Health & Medical Question

Watch the video to the link I have attached below and review the American Nurses Association (ANA) Code of Ethics pdf I have atached to address the questions below in the discussion post

https://www.youtube.com/watch?v=lKynN3sqab0

Address the questions below in your discussion post this week:

Does the ‘Code of Ethics’ require you to respond in disaster situations?

Do RNs have a contractual responsibility to respond in disaster situations?

Are you familiar with your state’s laws regarding disaster response?

Code of Ethics
for Nurses
with Interpretive
Statements
Silver Spring, Maryland 2015
The American Nurses Association is the only full-service professional organization
representing the interests of the nation’s 3.1 million registered nurses through its
constituent/state nurses associations and its organizational affiliates. ANA advances
the nursing profession by fostering high standards of nursing practice, promoting the
rights of nurses in the workplace, projecting a positive and realistic view of nursing,
and by lobbying the Congress and regulatory agencies on healthcare issues affecting
nurses and the public.
American Nurses Association
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910-3492
1-800-274-4ANA
www.Nursingworld.org
Published by Nursesbooks.org
The Publishing Program of ANA
www.Nursesbooks.org
Copyright © 2015 American Nurses Association. All rights reserved. Reproduction
or transmission in any form is not permitted without written permission of the
American Nurses Association (ANA). This publication may not be translated without
written permission of ANA. For inquiries, or to report unauthorized use, email
copyright@ana.org.
Library of Congress Cataloging-in-Publication available on request: copyright@ana.org.
ISBN-13: 978-1-55810-599-7
First printing: January 2015.
SAN: 851-3481
01/2015
Contributors and
Acknowledgments
This revision of the Code of Ethics for Nurses with Interpretive Statements was
informed by over 7,800 responses from 2,780 nurses in an online public
survey of the 2001 Code. After a revised code was drafted, it was posted for
public comment to which more than 1,500 additional responses,
representing approximately 1,000 nurses were posted. The contributions of
these nurses are gratefully acknowledged.
The revisions were implemented by a steering committee convened to revise
the 2001 Code. The members of that committee represented a variety of
nursing roles and settings and were drawn from across the United States. The
following persons were members of the Steering Committee for the Revision
of the Code of Ethics for Nurses with Interpretive Statements:
Margaret Hegge, EdD, RN, FAAN – Chair
Marsha Fowler, PhD, MDiv, MS, RN, FAAN
Dana Bjarnason, PhD, RN, NE-BC
Timothy Godfrey, SJ, DNP, RN, PHCNS-BC
Carla Lee, PhD, APRN-BC, FAAN
Lori Lioce, DNP, FNP-BC, CHSE, FAANP
Margaret Ngai, BSN, RN
Catherine Robichaux, PhD, RN, CNS
Kathryn Schroeter, PhD, RN, CNOR, CNE
Josephine Shije, BSN, RN
Elizabeth Swanson, DNP, MPH, APRN-BC
Mary Tanner, PhD, RN
Elizabeth Thomas, MEd, BS, RN, NCSN, FNASN
Lucia Wocial, PhD, RN
Karen Zanni, MSN, FNP-C
Contributors and Acknowledgements • Code of Ethics for Nurses with Interpretive Statements • i
The Steering Committee was staffed by Laurie Badzek, LLM, JD, RN, FAAN,
Director of ANA’s Center for Ethics and Human Rights (Co-Chair), and Martha
Turner, PhD, RN-BC, Assistant Director for ANA’s Center for Ethics and Human
Rights, who served as content editor, revision coordinator, and co-lead writer.
Committee member Marsha Fowler, PhD, MDiv, MS, RN, FAAN, who was named
Historian and Code Scholar, served as co-lead writer.
ii • Code of Ethics for Nurses with Interpretive Statements • Contributors and Acknowledgements
Contents
Contributors and Acknowledgments
i
Provisions of the Code of Ethics for Nurses with
Interpretive Statements
v
Preface
vii
Introduction
xi
Provision 1
1
1.1
1.2
1.3
1.4
1.5
Respect for Human Dignity
Relationships with Patients
The Nature of Health
The Right to Self-Determination
Relationships with Colleagues and Others
Provision 2
2.1
2.2
2.3
2.4
Primacy of the Patient’s Interests
Conflict of Interest for Nurses
Collaboration
Professional Boundaries
Provision 3
3.1
3.2
3.3
3.4
3.5
3.6
5
9
Protection of the Rights of Privacy and Confidentiality
Protection of Human Participants in Research
Performance Standards and Review Mechanisms
Professional Responsibility in Promoting a Culture of Safety
Protection of Patient Health and Safety by Acting on Questionable Practice
Patient Protection and Impaired Practice
Contents • Code of Ethics for Nurses with Interpretive Statements • iii
Provision 4
15
4.1 Authority, Accountability, and Responsibility
4.2 Accountability for Nursing Judgments, Decisions, and Actions
4.3 Responsibility for Nursing Judgments, Decisions, and Actions
4.4 Assignment and Delegation of Nursing Activities or Tasks
Provision 5
19
5.1 Duties to Self and Others
5.2 Promotion of Personal Health, Safety, and Well-Being
5.3 Preservation of Wholeness of Character
5.4 Preservation of Integrity
5.5 Maintenance of Competence and Continuation of Professional Growth
5.6 Continuation of Personal Growth
Provision 6
23
6.1 The Environment and Moral Virtue
6.2 The Environment and Ethical Obligation
6.3 Responsibility for the Healthcare Environment
Provision 7
27
7.1 Contributions through Research and Scholarly Inquiry
7.2 Contributions through Developing, Maintaining, and
Implementing Professional Practice Standards
7.3 Contributions through Nursing and Health Policy Development
Provision 8
31
8.1 Health Is a Universal Right
8.2 Collaboration for Health, Human Rights, and Health Diplomacy
8.3 Obligation to Advance Health and Human Rights and Reduce Disparities
8.4 Collaboration for Human Rights in Complex, Extreme, or
Extraordinary Practice Settings
Provision 9
9.1
9.2
9.3
9.4
35
Articulation and Assertion of Values
Integrity of the Profession
Integrating Social Justice
Social Justice in Nursing and Health Policy
Afterword
39
Glossary
41
Timeline: The Evolution of Nursing’s Code of Ethics
47
Index
49
iv • Code of Ethics for Nurses with Interpretive Statements • Contents
Provisions of the Code
of Ethics for Nurses with
Interpretive Statements
Provision 1 | The nurse practices with compassion and respect for the
inherent dignity, worth, and unique attributes of every person.
Provision 2 | The nurse’s primary commitment is to the patient, whether an
individual, family, group, community, or population.
Provision 3 | The nurse promotes, advocates for, and protects the rights,
health, and safety of the patient.
Provision 4 | The nurse has authority, accountability, and responsibility for
nursing practice; makes decisions; and takes action consistent with
the obligation to promote health and to provide optimal care.
Provision 5 | The nurse owes the same duties to self as to others, including
the responsibility to promote health and safety, preserve
wholeness of character and integrity, maintain competence,
and continue personal and professional growth.
Provision 6 | The nurse, through individual and collective effort, establishes,
maintains, and improves the ethical environment of the work
setting and conditions of employment that are conducive to
safe, quality health care.
Provision 7 | The nurse, in all roles and settings, advances the profession
through research and scholarly inquiry, professional
standards development, and the generation of both nursing
and health policy.
Provision 8 | The nurse collaborates with other health professionals and the
public to protect human rights, promote health diplomacy, and
reduce health disparities.
Provision 9 | The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the
integrity of the profession, and integrate principles of social
justice into nursing and health policy.
Provisions of Code of Ethics for Nurses • Code of Ethics for Nurses with Interpretive Statements • v
Preface
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 modern
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.
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 of 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.
Preface • Code of Ethics for Nurses with Interpretive Statements • vii
The Code of Ethics for Nurses with Interpretive Statements serves the
following purposes:
n
n
n
It is a succinct statement of the ethical values, obligations, duties,
and professional ideals of nurses individually and collectively.
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.
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
viii • Code of Ethics for Nurses with Interpretive Statements • Preface
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 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
modern 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.
Preface • Code of Ethics for Nurses with Interpretive Statements • ix
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.
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
Introduction • Code of Ethics for Nurses with Interpretive Statements • xi
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 wellbeing 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,
xii • Code of Ethics for Nurses with Interpretive Statements • Introduction
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 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-topatient, nurse-to-nurse, nurse-to-self, nurse-to-others, nurse-to-profession, nurseto-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
Introduction • Code of Ethics for Nurses with Interpretive Statements • xiii
Provision 1
The nurse practices with compassion and respect
for the inherent dignity, worth, and unique
attributes of every person.
