Continuing Education
The ANA Code of Ethics for Nurses
With Interpretive Statements: Resource for
Nursing Regulation
Linda L. Olson, PhD, RN, NEA-BC, FAAN, and Felicia Stokes, JD, RN
The American Nurses Association (ANA) Code of Ethics for Nurses With Interpretive Statements informs decision making
about ethical violations by nurses and nursing education programs. The Code is the nursing profession’s ethical standard of
practice and nursing’s contract with society. Nurse practice acts (NPAs) and the standards of practice are the profession’s
legal standard. This article describes the nine provisions of the Code and provides cases of ethical violations and the disciplinary actions that were taken. The intent of this article is to serve as an educational resource on how the Code can be used with
NPAs to support nurse regulators in their decision making.
Keywords: Boards of nursing, Code of Ethics for Nurses, ethics, nurse practice acts, nursing regulation
Objectives
Discuss the ANA’s Code of Ethics for Nurses with Interpretive
Statements as the profession’s ethical standard of practice.
⦁ Describe how nurse regulators use the Code of Ethics to support decision making.
⦁ Identify the nine provisions of the Code of Ethics.
⦁
T
he American Nurses Association (ANA) Code of
Ethics for Nurses With Interpretive Statements (the Code)
(American Nurses Association [ANA], 2015a), the
profession’s ethical standard of practice, provides a framework
for ethical practice and decision making, guides the profession
in self-regulation, establishes the profession’s social contract
with society, and educates the profession on ethical responsibilities. The Code consists of nine main provisions with interpretive statements that exemplify the application of the Code
in nursing practice.
As the profession’s ethical standard, the Code is nonnegotiable (ANA, 2015a, p. viii). Neither individual nurses
nor groups of nurses can negotiate changes in the language of
the Code. Nurses in all roles and settings must adhere to the
Code in their practice. Ethics occurs within the framework of
all relationships nurses encounter in their professional roles
(Olson, 2012). As licensed professionals, nurses have a relationship with their state boards of nursing (BONs), which regulate nursing practice and protect the public by ensuring that
the standards of nursing practice are met and that nurses are
competent to practice. “Nurses must always comply with and
adhere to state nurse practice acts [NPAs], regulations, stan-
Volume 7/Issue 2 July 2016
dards of care, and ANA’s Code of Ethics for Nurses with Interpretive
Statements” (ANA, 2015a, p. 15).
The 2015 version of the Code is the first revision since
2001, and the ANA declared 2015 as the “Year of Ethics”
(ANA, 2015b). This emphasis on ethics calls for nurses in
all roles and settings to know the Code and encourage colleagues to read and discuss it. In 2014, Johns Hopkins School
of Nursing and Johns Hopkins Berman Institute of Bioethics
led a national summit meeting on Nursing Ethics for the 21st
Century. The meeting focused on the commitment of nursing’s
professional organizations to uphold the professional values of
nursing and to identify the strategic nursing ethics priorities
for the profession. The ANA, the National Council of State
Boards of Nursing (NCSBN), and 18 other organizations participated as collaborating partners in this initiative, which
identified ways to improve the ethical environment for nurses,
and therefore the quality of care provided to patients and families (Rushton & Broome, 2014).
The purpose of this article is to describe and exemplify
how the Code is used as a resource by nurse regulators as they
consider cases related to violations of the NPA. Actual cases of
such violations are presented for five of the first six provisions.
Each violation also reflects an ethical violation. Because the
last three provisions emphasize the importance of leadership
by individuals and groups of nurses as well as of professional
nursing organizations, no cases are presented.
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Background
Provision 1
The ANA Code of Ethics was formally adopted in 1950; however, its focus on the profession’s core values and nurses’ obligations and duties dates to the 1893 Nightingale Pledge. Early
versions of the Code emphasized obligations to carry out physician orders, rules of conduct, and duties. By contrast, later versions emphasized obligations to patients, increased awareness
of technological advances, and increased autonomy of nursing
practice. The 1985 Code incorporated bioethical language in
alignment with society’s focus on bioethics and the use of lifesaving and life-prolonging technologies. New provisions in the
2001 Code stressed nurses’ primary obligation to the patient,
defined as an individual, a family, a group, a community, or a
population. The 2001 Code also addressed duties of the nurse
to self; stressed the responsibility of nurses for contributing
to ethical workplace environments that are conducive to safe,
quality health care; and made clear that the application of ethical guidelines expressed in the Code applied to nurses in all
roles and settings.
