Patient

• Primary commitment to the patient takes precedence over institutional pressures, family preferences, or personal convenience
• Holistic care addresses physical, emotional, psychological, and spiritual dimensions—not just the chief complaint
• Professional boundaries must be maintained while still building therapeutic rapport; this protects both nurse and patient

Advocacy for Patient Rights

• Informed consent requires empowering patients with complete, understandable information to make autonomous decisions
• Active defense of patient rights includes speaking up when others dismiss patient concerns or limit access to care
• Barrier removal means identifying and addressing obstacles—whether systemic, financial, or communication-based—that prevent appropriate care

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Protection and Safety Obligations

These principles address the nurse's duty to shield patients from harm—both active threats and passive failures. Protection encompasses everything from safeguarding information to preventing medical errors.

Protection of Patient Privacy and Confidentiality

• HIPAA compliance is the legal minimum, but ethical confidentiality extends to casual conversations, social media, and elevator discussions
• Private settings for care discussions protect patient dignity and encourage honest disclosure of sensitive information
• Patient education about privacy rights empowers individuals to understand and control how their information is shared

Promotion of Health and Safety

• Evidence-based practice isn't optional—it's an ethical obligation to provide care that's proven effective rather than tradition-based
• Health promotion extends nursing responsibility beyond treating illness to preventing disease and educating patients and families
• Safety reporting requires documenting and escalating concerns about adverse events, near-misses, or unsafe conditions without fear of retaliation

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Professional Accountability

These principles govern how nurses conduct themselves as practitioners and members of the profession. Accountability means owning your practice—the good outcomes and the mistakes.

Responsibility and Accountability for Nursing Practice

• Scope of practice defines legal and ethical boundaries; practicing outside your competence violates this principle regardless of intent
• Continuous competency requires honest self-assessment and commitment to addressing knowledge gaps through education
• Ownership of decisions means accepting consequences of your clinical judgments rather than deflecting blame to systems or colleagues

Integrity in Professional Practice

• Ethical consistency requires adhering to principles even when no one is watching or when shortcuts seem harmless
• Honesty and transparency apply to documentation, communication with patients, and interactions with the healthcare team
• Moral courage means speaking up about ethical violations even when it's uncomfortable or professionally risky

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Broader Professional and Social Obligations

These principles extend nursing ethics beyond individual patient encounters to the profession and society. Nurses have obligations not just to patients in front of them but to future patients, colleagues, and communities.

Advancement of the Nursing Profession

• Lifelong learning is an ethical duty, not just a licensure requirement—stagnant knowledge compromises patient care
• Research participation contributes to the evidence base that improves outcomes for all patients, not just your own
• Mentorship ensures the profession's future by supporting students and new graduates through knowledge transfer and role modeling

Collaboration with Healthcare Professionals

• Interprofessional teamwork recognizes that optimal patient outcomes require coordinated effort across disciplines
• Respectful communication with colleagues—including when disagreeing—models professional behavior and improves team function
• Knowledge sharing elevates practice standards across the team and prevents siloed expertise from limiting patient care

Promotion of Social Justice and Health Equity

• Equitable access advocacy addresses systemic barriers that prevent marginalized populations from receiving care
• Social determinants of health—housing, food security, education, transportation—must be recognized as factors affecting patient outcomes
• Community engagement extends nursing responsibility beyond clinical walls to address population health needs

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Quick Reference Table

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Self-Check Questions

1. A patient with strong religious beliefs refuses a blood transfusion that the healthcare team considers life-saving. Which two principles are most directly in tension, and how would you prioritize them?

2. Compare and contrast the nurse's obligation to an individual patient (Commitment to the Patient) with obligations to society (Social Justice). How might these conflict in a resource-limited situation?

3. Which principles would guide your response if you witnessed a colleague practicing outside their scope of competence? Identify at least two relevant provisions and explain how each applies.

4. A patient asks you not to document a fall because they're afraid of being transferred to a nursing home. Which principles conflict here, and what would ethical practice require?

5. How do Accountability and Integrity work together when a medication error occurs? Describe the ethical response that honors both principles, and explain why documentation matters in this scenario.