1.1 Respect for Human Dignity
A fundamental principle that underlies all nursing practice is respect for
the inherent dignity, worth, unique attributes, and human rights of all
individuals. The need for and right to health care is universal,
transcending all individual differences. Nurses consider the needs and
respect the values of each person in every professional relationship and
setting; they provide leadership in the development and implementation
of changes in public and health policies that support this duty.
1.2 Relationships with Patients
Nurses establish relationships of trust and provide nursing services according
to need, setting aside any bias or prejudice. Factors such as culture, value
systems, religious or spiritual beliefs, lifestyle, social support system,
sexual orientation or gender expression, and primary language are to be
considered when planning individual, family and population-centered
care. Such considerations must promote health and wellness, address
problems, and respect patients’ or clients’ decisions. Respect for patient
decisions does not require that the nurse agree with or support all
patient choices. When patient choices are risky or self-destructive, nurses
have an obligation to address the behavior and to offer opportunities
and resources to modify the behavior or to eradicate the risk.
1.3 The Nature of Health
Nurses respect the dignity and rights of all human beings regardless of
the factors contributing to the person’s health status. The worth of a
person is not affected by illness, abilitity, socioeconomic status, functional
status, or proximity to death. The nursing process is shaped by unique
Provision 1 • Code of Ethics for Nurses with Interpretive Statements • 1
patient preferences, needs, values, and choices. Respect is extended to all
who require and receive nursing care in the promotion of health,
prevention of illness and injury, restoration of health, alleviation of pain
and suffering, or provision of supportive care.
Optimal nursing care enables the patient to live with as much physical,
emotional, social, and religious or spiritual well-being as possible and
reflects the patient’s own values. Supportive care is particularly important
at the end of life in order to prevent and alleviate the cascade of symptoms
and suffering that are commonly associated with dying. Support is
extended to the family and to significant others and is directed toward
meeting needs comprehensively across the continuum of care.
Nurses are leaders who actively participate in assuring the responsible
and appropriate use of interventions in order to optimize the health and
well-being of those in their care. This includes acting to minimize unwarranted,
unwanted, or unnecessary medical treatment and patient suffering. Such
treatment must be avoided, and conversations about advance care plans
throughout multiple clinical encounters helps to make this possible. Nurses
are leaders who collaborate in altering systemic structures that have a
negative influence on individual and community health.
1.4 The Right to Self-Determination
Respect for human dignity requires the recognition of specific patient rights,
in particular, the right to self-determination. Patients have the moral and
legal right to determine what will be done with and to their own person; to
be given accurate, complete, and understandable information in a manner
that facilitates an informed decision; and to be assisted with weighing the
benefits, burdens, and available options in their treatment, including the
choice of no treatment. They also have the right to accept, refuse, or
terminate treatment without deceit, undue influence, duress, coercion, or
prejudice, and to be given necessary support throughout the decisionmaking and treatment process. Such support includes the opportunity to
make decisions with family and significant others and to obtain advice
from expert, knowledgeable nurses, and other health professionals.
Nurses have an obligation to be familiar with and to understand the
moral and legal rights of patients. Nurses preserve, protect, and support
those rights by assessing the patient’s understanding of the information
presented and explaining the implications of all potential decisions. When
2 • Code of Ethics for Nurses with Interpretive Statements • Provision 1
the patient lacks capacity to make a decision, a formally designated
surrogate should be consulted. The role of the surrogate is to make
decisions as the patient would, based upon the patient’s previously
expressed wishes and known values. In the absence of an appropriate
surrogate decision-maker, decisions should be made in the best interests
of the patient, considering the patient’s personal values to the extent that
they are known.
Nurses include patients or surrogate decision-makers in discussions,
provide referrals to other resources as indicated, identify options, and
address problems in the decision-making process. Support of patient
autonomy also includes respect for the patient’s method of decision-making
and recognition that different cultures have different beliefs and
understandings of health, autonomy, privacy and confidentiality, and
relationships, as well as varied practices of decision-making. Nurses should,
for example, affirm and respect patient values and decision-making processes
that are culturally hierarchical or communal.
The importance of carefully considered decisions regarding resuscitation
status, withholding and withdrawing life-sustaining therapies, foregoing
nutrition and hydration, palliative care, and advance directives is widely
recognized. Nurses assist patients as necessary with these decisions. Nurses
should promote advance care planning conversations and must be
knowledgeable about the benefits and limitations of various advance
directive documents. The nurse should provide interventions to relieve
pain and other symptoms in the dying patient consistent with palliative
care practice standards and may not act with the sole intent to end life.
Nurses have invaluable experience, knowledge, and insight into effective
and compassionate care at the end of life and should actively engage in
related research, scholarship, education, practice, and policy development.
Individuals are interdependent members of their communities. Nurses
recognize situations in which the right to self-determination may be
outweighed or limited by the rights, health, and welfare of others,
particularly in public health. The limitation of individual rights must always
be considered a serious departure from the standard of care, justified only
when there are no less-restrictive means available to preserve the rights of
others, meet the demands of law, and protect the public’s health.
Provision 1 • Code of Ethics for Nurses with Interpretive Statements • 3
1.5 Relationships with Colleagues and Others
Respect for persons extends to all individuals with whom the nurse
interacts. Nurses maintain professional, respectful, and caring relationships
with colleagues and are committed to fair treatment, transparency,
integrity-preserving compromise, and the best resolution of conflicts.
Nurses function in many roles and settings, including direct care provider,
care coordinator, administrator, educator, policy maker, researcher,
and consultant.
The nurse creates an ethical environment and culture of civility and
kindness, treating colleagues, coworkers, employees, students, and others
with dignity and respect. This standard of conduct includes an affirmative
duty to act to prevent harm. Disregard for the effects of one’s actions on
others, bullying, harassment, intimidation, manipulation, threats, or
violence are always morally unacceptable behaviors. Nurses value the
distinctive contribution of individuals or groups as they seek to achieve
safe, quality patient outcomes in all settings. Additionally, they collaborate
to meet the shared goals of providing compassionate, transparent, and
effective health services.
4 • Code of Ethics for Nurses with Interpretive Statements • Provision 1
Provision 2
The nurse’s primary commitment is to the patient,
whether an individual, family, group, community,
or population.
2.1 Primacy of the Patient’s Interests
The nurse’s primary commitment is to the recipients of nursing and
healthcare services—patient or client—whether individuals, families,
groups, communities, or populations. Each plan of care must reflect the
fundamental commitment of nursing to the uniqueness, worth, and
dignity of the patient. Nurses provide patients with opportunities to
participate in planning and implementing care and support that are
acceptable to the patient. Honest discussions about available resources,
treatment options, and capacity for self-care are essential. Addressing
patient interests requires recognition of the patient’s place within the family
and other relationships. When the patient’s wishes are in conflict with those
of others, nurses help to resolve the conflict. Where conflict persists, the
nurse’s commitment remains to the identified patient.
2.2 Conflict of Interest for Nurses
Nurses may experience conflict arising from competing loyalties in the
workplace, including conflicting expectations from patients, families,
physicians, colleagues, healthcare organizations, and health plans. Nurses
must examine the conflicts arising between their own personal and
professional values, the values and interests of others who are also
responsible for patient care and healthcare decisions, and perhaps even
the values and interests of the patients themselves. Nurses address such
conflicts in ways that ensure patient safety and that promote the patient’s
best interests while preserving the professional integrity of the nurse and
supporting interprofessional collaboration.
Conflicts of interest may arise in any domain of nursing activity,
including direct care, administration, education, consultation, policy
development, and research. Nurses in all roles must identify and,
whenever possible, avoid conflicts of interest. Nurses who bill for
Provision 2 • Code of Ethics for Nurses with Interpretive Statements • 5
services and nurse executives with budgetary responsibilities must be
especially aware of the potential for conflicts of interest. Healthcare
financing and delivery systems may create conflict between economic
self-interest and professional integrity. Bonuses, sanctions, and
incentives tied to financial targets may present such conflict. Any
perceived or actual conflict of interest should be disclosed to all
relevant parties and, if indicated, nurses should withdraw, without
prejudice, from further participation.
2.3 Collaboration
The complexity of health care requires collaborative effort that has the
strong support and active participation of all health professions. Nurses
should foster collaborative planning to provide safe, high-quality, patientcentered health care. Nurses are responsible for articulating, representing,
and preserving the scope of nursing practice, and the unique contributions
of nursing to patient care. The relationship between nursing and other
health professions also needs to be clearly articulated, represented, and
preserved.