The process for revising the Code in 2001 included the
establishment of working groups that coordinated obtaining
feedback and input from several thousand nurses through public comment and surveys to determine the need for clarification,
changes, or additions. The Code is a dynamic, living document that reflects changes in society, the nursing profession,
and the health care delivery system. What remains unchanged
are the fundamental commitments of the profession, including its commitment to society, and the ethical values, obligations, duties, and professional ideals of nurses individually
and collectively (ANA, 2015a, p. viii). Therefore, the Code
is evaluated and assessed for needed revisions approximately
every 10 years. Based on comments, the nine provisions of the
2001 Code were retained, but were made more clear and concise. The interpretive statements expanding on the provisions
were updated to include the changes that affected the profession since the 2001 revision. The first three provisions describe
the fundamental values and commitments of the nurse, such
as respect for patients, colleagues, and others; the next three
address issues of duty and loyalty, such as duties to self and
others and responsibilities for the health care environment. The
final three provisions address aspects of duty that go beyond
individual patient encounters, such as advancing the profession
through research and scholarly inquiry and advancing health
policy. These provisions also address the role of professional
organizations. Provisions 7, 8, and 9 have an enhanced focus on
social justice, the role of nurses in global health, the ethical use
of social media and electronic medical records, boundary issues,
ethical practice environments, the importance of interdisciplinary work and collaboration, the role of nurse leaders, and
the inclusion of nurses in all roles and settings (ANA, 2015a;
Epstein & Turner, 2015).
The nurse practices with compassion and respect for the inherent dignity,
worth, and unique attributes of every person (ANA, 2015a, p. 1).
In all roles and settings, nurses must respect the beliefs
and values of all patients without prejudice.
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Journal of Nursing Regulation
Interpretive Statement 1.2: Relationships With Patients
“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” (ANA, 2015a, p. 1). Interpretive statement 1.2 further
states that although nurses may not agree with a patient’s
choices, nurses are obligated to promote patient safety and provide opportunities to eradicate risky or self-destructive behaviors (ANA, 2015a).
Violation of Provision 1: Failure to Conform to Standards of
Acceptable Conduct
Stephanie, a registered nurse (RN), who worked in an inpatient
psychiatric unit, was caring for Amanda, a 20-year-old transgender patient with diagnoses of bipolar disorder and schizophrenia. Amanda identified as female, although her legal name
was Eric. During Stephanie’s shift, Amanda demonstrated
disruptive behavior in a group activity and placed herself and
other patients at risk. Stephanie attempted to diffuse the situation but intentionally chose to call her patient Eric, rather than
the patient’s preferred name, demonstrating a lack of respect
for the patient’s gender expression. Amanda became visibly
irritated, and her behavior escalated into a physical altercation with another patient, resulting in harm. The incident was
reported to Stephanie’s nurse manager, who reported it to the
BON.
Stephanie had an ethical duty to respect the values of her
patient, including sexual orientation or gender expression. The
Code states that “the need for and right to health care is universal” (ANA, 2015a, p.1). Nurses must respect the values of
each patient. Stephanie had a duty to promote the health and
safety of Amanda and protect other patients in the vicinity from
harm. Stephanie chose to call her patient by a name she knew
the patient had rejected, causing an escalation of an already
compromised situation. Stephanie’s actions constituted a violation of the Code and thereby established sufficient grounds for
disciplinary action. The BON charged her with failure to conform to standards of acceptable conduct, resulting in a 4-month
suspension from the practice of registered nursing.
Interpretive Statement 1.4: Right to Self-Determination
Autonomy affords patients the right to accept, refuse, or terminate treatment at any time. Nurses are obligated to respect
a patient’s decision by supporting and protecting these rights.
Nurses are often in a position to advocate for a patient’s choices
and should always provide compassion and care through the
various stages of medical decision making. Nurses in all settings must make sure patients are properly informed and
understand the consequences of all decisions without coercion,
duress, or undue influence. Furthermore, nurses have a duty to
find alternatives when appropriate and use nursing judgment
when patient safety is at risk.
Violation of Provision 1: Patient Abuse
Michael, an RN, was caring for several patients in a long-term
care facility, including Mr. Smith, an alert, oriented 75-yearold. When Michael tried to administer medication to Mr.
