4 Principles of Nursing Code of Ethics

4 Principles of Nursing Code of Ethics

According to the American Nurses Association (ANA), the nursing code of ethics guides “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 fundamental, given their role as caregivers.

Four main principles are part of the nursing code of ethics. They are:

  1. Autonomy
  2. Beneficence
  3. Justice
  4. Non-maleficence

Ideally, every nurse and healthcare provider should be aware of these principles in their daily nursing practice.

While ethical principles are sometimes confusing and often taught briefly during undergraduate nursing — they should be constants in nursing practice to provide the best, safest, and most humane care to all patients.


History of the Nursing Code of Ethics

Interestingly, the nursing code of ethics is suggested to have been founded in 1893 and named the “Nightingale Pledge” after Florence Nightingale, the founder of modern nursing. As a modification of the Hippocratic Oath, taken by medical doctors, the Nightingale Pledge has been recited by nursing students at graduations with little changes since inception.

The formal code of ethics was developed in the 1950s by the American Nurses Association (ANA) and has undergone numerous modifications since. The most significant recent change was in 2015 when nine interpretative statements or provisions were added to the code of ethics to help guide nursing practice more definitively.

Many states include the ANA’s nursing code of ethics in their practice statements. Even though the code of ethics is primarily ethics-related, it also has legal implications. Given the importance of the code to the nursing profession, revisions continue regularly.


4 Ethical Principles in Nursing 

1. Autonomy

Autonomy is recognizing each 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 to choose the best option 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 patient’s medical wishes.

Nurses must support the patient in their medical wishes and ensure the medical team remembers them. Sometimes, nurses must 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 rights despite the individual’s financial abilities, race, religion, gender, and sexual orientation.

An example is working at a free flu clinic or diabetes screening clinic. These are open to all community members 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 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 causing significant harm to a patient, including suicidal or homicidal ideations.

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