Collaboration intrinsically requires mutual trust, recognition, respect,
transparency, shared decision-making, and open communication among all
who share concern and responsibility for health outcomes. Nurses ensure
that all relevant persons, as moral agents, participate in patient care decisions.
Patients do not always know what questions to ask or may be limited by a
number of factors, including language or health literacy. Nurses facilitate
informed decision-making by assisting patients to secure the information that
they need to make choices consistent with their own values.
Collaboration within nursing is essential to address the health of patients
and the public effectively. Although nurses who are engaged in nonclinical
roles (e.g., educators, administrators, policy-makers, consultants, or
researchers) are not primarily involved in direct patient care, they
collaborate to provide high-quality care through the influence and
direction of direct care providers. In this sense, nurses in all roles are
interdependent and share a responsibility for outcomes in nursing care and
for maintaining nursing’s primary commitment to the patient.
6 • Code of Ethics for Nurses with Interpretive Statements • Provision 2
2.4 Professional Boundaries
The work of nursing is inherently personal. Within their professional role,
nurses recognize and maintain appropriate personal relationship
boundaries. Nurse–patient and nurse–colleague relationships have as their
foundation the promotion, protection, and restoration of health and the
alleviation of pain and suffering. Nurse–patient relationships are therapeutic
in nature but can also test the boundaries of professionalism. Accepting gifts
from patients is generally not appropriate; factors to consider include the
intent, the value, the nature, and the timing of the gift, as well as the patient’s
own cultural norms. When a gift is offered, facility policy should be followed.
The intimate nature of nursing care and the involvement of nurses in
important and sometimes highly stressful life events may contribute to the
risk of boundary violations. Dating and sexually intimate relationships with
patients are always prohibited.
Boundary violations can also occur in professional colleague relationships.
In all communications and actions, nurses are responsible for maintaining
professional boundaries. They should seek the assistance of peers or
supervisors in managing or removing themselves from difficult situations.
Provision 2 • Code of Ethics for Nurses with Interpretive Statements • 7
Provision 3
The nurse promotes, advocates for, and protects
the rights, health, and safety of the patient.
3.1 Protection of the Rights of Privacy and Confidentiality
The need for health care does not justify unwanted, unnecessary,
or unwarranted intrusion into a person’s life. Privacy is the right to
control access to, and disclosure or nondisclosure of, information
pertaining to oneself and to control the circumstances, timing, and
extent to which information may be disclosed. Nurses safeguard the
right to privacy for individuals, families, and communities. The nurse
advocates for an environment that provides sufficient physical privacy,
including privacy for discussions of a personal nature. Nurses also
participate in the development and maintenance of policies and
practices that protect both personal and clinical information at
institutional and societal levels.
Confidentiality pertains to the nondisclosure of personal information
that has been communicated within the nurse–patient relationship.
Central to that relationship is an element of trust and an expectation
that personal information will not be divulged without consent. The
nurse has a duty to maintain confidentiality of all patient information,
both personal and clinical in the work setting and off duty in all venues,
including social media or any other means of communication. Because
of rapidly evolving communication technology and the porous nature of
social media, nurses must maintain vigilance regarding postings, images,
recordings, or commentary that intentionally or unintentionally
breaches their obligation to maintain and protect patients’ rights to
privacy and confidentiality. The patient’s well-being could be
jeopardized, and the fundamental trust between patient and nurse could
be damaged by unauthorized access to data or by the inappropriate or
unwanted disclosure of identifiable information.
Provision 3 • Code of Ethics for Nurses with Interpretive Statements • 9
Patient rights are the primary factors in any decisions concerning personal
information, whether from or about the patient. These rights of privacy and
confidentiality pertain to all information in any manner that is communicated
or transmitted. Nurses are responsible for providing accurate, relevant data
to members of the healthcare team and others who have a need to know.
The duty to maintain confidentiality is not absolute and may be limited, as
necessary, to protect the patient or other parties, or by law or regulation
such as mandated reporting for safety or public health reasons.
Information used for purposes of continuity of care, education, peer
review, professional practice evaluation, third-party payments, and other
quality improvement or risk management mechanisms may be disclosed
only under defined policies, mandates, or protocols. These written
guidelines must ensure that the rights, safety, and well-being of the patient
remain protected. Information disclosed should be directly relevant to a
specific responsibility or a task being performed. When using electronic
communications or working with electronic health records, nurses should
make every effort to maintain data security.
3.2 Protection of Human Participants in Research
Stemming from the principle of respect for autonomy, respect for persons,
and respect for self-determination, individuals have the right to choose
whether or not to participate in research as a human subject. Participants
or legal surrogates must receive sufficient and materially relevant
information to make informed decisions and to understand that they have
the right to decline to participate or to withdraw at any time without fear
of adverse consequences or reprisal.
Information needed for informed consent includes the nature of
participation; potential risks and benefits; available alternatives to taking
part in the study; disclosure of incidental findings; return of research
results; and an explanation of how the data will be used, managed, and
protected. Those details must be communicated in a manner that is
comprehensible to the patient or a legally authorized representative. Prior
to initiation, all research proposals must be approved by a formally
constituted and qualified institutional review board to ensure participant
protection and the ethical integrity of the research.
Nurses should be aware of the special concerns raised by research
involving vulnerable groups, including children, cognitively impaired
persons, economically or educationally disadvantaged persons, fetuses,
10 • Code of Ethics for Nurses with Interpretive Statements • Provision 3
older adults, patients, pregnant women, prisoners, and underserved
populations. The nurse who directs or engages in research activities in
any capacity should be fully informed about the qualifications of the
principal investigator, the rights and obligations of all those involved in
the particular research study, and the ethical conduct of research in
general. Nurses have a duty to question and, if necessary, to report to
appropriate oversight bodies any researcher who violates participants’
rights or is involved in research that is ethically questionable, as well as
to advocate for participants who wish to decline to participate or to
withdraw from a study before completion.
3.3 Performance Standards and Review Mechanisms
Inherent in professional nursing is a process of education and formation.
That process involves the ongoing acquisition and development of the
knowledge, skills, dispositions, practice experiences, commitment, relational
maturity, and personal integrity essential for professional practice. Nurse
educators, whether in academics or direct care settings, must ensure that
basic competence and commitment to professional standards exist prior to
entry into practice.
Similarly, nurse managers and executives must ensure that nurses have
the knowledge, skills, and dispositions to perform professional
responsibilities that require preparation beyond the basic academic
programs. This is in full recognition of the relationship of nurse
competencies, performance standards, review mechanisms, and
educational preparation to patient safety and care outcomes. In this way,
nurses—individually, collectively, and as a profession—are responsible and
accountable for nursing practice and professional behavior.
3.4 Professional Responsibility in Promoting a Culture of Safety
Nurses must participate in the development, implementation, and review of
and adherence to policies that promote patient health and safety, reduce
errors and waste, and establish and sustain a culture of safety. When errors
or near misses occur, nurses must follow institutional guidelines in reporting
such events to the appropriate authority and must ensure responsible
disclosure of errors to patients. Nurses must establish processes to investigate
causes of errors or near misses and to address system factors that may
have been contributory. While ensuring that nurses are held accountable
for individual practice, errors should be corrected or remediated, and
Provision 3 • Code of Ethics for Nurses with Interpretive Statements • 11
disciplinary action taken only if warranted. When error occurs, whether it
is one’s own or that of a coworker, nurses may neither participate in, nor
condone through silence, any attempts to conceal the error.
Following the appropriate intra-institutional sequence of reporting to
authority is critical to maintaining a safe patient care environment. Nurses
must use the chain of authority when a problem or issue has grown
beyond their problem-solving capacity or their scope of responsibility or
authority. Issue reporting in a timely manner promotes a safe environment.
Communication should start at the level closest to the event and should
proceed to a responsive level as the situation warrants.
3.5 Protection of Patient Health and Safety by Acting on
Questionable Practice
Nurses must be alert to and must take appropriate action in all instances of
incompetent, unethical, illegal, or impaired practice or actions that place the
rights or best interests of the patient in jeopardy. To function effectively,
nurses must be knowledgeable about ANA’s Code of Ethics for Nurses with
Interpretive Statements; standards of practice for the profession; relevant
federal, state, and local laws and regulations; and the employing
organization’s policies and procedures.
When nurses become aware of inappropriate or questionable practice,
the concern must be expressed to the person involved, focusing on the
patient’s best interests as well as on the integrity of nursing practice. When
practices in the healthcare delivery system or organization threaten the
welfare of the patient, nurses should express their concern to the responsible
manager or administrator or, if indicated, to an appropriate higher authority
within the institution or agency or to an appropriate external authority.