Smith, the patient refused to take the medication. Mr. Smith
did not provide any justification for his refusal. Michael tried
several verbal measures to coax Mr. Smith into taking his medication. After Mr. Smith repeatedly refused and shook his head
to avoid taking the medication, Michael grabbed Mr. Smith’s
chin and forced the medication into his mouth. As a result,
Mr. Smith suffered lacerations to his upper lip. Another nurse
witnessed the incident and reported it to the BON.
Michael had an ethical duty to respect his patient’s right
of refusal. Michael argued that he had several patients and
did not have time to use an alternative method to administer the medication. However, a patient’s right of refusal must
be protected, and the patient should be given necessary support throughout the decision-making process (ANA, 2015a).
Michael violated Mr. Smith’s autonomy to refuse medication
and failed to assess the patient’s understanding of the refusal.
Moreover, Michael harmed the patient by physically forcing
him to take the medication. The BON evaluated the facts and
determined that the nurse violated the Code and failed to conform to an ethical or quality standard of the profession, thereby
violating the state NPA.
Provision 2
The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population (ANA, 2015a, p. 5).
Nurses are caring and compassionate and often spend
numerous hours with a patient and family at the bedside.
Rapport and trust are common attributes in a nurse-patient
relationship. Nurses care for patients who are sick and may be
vulnerable because of stress, illness, or medication. Nurses have
an ethical duty to uphold professional boundaries and refrain
from dating or engaging in sexually intimate relationships
with patients (ANA, 2015a, p. 7).
Violation of Provision 2: Failure to Adhere to Professional
Boundaries
Kelly, an RN, was a new nurse working in a postoperative care
unit. Kelly had been caring for Jason, a postoperative heart
bypass patient, for three shifts. Jason had been flirtatious every
Volume 7/Issue 2 July 2016
shift and enjoyed having Kelly take care of him. Kelly also
found Jason attractive and requested an assignment to care for
him. Late into the shift, Jason proposed that Kelly close the
door to his room. Kelly obliged, and they engaged in consensual sexual intercourse. The next day, Jason asked the attending
physician if he can have home nursing care and requested that
Kelly be his nurse. The attending physician found the request
odd and initiated an investigation. Kelly and Jason admitted
to having consensual sex during Kelly’s shift. The incident
was reported to the BON, which evaluated the facts and determined that Kelly violated the Code, thereby establishing sufficient grounds for disciplinary action. The BON determined
that the nurse failed to conform to an ethical or quality standard of the profession, thereby violating the state NPA. The
nurse’s license was permanently revoked.
Kelly violated her ethical duty to maintain a professional
boundary between herself and her patient, despite the consensual nature of the act. Many states have laws in their NPAs
that specify professional boundary violations, including sexual
contact, as violations of the standard of conduct for nurses, thus
establishing sufficient grounds for discipline.
Provision 3
The nurse promotes, advocates for, and protects the rights, health, and
safety of the patient (ANA, 2015a, p. 9).
Protection of patient rights to privacy and confidentiality are fundamental to trust in a nurse-patient relationship.
Violations of these rights include electronic postings, images,
or commentary via social media or other public communications of personal or clinical information that could breach a
patient’s confidentiality or right to privacy. Several states have
specific language in their NPAs that identifies a breach of confidentiality or right to privacy as a violation of the standard of
care. For example, in Massachusetts, a nurse may be subject
to disciplinary action if he or she fails to “safeguard patient
information from any person or entity, or both, not entitled
to such information” (Code of Massachusetts Regulations,
n.d.). In Utah, unprofessional conduct subject to discipline
includes “failure to safeguard a patient’s right to privacy as
to the patient’s person, condition [or] diagnosis” (Utah State
Legislature, 2016). In Oregon, a similar provision exists:
“Violating the rights of privacy, confidentiality of information,
or knowledge concerning the client, unless required by law to
disclose such information or unless there is a ‘need to know’
may result in disciplinary action against the nurse” (Oregon
Administrative Rules, 2012).
