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Understanding the ethics in any professional role provides individuals with a moral compass, set of principles and values needed to perform their job well. In a profession like nursing, upholding ethical standards is particularly important because of the level of medical care, compassion and high-risk situations that nurses navigate. Knowing the principles of ethics in nursing can not only help future nurses understand more about the profession, but it can also help them treat patients with the best care possible.

Read more to learn about the importance of nursing ethics, its history and some of its core principles.

What are ethics in nursing?

The establishes ethical principles in nursing. Far more than just words on paper, the code is nursing’s north star. It governs how nurses should 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 (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 family nurse practitioners. Today, there are four principles of nursing ethics and nine provisions that guide practice.

The importance of ethics in nursing 

As you’ve likely gathered, prioritizing ethics in nursing is an important part of this career. Ethics serve as a guiding force behind the decisions nursing professionals make, and ultimately help nurses serve their patients with the utmost respect and care. The emphasis on patient-centered care, which you’ll read more about in the four principles of nursing ethics, allows nurses to prioritize the well-being of their patients in significant ways. Upholding ethical principles ensures that nurses can make the most-informed decisions while cultivating trust and professionalism.

Nurses provide a deep level of care, especially in moments when their patients are most vulnerable. As such, ethics play a vital role in maintaining patient confidentiality and promoting equity in healthcare. Nurses may often find themselves navigating the preferences of their patients while also navigating cultural differences.

We spoke with Raelene Brooks, PhD, RN, dean of the College of Nursing at UOPX, about the role and importance of ethics in nursing:

“Nursing ethics is the foundational core value that guides our practice. Ethics in nursing influences the framework of nursing education and can be witness in every core value in the College of Nursing: Leadership, Scholarship, Professional Practice, Safe Patient Care, Interprofessional Collaboration, and Caring.”

4 principles of nursing ethics 

Nurses make ethical decisions daily. In fact, nurses often walk a line between advocating for patients while also adhering to ethical nursing principles.

The ANA’s ethical provisions can be categorized among four principles of ethics to guide nurses in this sacred charge. These principles are autonomy, beneficence, justice and nonmaleficence.

1. Autonomy 

Autonomy in nursing means that patients have the right to make their own decisions based on their beliefs and values. According to an , this means a patient has the right to refuse medications, treatment, surgery or other medical interventions. The nurse must respect this choice.

2. Beneficence 

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. Brooks points out that beneficence can take other forms as well. For example, she recalls advocating in the 1990s for updated patient-to-nurse ratios that better supported patient care in the ICU. Her guiding force? Compassion.

“The patient depends on the ICU nurse to be their eyes, ears and advocate,” explains Brooks. “Patients are intubated, sedated and on life support. A nurse with more than two patients in the ICU can miss a critical sign/symptom indicating the patient is decompensating. Ethics and patient safety were my guiding principles when I decided to be a spokesperson in local nursing schools [advocating for the legislation] that changed the patient-to-nurse ratio in the state of California.”

3. Justice 

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.

4. Nonmaleficence 

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 their limits. However, according to an article in the , 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 doing so.