When incompetent, unethical, illegal, or impaired practice is not
corrected and continues to jeopardize patient well-being and safety, nurses
must report the problem to appropriate external authorities such as
practice committees of professional organizations, licensing boards, and
regulatory or quality assurance agencies. Some situations are sufficiently
egregious as to warrant the notification and involvement of all such groups
and/or law enforcement.
Nurses should use established processes for reporting and handling
questionable practices. All nurses have a responsibility to assist
whistleblowers who identify potentially questionable practices that are
factually supported in order to reduce the risk of reprisal against the
12 • Code of Ethics for Nurses with Interpretive Statements • Provision 3
reporting nurse. State nurses’ associations should be prepared to provide
their members with advice and support in the development and evaluation of
such processes and reporting procedures. Factual documentation and accurate
reporting are essential for all such actions. When a nurse chooses to engage
in the act of responsible reporting about situations that are perceived as
unethical, incompetent, illegal, or impaired, the professional organization has
a responsibility to protect the practice of nurses who choose to report their
concerns through formal channels. Reporting questionable practice, even
when done appropriately, may present substantial risk to the nurse; however,
such risk does not eliminate the obligation to address threats to patient safety.
3.6 Patient Protection and Impaired Practice
Nurses must protect the patient, the public, and the profession from potential
harm when practice appears to be impaired. The nurse’s duty is to take action
to protect patients and to ensure that the impaired individual receives
assistance. This process begins with consulting supervisory personnel,
followed by approaching the individual in a clear and supportive manner and
by helping the individual access appropriate resources. The nurse should
extend compassion and caring to colleagues throughout the processes of
identification, remediation, and recovery. Care must also be taken in identifying
any impairment in one’s own practice and in seeking immediate assistance.
Nurses must follow policies of the employing organization, guidelines
outlined by the profession, and relevant laws to assist colleagues whose
job performance may be adversely affected by mental or physical illness,
fatigue, substance abuse, or personal circumstances. In instances of
impaired practice, nurses within all professional relationships must
advocate for appropriate assistance, treatment, and access to fair
institutional and legal processes. Advocacy includes supporting the return
to practice of individuals who have sought assistance and, after recovery,
are ready to resume professional duties.
If impaired practice poses a threat or danger to patients, self, or others,
regardless of whether the individual has sought help, a nurse must report
the practice to persons authorized to address the problem. Nurses who report
those whose job performance creates risk should be protected from retaliation
or other negative consequences. If workplace policies for the protection of
impaired nurses do not exist or are inappropriate—that is, they deny the nurse
who is reported access to due legal process or they demand resignation—
nurses may obtain guidance from professional associations, state peer
assistance programs, employee assistance programs, or similar resources.
Provision 3 • Code of Ethics for Nurses with Interpretive Statements • 13
Provision 4
The nurse has authority, accountability, and
responsibility for nursing practice; makes decisions;
and takes action consistent with the obligation to
promote health and to provide optimal care.
4.1 Authority, Accountability, and Responsibility
Nurses bear primary responsibility for the nursing care that their patients
and clients receive and are accountable for their own practice. Nursing
practice includes independent direct nursing care activities; care as
ordered by an authorized healthcare provider; care coordination;
evaluation of interventions; delegation of nursing interventions; and other
responsibilities such as teaching, research, and administration. In every
role, nurses have vested authority, and are accountable and responsible
for the quality of their practice. Additionally, nurses must always comply
with and adhere to state nurse practice acts, regulations, standards of
care, and ANA’s Code of Ethics for Nurses with Interpretive Statements.
Given the context of increased complexity, development of evidence,
and changing patterns in healthcare delivery, the scope of nursing
practice continues to evolve. Nurses must exercise judgment in
accepting responsibilities, seeking consultation, and assigning activities
to others who provide nursing care. Where advanced practice registered
nurses (APRNs) have prescriptive authority, these are not acts of
delegation. Both the APRN issuing the order and the nurse accepting
the order are responsible for the judgments made and are accountable
for the actions taken.
4.2 Accountability for Nursing Judgments, Decisions, and Actions
To be accountable, nurses follow a code of ethical conduct that includes
moral principles such as fidelity, loyalty, veracity, beneficence, and
respect for the dignity, worth, and self-determination of patients, as well
as adhering to the scope and standards of nursing practice. Nurses in all
roles are accountable for decisions made and actions taken in the course
Provision 4 • Code of Ethics for Nurses with Interpretive Statements • 15
of nursing practice. Systems and technologies that assist in clinical practice
are adjunct to, not replacements for, the nurse’s knowledge and skill.
Therefore, nurses are accountable for their practice even in instances of
system or technology failure.
4.3 Responsibility for Nursing Judgments, Decisions, and Actions
Nurses are always accountable for their judgments, decisions, and actions:
however, in some circumstances, responsibility may be borne by both the
nurse and the institution. Nurses accept or reject specific role demands and
assignments based on their education, knowledge, competence, and
experience, as well as their assessment of the level of risk for patient safety.
Nurses in administration, education, policy, and research also have obligations
to the recipients of nursing care. Although their relationships with patients
are less direct, in assuming the responsibilities of a particular role, nurses
not in direct care share responsibility for the care provided by those whom
they supervise and teach. Nurses must not engage in practices prohibited
by law or delegate activities to others that are prohibited by their state
nurse practice acts or those practice acts of other healthcare providers.
Nurses have a responsibility to define, implement, and maintain
standards of professional practice. Nurses must plan, establish, implement,
and evaluate review mechanisms to safeguard patients, nurses, colleagues,
and the environment. These safeguards include peer review processes,
staffing plans, credentialing processes, and quality improvement and
research initiatives. Nurses must bring forward difficult issues related to
patient care and/or institutional constraints upon ethical practice for
discussion and review. The nurse acts to promote inclusion of appropriate
individuals in all ethical deliberation. Nurse executives are responsible for
ensuring that nurses have access to and inclusion on organizational
committees and in decision-making processes that affect the ethics, quality,
and safety of patient care. Nurses who participate in those committees and
decision-making processes are obligated to actively engage in, and
contribute to, the dialogue and decisions made.
Nurses are responsible for assessing their own competence. When the
needs of the patient are beyond the qualifications or competencies of the
nurse, that nurse must seek consultation and collaboration from qualified
nurses, other health professionals, or other appropriate resources.
Educational resources should be provided by agencies or organizations
and used by nurses to maintain and advance competence. Nurse educators
16 • Code of Ethics for Nurses with Interpretive Statements • Provision 4
in any setting should collaborate with their students to assess learning
needs, to develop learning outcomes, to provide appropriate learning
resources, and to evaluate teaching effectiveness.
4.4 Assignment and Delegation of Nursing Activities or Tasks
Nurses are accountable and responsible for the assignment or delegation of
nursing activities. Such assignment or delegation must be consistent with
state practice acts, organizational policy, and nursing standards of practice.
Nurses must make reasonable effort to assess individual competence
when delegating selected nursing activities. This assessment includes the
evaluation of the knowledge, skill, and experience of the individual to
whom the care is assigned or delegated; the complexity of the tasks; and
the nursing care needs of the patient.
Nurses are responsible for monitoring the activities and evaluating the
quality and outcomes of the care provided by other healthcare workers to
whom they have assigned or delegated tasks. Nurses may not delegate
responsibilities such as assessment and evaluation; they may delegate
selected interventions according to state nurse practice acts. Nurses must
not knowingly assign or delegate to any member of the nursing team a
task for which that person is not prepared or qualified. Employer policies
or directives do not relieve the nurse of responsibility for making
assignment or delegation decisions.
Nurses in management and administration have a particular responsibility
to provide a safe environment that supports and facilitates appropriate
assignment and delegation. This environment includes orientation and skill
development; licensure, certification, continuing education, and competency
verification; adequate and flexible staffing; and policies that protect both the
patient and the nurse from inappropriate assignment or delegation of nursing
responsibilities, activities, or tasks. Nurses in management or administration
should facilitate open communication with healthcare personnel allowing
them, without fear of reprisal, to express concerns or even to refuse an
assignment for which they do not possess the requisite skill.
Nurses functioning in educator or preceptor roles share responsibility
and accountability for the care provided by students when they make
clinical assignments. It is imperative that the knowledge and skill of the
nurse or nursing student be sufficient to provide the assigned nursing care
under appropriate supervision.
Provision 4 • Code of Ethics for Nurses with Interpretive Statements • 17
Provision 5
The nurse owes the same duties to self as to others,
including the responsibility to promote health and safety,
preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth.