The ANA and NCSBN have endorsed each other’s guidelines for the legal and ethical use of social media and other
electronic communication, emphasizing the critical importance
of protecting patient rights to privacy and confidentiality and
to safeguarding professional boundaries (National Council of
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11
State Boards of Nursing [NCSBN], 2011a). The NCSBN publication, A Nurse’s Guide to the Use of Social Media (NCSBN,
2011b), presents several examples of violations of patient confidentiality via inappropriate use of social media. One describes
a breach of patient confidentiality by a junior nursing student
who took a photo of a 3-year-old patient with leukemia on a
pediatric unit and posted it on her Facebook page. The photo
showed not only the patient but also the patient’s room number. As a result, the nursing student was terminated from her
nursing program for breach of patient confidentiality and a
HIPAA violation (NCSBN, 2011b, pp. 8-9). Nurses and nursing students who inappropriately use social media and breach
patient confidentiality or privacy may be violating state and
federal laws and face disciplinary action by the BON as well as
civil and criminal penalties.
Interpretive Statement 3.4: Professional Responsibility in
Promoting a Culture of Safety
The nursing profession has an ethical duty to promote a safe
culture for patients and families by reducing the number of
errors and near misses. Historically, reporting errors to BONs
resulted in punitive, disciplinary action. Many BONs now use
remediation, supervision, and counseling for errors that do
not involve deliberate, reckless, or malicious intent (Russell &
Radtke, 2014). This Just Culture model is designed to reduce
errors, not to conceal them (Marx, 2001). In efforts to increase
patient safety when errors occur, the Just Culture model promotes education and remediation, rather than punishment.
The Code identifies the Just Culture model as one that “recognizes individuals choose and need to manage human error,
at-risk behavior, and reckless behaviors; recognizes individuals
make mistakes and systems fail” (ANA, 2015a, p. 43). The
Code further states that Just Culture supports a nurse’s ability
to learn from mistakes and encourages education on avoiding
risky behaviors (ANA, 2015a). This shift in nursing practice to
a Just Culture model eliminates fear of discipline and embarrassment and deters nurses from remaining silent (Burhans,
Chastain, & George, 2012).
Nurses have an ethical obligation to report errors and
near misses to an appropriate authority to provide an opportunity for education, remediation, and accountability for individual practice (ANA, 2015a; Lachman, 2007). The Code
emphatically states that nurses may “neither participate in, nor
condone through silence, any attempts to conceal the error”
(ANA, 2015a, p. 12). Nurse managers, administrators, and
educators must provide an open and accessible process for
reporting errors and determining and analyzing the root causes
of errors to obtain and maintain a healthy and ethical work
environment. By creating and supporting an ethical work environment in which nurses feel free to disagree with one another
and with other members of the health care team without fear
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Journal of Nursing Regulation
of reprisal and to discuss difficult or unsafe conditions openly,
nurses in leadership roles promote a culture of safety.
Interpretive Statement 3.6: Patient Protection and Impaired
Practice
Nurses have a duty to protect the patient, the public, and the
integrity of the nursing profession when they observe physical or
mental impairment in a nurse or other health care professional.
Substance use disorder (SUD) in the nursing profession has been
recognized for more than 100 years (Monroe & Kenaga, 2011).
Stress, fatigue, and access to drugs place nurses at increased risk
for developing SUD and addiction (NCSBN, 2011b).
Although research has shown that 20% of RNs were
reluctant to report a colleague suspected of drug diversion
(Bettinardi-Angres & Bologeorges, 2011), nurses who suspect
their colleagues of diversion or physical or mental impairment have an ethical duty to protect patients from harm.
Reporting suspected impairment of a colleague to an appropriate authority protects the safety of the patient and initiates a path of recovery for the nurse (NCSBN, 2011c). Nurses
must also uphold the integrity of the profession by reporting
a colleague suspected of diversion. Such a report should not be
construed as betrayal. Many nurses fear reporting an impaired
colleague because of the disciplinary action the colleague may
face, including loss of licensure. However, reporting a nurse for
suspected impairment may not result in adverse disciplinary
action but in an offer of medical assistance that may save the
lives of the colleague as well as the colleague’s patients.
Several BONs offer nurses an alternative-to-discipline
program (ADP) to treat addiction and SUD. These programs
are designed to protect the welfare and safety of the public and
assist nurses with recovery. ADPs encourage nurses with SUD
to seek help without fear of public BON discipline. Dunn
(2005) posits that the nature of confidentiality encourages
nurses to self-report and seek assistance with recovery. As such,
the nursing profession promotes a nonpunitive environment
that encourages rehabilitation and recovery for impaired nurses
(Tanga, 2011).
In some jurisdictions, the ethical duty to report suspected
impairment is required by law in the NPA or administrative
code, and failure to report can result in disciplinary action. For
example, in Michigan, a nurse “who has a reasonable cause
to believe that a licensee…is impaired shall report that fact
to the department” (Michigan Legislature, 2007). Failure to
report may result in disciplinary action. A nurse who has a
bona fide nurse-patient relationship with the impaired nurse
is exempt from the requirement to report. In West Virginia, a
failure “to report through proper channels…impaired practice
of another person who provided health care” (West Virginia
Board of Examiners, 2015, §14.1.bb) may constitute professional misconduct. The Alabama BON mandates that nurses
report unsafe or incompetent nursing practice; failure to do so
is a violation and may warrant disciplinary action (Alabama
Administrative Codes, 2014). Not all BONs have mandatory
reporting laws.
In states with mandatory reporting laws, nurse managers
and administrators may also be subject to discipline for failure
to report a nurse suspected of impairment. Nurse managers
and administrators must be aware of and educated about the
signs of physical or mental impairment. Nurses who report
colleagues must also be supportive and caring throughout
recovery, especially when a recovering nurse is returning to the
workforce. A nurse who has a strong recovery program that
includes accountability and monitoring has much to offer to
patients and the profession (NCSBN, 2011c, Appendix J).
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 (ANA, 2015a, p. 15).
Nurses function in various roles and are responsible for
assessing their own competence. Nurse managers and executives not involved in direct patient care have a duty to share
responsibility for the care provided by the nurses they supervise. Nurse managers must ensure that nurses are practicing
within their scope of practice and that they do not delegate
activities to others that are prohibited by their NPAs. Nurse
educators have a duty to nursing students to ensure their learning needs are assessed and satisfied. The role of the BON is
essential in the regulation of curriculum, oversight, and
enforcement of satisfactory education programs.
The Code mandates that nurse educators assess the
knowledge and skills of nurses and nursing students to determine whether they are competent to provide the nursing care
to which they are assigned under appropriate supervision
(ANA, 2015a). If nursing education is unsatisfactory, not in
compliance with state or federal law, or fraudulent in nature,
BONs have a legal duty according to their NPAs to take action
to protect patients and uphold the integrity of the profession.
Interpretive Statement 4.3: Responsibility for Nursing
Judgments, Decisions, and Actions
“Nurses in administration, education, policy, and research
also have obligations to the recipients of nursing care” (ANA,
2015a, p. 16). Nurses in administrative or supervisory roles
who direct care do not relinquish responsibility to safeguard
patients and promote health. Nurses, including advanced practice registered nurses (APRNs), are accountable for nursing
judgments, decisions, and actions they delegate or supervise.
The delegating or supervising nurse has an obligation to assess
the skills, education, and experience of the supervisee or delegatee. Also, APRNs must provide education, instruction, and
assistance to those individuals whom they supervise.
Volume 7/Issue 2 July 2016
Violation of Provision 4: Failure to Conform to Ethical and Quality
Standards
Robert, an APRN, was the owner and delegating nurse of an
assisted-living facility. Robert had a contract to precept and
supervise four students in an RN program. After a complaint
was filed with the Department of Health, an investigation
into Robert’s assisted-living facility revealed that the students
were unsupervised when performing nursing tasks. Each student stated that Robert was often absent from the facility and
no other licensed personnel were present. The students also
reported that patients were found in wet diapers and soiled
sheets. The students were instructed to give medications without supervision and were instructed not to sign the medication
administration record. The Department of Health investigator
was unable to find adequate documentation of nursing care.
The students were instructed to feed the residents outdated
and spoiled meals.
Robert had an ethical duty to safeguard patients from
harm by providing proper supervision. “Nurses must make
a 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”
(ANA, 2015a, p. 17).
After review, the BON determined that Robert violated
the Code and failed to conform to an ethical or quality standard of the profession, thereby violating the NPA. Specifically,
the BON charged Robert with delegation of nursing acts to
an individual lacking the ability to perform, failure to properly supervise nursing students, failure to provide instructions,
and failure to assess the skill or experience of the individual he
supervised. The BON ordered an emergency suspension of the
APRN’s license.
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 (ANA, 2015a, p. 19).
Nurses working at the bedside often endure long hours
of physically and emotionally demanding work. Fatigue can
easily occur in nurses working long hours with varying day
and night shifts. Nurses must be cognizant of their health and
well-being. Nurses must be aware of work activities that may
contribute to fatigue and adopt ergonomic techniques and
practical solutions to adjust their daily nursing practice (Chen,
Daraiseh, Davis, & Pan, 2014). Nurses should maintain the
same healthy work and life balance that they teach patients
(ANA, 2015a, p. 19).