5.1 Duties to Self and Others
Moral respect accords moral worth and dignity to all human beings
regardless of their personal attributes or life situation. Such respect
extends to oneself as well: the same duties that we owe to others we owe
to ourselves. Self-regarding duties primarily concern oneself and include
promotion of health and safety, preservation of wholeness of character
and integrity, maintenance of competence, and continuation of personal
and professional growth.
5.2 Promotion of Personal Health, Safety, and Well-Being
As professionals who assess, intervene, evaluate, protect, promote,
advocate, educate, and conduct research for the health and safety of
others and society, nurses have a duty to take the same care for their
own health and safety. Nurses should model the same health
maintenance and health promotion measures that they teach and
research, obtain health care when needed, and avoid taking unnecessary
risks to health or safety in the course of their professional and personal
activities. Fatigue and compassion fatigue affect a nurse’s professional
performance and personal life. To mitigate these effects, nurses should
eat a healthy diet, exercise, get sufficient rest, maintain family and
personal relationships, engage in adequate leisure and recreational
activities, and attend to spiritual or religious needs. These activities and
satisfying work must be held in balance to promote and maintain their
own health and well-being. Nurses in all roles should seek this balance,
and it is the responsibility of nurse leaders to foster this balance within
their organizations.
Provision 5 • Code of Ethics for Nurses with Interpretive Statements • 19
5.3 Preservation of Wholeness of Character
Nurses have both personal and professional identities that are integrated
and that embrace the values of the profession, merging them with personal
values. Authentic expression of one’s own moral point of view is a duty to
self. Sound ethical decision-making requires the respectful and open
exchange of views among all those with relevant interests. Nurses must
work to foster a community of moral discourse. As moral agents, nurses
are an important part of that community and have a responsibility to
express moral perspectives, especially when such perspectives are integral
to the situation, whether or not those perspectives are shared by others
and whether or not they might prevail.
Wholeness of character pertains to all professional relationships with
patients or clients. When nurses are asked for a personal opinion, they are
generally free to express an informed personal opinion as long as this
maintains appropriate professional and moral boundaries and preserves
the voluntariness or free will of the patient. Nurses must be aware of the
potential for undue influence attached to their professional role. Nurses
assist others to clarify values in reaching informed decisions, always
avoiding coercion, manipulation, and unintended influence. When nurses
care for those whose health condition, attributes, lifestyle, or situations are
stigmatized, or encounter a conflict with their own personal beliefs, nurses
must render compassionate, respectful and competent care.
5.4 Preservation of Integrity
Personal integrity is an aspect of wholeness of character that requires
reflection and discernment; its maintenance is a self-regarding duty.
Nurses may face threats to their integrity in any healthcare environment.
Such threats may include requests or requirements to deceive patients, to
withhold information, to falsify records, or to misrepresent research aims.
Verbal and other forms of abuse by patients, family members, or
coworkers are also threats; nurses must be treated with respect and need
never tolerate abuse.
In some settings, expectations that nurses will make decisions or take
actions that are inconsistent with nursing ideals and values, or that are in
direct violation of this Code of Ethics for Nurses with Interpretive Statements,
may occur. Nurses have a right and a duty to act according to their
personal and professional values and to accept compromise only if
20 • Code of Ethics for Nurses with Interpretive Statements • Provision 5
reaching a compromise preserves the nurse’s moral integrity and does not
jeopardize the dignity or well-being of the nurse or others. Compromises
that preserve integrity can be difficult to achieve but are more likely to be
accomplished where there is an open forum for moral discourse and a safe
environment of mutual respect.
When nurses are placed in circumstances that exceed moral limits or
that violate moral standards in any nursing practice setting, they must
express to the appropriate authority their conscientious objection to
participating in these situations. When a particular decision or action is
morally objectionable to the nurse, whether intrinsically so or because it
may jeopardize a specific patient, family, community, or population, or
when it may jeopardize nursing practice, the nurse is justified in refusing to
participate on moral grounds. Conscience-based refusals to participate
exclude personal preference, prejudice, bias, convenience, or arbitrariness.
Acts of conscientious objection may be acts of moral courage and may not
insulate nurses from formal or informal consequences. Nurses who decide
not to participate on the grounds of conscientious objection must
communicate this decision in a timely and appropriate manner. Such refusal
should be made known as soon as possible, in advance and in time for
alternate arrangements to be made for patient care. Nurse executives
should ensure the availabilty of policies that address conscientious
objection. Nurses are obliged to provide for patient safety, to avoid patient
abandonment, and to withdraw only when assured that nursing care is
available to the patient.
When the integrity of nurses is compromised by patterns of institutional
behavior or professional practice, thereby eroding the ethical environment
and resulting in moral distress, nurses have an obligation to express their
concern or conscientious objection individually or collectively to the
appropriate authority or committee. Nurse administrators must respond to
concerns and work to resolve them in a way that preserves the integrity of
the nurses. They must seek to change enduring activities or expectations in
the practice setting that are morally objectionable.
Provision 5 • Code of Ethics for Nurses with Interpretive Statements • 21
5.5 Maintenance of Competence and Continuation of
Professional Growth
Competence is a self-regarding duty. It affects not only the quality of care
rendered but also one’s self-respect, self-esteem, and the meaningfulness of
work. Nurses must maintain competence and strive for excellence in their
nursing practice, whatever the role or setting. Nurses are responsible for
developing criteria for evaluation of practice and for using those criteria in
both peer and self-assessments. To achieve the highest standards, nurses
must routinely evaluate their own performance and participate in
substantive peer review.
Professional growth requires a commitment to lifelong learning. Such
learning includes continuing education and self-study, networking with
professional colleagues, self-study, professional reading, achieving specialty
certification, and seeking advanced degrees. Nurses must continue to
learn about new concepts, issues, concerns, controversies, and healthcare
ethics relevant to the current and evolving scope and standards of
nursing practice.
5.6 Continuation of Personal Growth
Nursing care addresses the whole person as an integrated being; nurses
should also apply this principle to themselves. Professional and personal
growth reciprocate and interact. Activities that broaden nurses’
understanding of the world and of themselves affect their understanding of
patients; those that increase and broaden nurses’ understanding of nursing’s
science and art, values, ethics, and policies also affect nurses’ selfunderstanding. Nurses are encouraged to read broadly, continue life-long
learning, engage in personal study, seek financial security, participate in a
wide range of social advocacy and civic activities, and pursue leisure and
recreational activities.
22 • Code of Ethics for Nurses with Interpretive Statements • Provision 5
Provision 6
The nurse, through individual and collective effort,
establishes, maintains, and improves the ethical
environment of the work setting and conditions of
employment that are conducive to safe, quality health care.
6.1 The Environment and Moral Virtue
Virtues are universal, learned, and habituated attributes of moral
character that predispose persons to meet their moral obligations; that is,
to do what is right. There is a presumption and expectation that we will
commonly see virtues such as integrity, respect, moderation, and
industry in all those whom we encounter. Virtues are what we are to be
and make for a morally “good person.” Certain particular attributes of
moral character might not be expected of everyone but are expected of
nurses. These include knowledge, skill, wisdom, patience, compassion,
honesty, altruism, and courage. These attributes describe what the nurse
is to be as a morally “good nurse.” Additionally, virtues are necessary for
the affirmation and promotion of the values of human dignity, wellbeing, respect, health, independence, and other ends that nursing seeks.
For virtues to develop and be operative, they must be supported by a
moral milieu that enables them to flourish. Nurses must create, maintain,
and contribute to morally good environments that enable nurses to be
virtuous. Such a moral milieu fosters mutual caring, communication,
dignity, generosity, kindness, moral equality, prudence, respect, and
transparency. These virtues apply to all nurses, colleagues, patients,
or others.
6.2 The Environment and Ethical Obligation
Virtues focus on what is good and bad in regard to whom we are to be as
moral persons; obligations focus on what is right and wrong or what we
are to do as moral agents. Obligations are often specified in terms of
principles such as beneficence or doing good; nonmaleficence or doing
no harm; justice or treating people fairly; reparations, or making amends
for harm; fidelity, and respect for persons. Nurses, in all roles, must
Provision 6 • Code of Ethics for Nurses with Interpretive Statements • 23
create a culture of excellence and maintain practice environments that
support nurses and others in the fulfillment of their ethical obligations.
Environmental factors contribute to working conditions and include but are
not limited to: clear policies and procedures that set out professional ethical
expectations for nurses; uniform knowledge of the Code and associated ethical
position statements. Peer pressure can also shape moral expectations within
a work group. Many factors contribute to a practice environment that can
either present barriers or foster ethical practice and professional fulfillment.