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13
Significant evidence indicates that nurses have an
increased risk of making errors because of fatigue from working
extended shifts (Geiger-Brown & Trinkoff, 2010). Although
BONs recognize the seriousness of nurse fatigue, they also
expect nurses to maintain a safe environment for patients and
to recognize when their level of fatigue and physical condition
could place patients at risk. The Texas BON addressed nurse
fatigue by taking a position that nurses are accountable for
making sound clinical judgments and protecting patient safety
when accepting an assignment. The “prudence and accountability of the nurse is especially significant in the context of
fatigue” (Cropley, 2015, p. 4). Many jurisdictions offer safe harbor protection and whistleblower protection for nurses who, in
good faith, deem patient safety to be in jeopardy. Processes by
which a fatigued nurse can request peer review of an assignment he or she believes to be in violation of the NPA or BON
rules are available (Cropley, 2015).
Violation of Provision 5: Failure to Conform to Ethical and
Quality Standards
Sasha, an RN, was caring for five patients in a step-down unit.
She was working the night shift but also worked a day shift as a
home care nurse. Around 4 a.m., Sasha’s patient Mr. Goodman
came out of his room for something to eat. Sasha was sitting at
the nurses’ desk with her head down. Mr. Goodman was at risk
for falls and used a walker. However, Mr. Goodman forgot his
walker and fell onto the floor in the middle of the hall. Sasha
was asleep and did not hear the commotion. A nursing assistant
woke her and informed her of the fall. Sasha stood up to see Mr.
Goodman, but did not assess the patient or take any action.
Instead, Sasha instructed the nursing assistant to help Mr.
Goodman back to bed. The incident was reported to the BON.
Sasha had a duty to evaluate and assess her fatigue and
resulting physical condition, which posed a risk to her patients,
and a duty to explain this risk to her supervisor. The BON
evaluated the facts and determined that the nurse violated the
Code and failed to conform to an ethical or quality standard of
the profession, thereby violating the NPA. The BON charged
the nurse with failure to conform to standards of acceptable
conduct, which resulted in a 2-month suspension from the
practice of nursing.
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
(ANA, 2015a, p. 23).
Provision 6 of the Code focuses on the responsibility
of nurses to contribute to health care environments that are
conducive to safe, quality health care. One component is the
ethical duty to respect the worth, dignity, and human rights
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Journal of Nursing Regulation
of all individuals with whom nurses interact in the workplace
(Longo, 2012). Incivility, bullying, lateral or psychological
violence, and behaviors that include threats, verbal abuse, and
physical abuse are considered acts of workplace violence and
create a hostile work environment. The incidence of workplace
incivility has been linked through research to medical errors,
negative patient outcomes, and unsafe work environments
(Skarbek, Johnson, & Dawson, 2015). Such unprofessional conduct can lead to complaints about nurses being reported to the
BON in light of its role in protecting public safety.
The role of nurse executives and leaders in creating a
healthy, ethical work environment is emphasized throughout the Code as a key mechanism for the promotion of safe
patient care and public protection. Such an environment
must be one of respect for diverse opinions and perspectives
and include “respect, mutuality, openness, transparency, and
moral equality” (Fowler, 2015, p. 108). An ethical work environment is one in which nurses feel free to speak out about
unsafe practices, mistakes, lack of support, incompetence, poor
teamwork, disrespect, and micromanagement. As found in
the study by the American Association of Critical Care Nurses
and VitalSmarts, Silence Kills: The Seven Crucial Conversations
for Healthcare, nurses should stay in a work environment only
when hope for change and the ability to speak out without fear
of retaliation exist (Fowler, 2015, p. 108; Maxfield, Grenny,
McMillan, Patterson, & Switzler, 2005).
Violation of Provision 6: Failure to Conform to Ethical and
Quality Standards
Jacob, an RN, and Melanie, an RN, were working an evening
shift in a long-term care facility. Melanie had 17 years of nursing experience, and Jacob had 2 years. Jacob was assigned to
Mr. Tyson, a patient diagnosed with dementia. On rounds,
Melanie entered Mr. Tyson’s room and noted that his gown
was too tight. When Jacob entered the room, Melanie stated
that Mr. Tyson’s gown was too tight. Jacob disagreed. Melanie
turned to Jacob and put her finger in his face, demanding that
he recognize her authority. Jacob asked Melanie to lower her
voice. Melanie began screaming and grabbed Jacob’s uniform.
When Jacob turned to leave the room, Melanie hit him on his
back. The supervisory nurse reported the incident to the police
and the BON.
Jacob declined to press criminal charges, but the BON
investigated the incident and determined that Melanie violated the Code and failed to conform to an ethical or quality
standard of the profession, thereby violating the NPA. This
case exemplifies how disrespectful, uncivil interactions among
employees affect the delivery of safe, quality patient care and
creates an unhealthy work environment. Although this case is
an egregious example, numerous examples of uncivil behaviors
and the importance of using evidence-based interventions to
prevent workplace incivility and bullying have been published
(Bartholomew, 2006; Longo, 2012). The Code clearly states that
nurses at all levels are responsible for creating an ethical environment and culture of respect with zero tolerance for incivility,
bullying, and workplace violence (ANA, 2015a; Clark, 2015).
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 (ANA, 2015a, p. 27).
Interpretive Statement 7.1: Contributions Through Research
and Scholarly Inquiry
Nurses have multiple ways to advance the profession through
knowledge development, research, and evidence-informed
practice. The Code states that all nurses have an obligation to
advance the profession and identifies several ways to do so. Not
all nurses must conduct research, but all nurses can participate in research by utilizing research findings and evidence in
practice and maintaining their current knowledge of research,
especially in their practice areas (Fowler, 2015, p. 117). The
nurse who is a researcher or caregiver for patients who are participants in research must adhere to Provision 1 that recognizes the principle of respect and right to self-determination,
Provision 2 that recognizes nurse’s primary commitment to the
patient, and Provision 3 that identifies the obligation to protect patients from potential harm.
Interpretive Statement 7.2: Contributions Through Developing,
Maintaining, and Implementing Professional Practice
Standards
Standards of professional nursing practice are “authoritative
statements of the duties that all registered nurses, regardless
of role, population, or specialty, are expected to perform competently” (Fowler, 2015, p. 122). Practice standards reflect
nursing’s responsibility to society, change as “new patterns of
professional practice are developed and accepted by the nursing
profession and the public,” and “interface with state nurse practice acts and federal laws governing nursing” (Fowler, 2015,
p. 122). The ethical practice of nursing requires that practice
standards for all areas of nursing be developed by nurses. In
compliance with state and federal law and regulations and
NPAs, nursing identifies its own scope of practice (ANA,
2015a, p. 28). Nurses must be aware of their own scope of practice as well as the scopes of practice of those with whom they
work. Nurses have professional, ethical, and legal responsibilities to assume accountability and control of their own practice
and actions and to practice according to prevailing standards of
safe nursing care within their scope of practice.
Volume 7/Issue 2 July 2016
Interpretive Statement 7.3: Contributions Through Nursing
and Health Policy Development
Nurses in all roles and settings have a variety of opportunities to participate in local, regional, state, national, and global
nursing and health policy development as individuals, employees in their workplaces, or as members of professional associations. Nurses can be involved in generating awareness of and
collecting evidence on issues that ultimately lead to changes in
policy at any of these levels as well as using evidence-informed
approaches to influence others to make changes that ultimately
lead to improvements in quality and safe care.
Provision 8
The nurse collaborates with other health professionals and the public
to protect human rights, promote health diplomacy, and reduce health
disparities (ANA, 2015a, p. 31).
At the core of this provision is the commitment to health
as a fundamental, universal human right. As a profession, nursing evolves from and is responsible to the society that authorizes nurses to practice through licensure and regulation. The
primary role of nursing regulation and NPAs is to protect the
public. Collaboration with other health care professionals and
the public to achieve health care equity, advance health and
human rights across various practice settings and geographic
areas, and prevent violations of human rights is stressed in all
four interpretive statements of this provision. Collaboration
to achieve goals that cannot be achieved individually requires
respect, trust, inclusion, the ability to deal with varied opinions, and equality.
Interpretive Statement 8.1: Health is a Universal Right
The commitment to health as a universal right is not new to
the profession; however, it is now stated directly in the Code
and is an affirmation held in common with the United Nations,
the International Council of Nurses, and the World Health
Organization (ANA, 2015a, p. 31; Fowler, 2015, p. 131).