These include compensation systems, disciplinary procedures, ethics
committees and consulting services, grievance mechanisms that prevent
reprisal, health and safety initiatives, organizational processes and structures,
performance standards, policies addressing discrimination and incivility
position descriptions, and more. Environments constructed for the
equitable, fair, and just treatment of all reflect the values of the profession
and nurture excellent nursing practice.
6.3 Responsibility for the Healthcare Environment
Nurses are responsible for contributing to a moral environment that
demands respectful interactions among colleagues, mutual peer support,
and open identification of difficult issues, which includes ongoing
professional development of staff in ethical problem solving. Nurse
executives have a particular responsibility to assure that employees are
treated fairly and justly, and that nurses are involved in decisions related to
their practice and working conditions. Unsafe or inappropriate activities or
practices must not be condoned or allowed to persist. Organizational
changes are difficult to achieve and require persistent, often collective
efforts over time. Participation in collective and inter-professional efforts
for workplace advocacy to address conditions of employment is
appropriate. Agreements reached through such actions must be consistent
with the nursing profession’s standards of practice and the Code of Ethics
for Nurses with Interpretive Statements.
Nurses should address concerns about the healthcare environment
through appropriate channels and/or regulatory or accrediting bodies. After
repeated efforts to bring about change, nurses have a duty to resign from
healthcare facilities, agencies, or institutions where there are sustained
patterns of violation of patient’s rights, where nurses are required to
compromise standards of practice or personal integrity, or where the
administration is unresponsive to nurses’ expressions of concern. Following
24 • Code of Ethics for Nurses with Interpretive Statements • Provision 6
resignation, reasonable efforts to address violations should continue. The
needs of patients may never be used to obligate nurses to remain in
persistently morally unacceptable work environments. By remaining in
such an environment, even if from financial necessity, nurses risk
becoming complicit in ethically unacceptable practices and may suffer
adverse personal and professional consequences.
The workplace must be a morally good environment to ensure ongoing
safe, quality patient care and professional satisfaction for nurses and to
minimize and address moral distress, strain, and dissonance. Through
professional organizations, nurses can help to secure the just economic and
general welfare of nurses, safe practice environments, and a balance of
interests. These organizations advocate for nurses by supporting legislation;
publishing position statements; maintaining standards of practice; and
monitoring social, professional, and healthcare changes.
Provision 6 • Code of Ethics for Nurses with Interpretive Statements • 25
Provision 7
The nurse, in all roles and settings, advances the
profession through research and scholarly inquiry,
professional standards development, and the
generation of both nursing and health policy.
7.1 Contributions through Research and Scholarly Inquiry
All nurses must participate in the advancement of the profession through
knowledge development, evaluation, dissemination, and application to
practice. Knowledge development relies chiefly, though not exclusively,
upon research and scholarly inquiry. Nurses engage in scholarly inquiry
in order to expand the body of knowledge that forms and advances the
theory and practice of the discipline in all its spheres. Nurse researchers
test existing and generate new nursing knowledge. Nursing knowledge
draws from and contributes to corresponding sciences and humanities.
Nurse researchers may involve human participants in their research,
as individuals, families, groups, communities, or populations. In such
cases, nursing research conforms to national and international ethical
standards for the conduct of research employing human participants.
Community consultation can help to ensure enhanced protection,
enhanced benefits, legitimacy, and shared responsibility for members of
communities during all phases of the research process. Additionally,
when research is conducted with the use of animals, all appropriate
ethical standards are observed.
Nurses take care to ensure that research is soundly constructed,
significant, worthwhile, and in conformity with ethical standards
including review by an Institutional Review Board prior to initiation.
Dissemination of research findings, regardless of results, is an essential
part of respect for the participants. Knowledge development also occurs
through the process of scholarly inquiry, clinical and educational
innovation, and interprofessional collaboration. Dissemination of
findings is fundamental to ongoing disciplinary discourse and
knowledge development.
Provision 7 • Code of Ethics for Nurses with Interpretive Statements • 27
Nurses remain committed to patients/participants throughout the
continuum of care and during their participation in research. Whether the
nurse is data collector, investigator, member of an institutional review
board, or care provider, the patients’ rights and autonomy must be
honored and respected. Patients’/participants’ welfare may never be
sacrificed for research ends.
Nurse executives and administrators should develop the structure and
foster the processes that create an organizational climate and infrastructure
conducive to scholarly inquiry. In addition to teaching research methods,
nurse educators should teach the moral standards that guide the profession
in the conduct and dissemination of its research. Research utilization and
evidence informed practice are expected of all nurses.
7.2 Contributions through Developing, Maintaining, and
Implementing Professional Practice Standards
Practice standards must be developed by nurses and grounded in nursing’s
ethical commitments and developing body of knowledge. These standards
must also reflect nursing’s responsibility to society. Nursing identifies its
own scope of practice as informed, specified, or directed by state and
federal law and regulation, by relevant societal values, and by ANA’s Code
of Ethics for Nurses with Interpretive Statements and other foundational
documents.
Nurse executives establish, maintain, and promote conditions of
employment that enable nurses to practice according to accepted standards.
Professional autonomy and self-regulation are necessary for implementing
nursing standards and guidelines and for assuring quality care.
Nurse educators promote and maintain optimal standards of education
and practice in every setting where learning activities occur. Academic
educators must also seek to ensure that all their graduates possess the
knowledge, skills, and moral dispositions that are essential to nursing.
7.3 Contributions through Nursing and Health Policy Development
Nurses must lead, serve, and mentor on institutional or agency policy
committees within the practice setting. They must also participate as
advocates or as elected or appointed representatives in civic activities
related to health care through local, regional, state, national, or
global initiatives.
28 • Code of Ethics for Nurses with Interpretive Statements • Provision 7
Nurse educators have a particular responsibility to foster and develop
students’ commitment to the full scope of practice, to professional and civic
values, and to informed perspectives on nursing and healthcare policy.
Nurse executives and administrators must foster institutional or agency
policies that reinforce a work environment committed to promoting
evidence informed practice and to supporting nurses’ ethical integrity and
professionalism. Nurse researchers and scholars must contribute to the
body of knowledge by translating science; supporting evidence informed
nursing practice; and advancing effective, ethical healthcare policies,
environments, and a balance of patient–nurse interests.
Provision 7 • Code of Ethics for Nurses with Interpretive Statements • 29
Provision 8
The nurse collaborates with other health professionals
and the public to protect human rights, promote
health diplomacy, and reduce health disparities.
8.1 Health Is a Universal Right
The nursing profession holds that health is a universal human right.
Therefore, the need for nursing is universal. As the World Health
Organization states: “…the highest attainable standard of health is a
fundamental right of every human being.” This right has economic,
political, social, and cultural dimensions. It includes: access to health
care, emergency care, and trauma care; basic sanitation; education
concerning the prevention, treatment, and control of prevailing health
problems; food security; immunizations; injury prevention; prevention
and control of locally endemic diseases and vectors; public education
concerning health promotion and maintenance; potable water; and
reproductive health care. This affirmation of health as a fundamental,
universal human right is held in common with the United Nations, the
International Council of Nurses, and many human rights treaties.
8.2 Collaboration for Health, Human Rights, and Health Diplomacy
All nurses commit to advancing health, welfare, and safety. This nursing
commitment reflects the intent to achieve and sustain health as a means
to the common good so that individuals and communities worldwide can
develop to their fullest potential and live with dignity. Ethics, human
rights, and nursing converge as a formidable instrument for social justice
and health diplomacy that can be amplified by collaboration with other
health professionals. Nurses understand that the lived experiences of
inequality, poverty, and social marginalization contribute to the
deterioration of health globally.
Nurses must address the context of health, including social determinants
of health such as poverty, access to clean water and clean air, sanitation,
human rights violations, hunger, nutritionally sound food, education, safe
Provision 8 • Code of Ethics for Nurses with Interpretive Statements • 31
medications, and healthcare disparities. Nurses must lead collaborative
partnerships to develop effective public health legislation, policies, projects,
and programs that promote and restore health, prevent illness, and
alleviate suffering.
Such partnerships must raise health diplomacy to parity with other
international concerns such as commerce, treaties, and warfare. Human
rights must be diligently protected and promoted and may be interfered
with only when necessary and in ways that are proportionate and in
accord with international standards. Examples might include
communicable disease reporting, helmet laws, immunization requirements,
mandatory reporting of abuse, quarantine, and smoking bans.
8.3 Obligation to Advance Health and Human Rights and
Reduce Disparities
Advances in technology, genetics, and environmental science require
robust responses from nurses working together with other health
professionals for creative solutions and innovative approaches that are
ethical, respectful of human rights, and equitable in reducing health
disparities. Nurses collaborate with others to change unjust structures and
processes that affect both individuals and communities. Structural, social,
and institutional inequalities and disparities exacerbate the incidence and
burden of illness, trauma, suffering, and premature death.
Through community organizations and groups, nurses educate the
public; facilitate informed choice; identify conditions and circumstances
that contribute to illness, injury, and disease; foster healthy life styles; and
participate in institutional and legislative efforts to protect and promote
health. Nurses collaborate to address barriers to health—poverty
homelessness, unsafe living conditions, abuse and violence, and lack of
access—by engaging in open discussion, education, public debate, and
legislative action. Nurses must recognize that health care is provided to
culturally diverse populations in this country and across the globe. Nurses
should collaborate to create a moral milieu that is sensitive to diverse
cultural values and practices.
32 • Code of Ethics for Nurses with Interpretive Statements • Provision 8
8.4 Collaboration for Human Rights in Complex, Extreme, or
Extraordinary Practice Settings
Nurses must be mindful of competing moral claims—that is, conflicting
values or obligations—and must bring attention to human rights violations
in all settings and contexts. Of grave concern to nurses are genocide, the
global feminization of poverty, abuse, rape as an instrument of war, hate
crimes, human trafficking, the oppression or exploitation of migrant
workers, and all such human rights violations. The nursing profession must
respond when these violations are encountered. Human rights may be
jeopardized in extraordinary contexts related to fields of battle, pandemics,
political turmoil, regional conflicts, environmental catastrophes or disasters
where nurses must necessarily practice in extreme settings, under altered
standards of care. Nurses must always stress human rights protection with
particular attention to preserving the human rights of vulnerable groups
such as the poor, the homeless, the elderly, the mentally ill, prisoners,
refugees, women, children, and socially stigmatized groups.
All actions and omissions risk unintended consequences with
implications for human rights. Thus, nurses must engage in discernment,
carefully assessing their intentions, reflectively weighing all possible options
and rationales, and formulating clear moral justifications for their actions.
Only in extreme emergencies and under exceptional conditions, whether
due to forces of nature or to human action, may nurses subordinate
human rights concerns to other considerations. This subordination may
occur when there is both an increase in the number of ill, injured, or atrisk patients and a decrease in access to customary resources and
healthcare personnel.
A utilitarian framework usually guides decisions and actions with special
emphasis on transparency, protection of the public, proportional restriction
of individual liberty, and fair stewardship of resources. Conforming to
international emergency management standards and collaborating with
public health officials and members of the healthcare team are essential
throughout the event.
Provision 8 • Code of Ethics for Nurses with Interpretive Statements • 33
Provision 9
The profession of nursing, collectively through its
professional organizations, must articulate nursing values,
maintain the integrity of the profession, and integrate
principles of social justice into nursing and health policy.
9.1 Articulation and Assertion of Values
Individual nurses are represented by their professional associations and
organizations. These groups give united voice to the profession. It is the
responsibility of a profession collectively to communicate, affirm, and
promote shared values both within the profession and to the public. It is
essential that the profession engage in discourse that supports ongoing
self-reflection, critical self-analysis, and evaluation. The language that is
chosen evokes the shared meaning of nursing, as well as its values and
ideals, as it interprets and explains the place and role of nursing in
society. The profession’s organizations communicate to the public the
values that nursing considers central to the promotion or restoration of
health, the prevention of illness and injury, and the alleviation of pain
and suffering. Through its professional organizations, the nursing
profession must reaffirm and strengthen nursing values and ideals so that
when those values are challenged, adherence is steadfast and
unwavering. Acting in solidarity, the ability of the profession to influence
social justice and global health is formidable.
9.2 Integrity of the Profession
The values and ethics of the profession should be affirmed in all
professional and organizational relationships whether local, interorganizational, or international. Nursing must continually emphasize the
values of respect, fairness, and caring within the national and global
nursing communities in order to promote health in all sectors of the
population. A fundamental responsibility is to promote awareness of and
adherence to the codes of ethics for nurses (the American Nurses
Association and the International Council of Nurses and others). Balanced
policies and practices regarding access to nursing education, workforce
sustainability, and nurse migration and utilization are requisite to
Provision 9 • Code of Ethics for Nurses with Interpretive Statements • 35
achieving these ends. Together, nurses must bring about the improvement
of all facets of nursing, fostering and assisting in the education of
professional nurses in developing regions across the globe.
The nursing profession engages in ongoing formal and informal dialogue
with society. The covenant between the profession and society is made
explicit through the Code of Ethics for Nurses with Interpretive Statements,
foundational documents, and other published standards of nursing
specialty practice; continued development and dissemination of nursing
scholarship; rigorous educational requirements for entry into practice,
advanced practice, and continued practice including certification and
licensure; and commitment to evidence informed practice.
9.3 Integrating Social Justice
It is the shared responsibility of professional nursing organizations to speak
for nurses collectively in shaping health care and to promulgate change for
the improvement of health and health care locally, nationally, and
internationally. Nurses must be vigilant and take action to influence
leaders, legislators, governmental agencies, non-governmental
organizations, and international bodies in all related health affairs to
address the social determinants of health. All nurses, through organizations
and accrediting bodies involved in nurse formation, education, and
development, must firmly anchor students in nursing’s professional
responsibility to address unjust systems and structures, modeling the
profession’s commitment to social justice and health through content,
clinical and field experiences, and critical thought.
9.4 Social Justice in Nursing and Health Policy
The nursing profession must actively participate in solidarity with the
global nursing community and health organizations to represent the
collective voice of U.S. nurses around the globe. Professional nursing
organizations must actively engage in the political process, particularly in
addressing legislative and regulatory concerns that most affect—positively
and negatively—the public’s health and the profession of nursing. Nurses
must promote open and honest communication that enables nurses to
work in concert, share in scholarship, and advance a nursing agenda for
health. Global health, as well as the common good, are ideals that can be
realized when all nurses unite their efforts and energies.
36 • Code of Ethics for Nurses with Interpretive Statements • Provision 9
Social justice extends beyond human health and well-being to the health
and well-being of the natural world. Human life and health are profoundly
affected by the state of the natural world that surrounds us. Consistent
with Florence Nightingale’s historic concerns for environmental influences
on health, and with the metaparadigm of nursing, the profession’s
advocacy for social justice extends to eco-justice. Environmental
degradation, aridification, earth resources exploitation, ecosystem
destruction, waste, and other environmental assaults disproportionately
affect the health of the poor and ultimately affect the health of all humanity.
Nursing must also advocate for policies, programs, and practices within the
healthcare environment that maintain, sustain, and repair the natural
world. As nursing seeks to promote and restore health, prevent illness and
injury, and alleviate pain and suffering, it does so within the holistic
context of healing the world.
Provision 9 • Code of Ethics for Nurses with Interpretive Statements • 37
Afterword
The development of the Code of Ethics for Nurses with Interpretive Statements
(Code) is a benchmark both for the American Nurses Association (ANA) and
for the profession of nursing as a whole.
In its articles of incorporation, ANA set forth the objectives of the Association
as follows:
The object of the Association shall be: to establish and
maintain a code of ethics, to the end that the standard of
nursing education be elevated; the usefulness, honor, and
interests of the nursing profession be promoted; public opinion
in regard to duties, responsibilities, and requirements of nurses
be enlightened; emulation and concert of action in the
profession be stimulated; professional loyalty be fostered, and
friendly intercourse between nurses be facilitated. (Alumnae,
1896)
The first object, then, was the creation and maintenance of a
code of ethics for nurses…. The ANA is recognized nationally
and internationally as the spokes-organization for nursing in
the United States, and as the basis for the US membership in
the International Council of Nurses based in Geneva,
Switzerland. (Fowler, 2006)
Therefore, the Code of Ethics for Nurses with Interpretive Statements serves
all U.S. nurses in all settings and in all roles. The Code is also incorporated
into the nurse practice acts of a number of states, according it actual
regulatory force in those states.
Afterword • Code of Ethics for Nurses with Interpretive Statements • 39
The evolution of the Code dates from Articles of Incorporation of 1896;
from 1893, when the “Nightingale Pledge” was written and administered at
commencement; and from 1926 and 1940, when tentative codes were
suggested but not formally ratified. In 1950, the ANA House of Delegates
formally adopted A Code for Professional Nurses. It was not accompanied by
interpretive statements although the American Journal of Nursing subsequently
published a series of articles that served this function. There were several
subsequent revisions of the Code, approximately every decade, some more
substantive than others. The 2001 revision was the first time in 25 years that
both the provisions of the Code and the interpretive statements were
thoroughly revised.
This 2015 revision is the result of changes made by the Code of Ethics
Steering Committee and was informed by 7,800 responses from 2,780 nurses
during an online survey of the 2001 Code for public comment. The draft of
the revised Code was posted for public comment; more than 1,500 comments
from almost 1,000 nurses were received. This 2015 revision of the Code
reflects comments from hundreds of nurses across the United States and
abroad, multiple drafts, review by the ANA Ethics Advisory Board, and
approval by the ANA Board of Directors.
The ethical tradition manifested in every iteration of the Code is selfreflective, enduring, and distinctive. That is, the Code steadfastly supports
nurses across all settings and in all roles. The Code is particularly useful at the
beginning of the 21st century because it reiterates the fundamental values and
commitments of the nurse (Provisions 1–3), identifies the boundaries of duty
and loyalty (Provisions 4–6), and describes the duties of the nurse that extend
beyond individual patient encounters (Provisions 7–9).
It also addresses the variety of relationships that nurses encounter in the
course of their professional duties. The achievement of a true global
awareness about the human condition; the sociopolitical, economic,
interdependent, environmental context of all humanity; and the universal need
for health care are the most important moral challenges of the 21st century.
This Code summons nurses to actively meet these challenges.
ANA’s Code of Ethics for Nurses with Interpretive Statements is the promise
that nurses are doing their best to provide care for their patients and their
communities and are supporting each other in the process so that all nurses
can fulfill their ethical and professional obligations. This Code is an important
tool that can be used now as leverage to a better future for nurses, patients,
and health care.
40 • Code of Ethics for Nurses with Interpretive Statements • Afterword
Glossary
accountability. To be answerable to oneself and others for one’s own
choices, decisions and actions as measured against a standard such as that
established by the Code of Ethics for Nurses with Interpretive Statements.
advocacy. The act or process of pleading for, supporting, or recommending
a cause or course of action. Advocacy may be for persons (whether as an
individual, group, population, or society) or for an issue, such as potable
water or global health.
altered standard of care. Describes how treatment may change in
extraordinary circumstances such as natural disasters or warfare. It involves a
systematic, uniform, and standardized reprioritization of the allocation of
health care.
altruism. Disinterested or selfless concern for the well-being or benefit of
others as a virtue, principle, and motivation for action.
autonomy. Rational self-legislation and self-determination that is grounded
in informedness, voluntariness, consent, and rationality.
beneficence. The bioethical principle of benefitting others by preventing
harm, removing harmful conditions, or affirmatively acting to benefit another
or others, often going beyond what is required by law.
civil rights. See rights, civil.
collaboration. Working cooperatively with others, especially in joint
intellectual efforts, in a way that includes collegial action and respectful dialog.
compassion. An awareness of suffering, tempered with reason, coupled with
a desire to relieve the suffering; a virtue combining sympathy, empathy,
benevolence, caring, and mercy. Used with the cognitive and psychomotor
skills of healing to meet the patient’s needs.
Glossary • Code of Ethics for Nurses with Interpretive Statements • 41
compassion fatigue. A form of burnout, which results from helping, or
desiring to help to relieve the suffering of others. It may appear suddenly and
subside more quickly than burnout, which is characterized by emotional
exhaustion, depersonalization, and reduced job satisfaction.
confidentiality. A right to have one’s private, intimate, or secret information
kept undisclosed to a third party unless permission is granted for disclosure.
conflict of interest. A set of circumstances that creates a risk that the
motivation for a nurse’s professional judgment or action might be corrupted
or unduly influenced by self-interest.
conscientious objection. A conscience-based refusal, on moral or religious
grounds, to act or participate in an action that falls within the scope of
one’s practice.
courage. The virtue that strengthens one’s response in difficult or threatening
circumstances or situations.
culturally sensitive. Being aware that cultural differences and similarities exist
and effect values, learning, preferences, and behavior.
dispositions, moral. An intrinsic state of being or qualities of mind or
character, in which one has a habit or inclination to act in a specific way
morally. Dispositions are shaped by virtues.
eco-justice. Contraction of “ecological justice” that links environmental and
social justice issues, challenging thereby both humanity’s destruction of the
earth and the abuse of economic and political power that results in poor people
having to suffer disproportionately the effects of environmental damage,
particularly those affecting health and well-being.
environmental degradation. The deterioration in environmental quality from
human activities and processes, such as, improper land use, as well as from
natural disasters.
environmental justice. A form of justice whose concerns include degradation
of agricultural land and food sufficiency; aridification, desertification, water
takings, and potable water; ozone layer degradation, deforestation, climate
change, and air pollution; habitat loss and ecosystem destruction; industrial
waste, sanitation, and nonbiodegradables; and choices of nonreplenishable over
replenishable resources. It is also concerned with how various forms of
environmental damage in the pursuit of economic self-interest places the
heaviest burden upon the poor, forcing them to bear the highest social,
environmental, economic, and health costs.
42 • Code of Ethics for Nurses with Interpretive Statements • Glossary
ethics. The branch of philosophy or theology in which one reflects on
morality; the formal study of morality from a wide range of perspectives
including semantic, logical, analytic, epistemological, normative, and applied.
evidence informed practice. In any role or setting, practice that is
characterized by combining the best available research; role or practice
expertise; applied nursing, research, and healthcare ethics; and clinical or
experiential insight. In patient care, it includes patient preferences, cultural
backgrounds, and community values. Concepts and elements of evidence based
practice are used interchangeably with this term in some contexts.
fidelity. The ethical principle that requires loyalty, fairness, truthfulness,
advocacy, and dedication in relationships. It includes promise-keeping, truthtelling, and fulfilling commitments.
health diplomacy. Prioritizing global health issues and concerns within the
context of international diplomacy and practices. Bringing together public
health, international affairs, management, law, economics, health, foreign
policy, and trade, it focuses on negotiations that shape and manage the global
policy environment for health.
human rights. See rights, human.
impaired practice. Functioning poorly or with diminished competence, as
evident in changes in work habits, job performance, appearance, or other
behaviors that may occur in any role or any setting.
incompetence. Lack of possession or failure to exercise that degree of
learning, skill, care, and experience ordinarily possessed and exercised by a
competent professional.
integrity. An internal quality (virtue) within oneself; a cluster of attributes. It
manifests externally as honesty and moral consistency, i.e., consistency with
one’s internal values, convictions, beliefs, knowledge, commitments, and
obligations. It requires ongoing self-examination and taking seriously one’s life,
values, commitments, and so forth.
interprofessional. Characterized by practicing professionals from two or more
academic disciplines working, learning, or taking action together.
Just Culture. An organizational environment that holds individuals
accountable for performing duties of avoiding harm, producing outcomes and
following policies, procedures or guidelines that: recognizes individuals choose
and need to manage human error, at-risk behaviors and reckless behaviors;
Glossary • Code of Ethics for Nurses with Interpretive Statements • 43
recognizes individuals make mistakes and systems fail; learns from mistakes,
treats individuals fairly; coaches to avoid risky behaviors; and disciplines
reckless or knowingly dangerous behaviors.
justice. A bioethical principle with various types or domains of justice,
including distributive, retributive, restorative, transitional, intergenerational,
and procedural. Bioethics is chiefly concerned with distributive justice.
Distributive justice deals with the equitable distribution of social burdens and
benefits in society. When this allocation occurs under conditions of scarcity, it
raises questions of rationing. The formal principle of justice states that equals
shall be treated equally, and un-equals unequally, in proportion to their
relevant differences.
metaparadigm. An overarching and general statement of a discipline that
functions as a framework within which conceptual models develop.
moral distress. The condition of knowing the morally right thing to do, but
institutional, procedural or social constraints make doing the right thing nearly
impossible; threatens core values and moral integrity.
morality. Refers to personal values, character, or conduct of individuals
or groups within communities and societies; often used interchangeably
with ethics.
nonmaleficence. The bioethical principle that specifies a duty not to inflict
harm and balances unavoidable harm with benefits of good achieved.
nursing. The protection, promotion, and optimization of health and abilities,
prevention of illness and injury, alleviation of suffering through the diagnosis
and treatment of human response, and advocacy in the care of individuals,
families, communities, and populations.
organizations. Groups and associations that affiliate to enhance the work of
nurses by promoting unity, engaging in political advocacy, disseminating
professional knowledge, and facilitating professional development.
participants (in research). Persons taking part in research studies under the
direction of an investigator who …

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