Interpretive Statement 8.2: Collaboration for Health, Human
Rights, and Health Diplomacy
The 2015 Code has an increased emphasis on social justice and
the leadership role of nurses (in collaboration with other health
professionals) in developing “public health legislation, policies, projects, and programs that promote and restore health,
prevent illness, and alleviate suffering” (ANA, 2015a, p. 32).
Interpretive Statement 8.3: Obligation to Advance Health and
Human Rights and Reduce Disparities
This statement reinforces the need for collaboration to reduce
health disparities, especially in light of advances in technology, genetics, and environmental science. As noted, the Code
www.journalofnursingregulation.com
15
changes in response to changes in society, the profession, and
health care delivery.
Interpretive Statement 8.4: Collaboration for Human Rights in
Complex, Extreme, or Extraordinary Practice Settings
During extreme circumstances, such as natural disasters, mass
casualty events, epidemics, pandemics, and extreme emergencies, care may have to be delivered under altered standards of care. When practicing in such circumstances, nurses
must remain attentive to their primary commitment to the
patient and the ethical obligation to protect the human rights
of patients. These situations also require nurses to collaborate
with other health professionals to meet the needs of individuals, groups, communities, or populations.
Provision 9
The profession of nursing 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
(ANA, 2015a, p. 35).
This provision, which is directed toward the profession
through its professional associations rather than the individual
nurse, was new to the 2001 Code and reaffirmed in the 2015
Code. Before the revisions in 2001, the previous Codes were
directed primarily at the clinical nurse at the bedside. Since
then, the Code applies to nurses in all roles and settings as well
as to nursing’s professional organizations.
Interpretive Statement 9.1: Articulation and Assertion of
Values
Within the domain of social ethics, associations that represent
and regulate the nursing profession are expected to uphold,
affirm, and disseminate the values and integrity of the profession. Through professional and regulatory organizations at
the organizational, local, national, regional, and international
levels, nurses have many opportunities to influence changes in
the profession, in health care delivery systems, in policy, and
for patients and their access to safe, quality health care (Benton,
2012). By working within their national nursing associations,
nurses can effectively work for health and public policies that
improve standards of nursing practice, the quality of patient
care, and the quality of nursing education.
Interpretive Statement 9.2: Integrity of the Profession
The documents, structures, decisions, and actions of nursing associations and organizations are the means by which
the values of the profession are articulated (Fowler, 2015).
Maintaining the integrity of the profession is both a national
and a global duty.
16
Journal of Nursing Regulation
Interpretive Statement 9.3: Integrating Social Justice
Professional nursing organizations have a shared responsibility
to speak for nurses in promoting improvement in health care
systems and health care locally, nationally, and internationally
by influencing leaders, legislators, and governmental, nongovernmental, and international agencies.
Interpretive Statement 9.4: Social Justice in Nursing and
Health Policy
Through political action, professional nursing organizations
address legislative and regulatory issues that have an impact
on public health and safety. This includes global health and
environmental issues.
Incorporation of the Code into NPAs
The Code provides guidance to nurse regulators investigating
and deliberating on violations of the ethical standard of care.
Just as nurses should be familiar with the Code, they should
also have a thorough understanding of the provisions in their
NPA, which may incorporate the Code.
In the District of Columbia, the nurse’s responsibility to
adhere to the standards in the Code is incorporated into the DC
Municipal Regulations (Stokes, 2015). “A [registered or practical] nurse shall adhere to the standards set forth in the ‘Code
of Ethics for Nurses’ as published by the American Nurses
Association, as they may be amended or republished from time
to time” (District of Columbia, 2004). The South Carolina
BON (n.d.) officially adopted the Code as the ethical standard
for nurses, mandating that “nurses shall conduct themselves
in accordance with the code of ethics adopted by the board in
regulation” The BON’s policies and position statements cite
the Code, and its website provides a link to the ANA website.
The Delaware rules incorporating the Code state: “Standards of
nursing practice and position statements developed by general
and specialty nursing professional organizations may be used
to address scope of practice accountability” (State of Delaware,
2015).
Several states, though not expressly citing the Code in
their law or regulations, have incorporated it through general
language or in a position or declaratory statement. For example, West Virginia holds that a nurse who fails to “adhere to
standards established by a national professional nursing organization” may be subject to disciplinary action by the BON
(The West Virginia Board of Examiners, 2015, citation 19-314.1.a). In Kentucky, the BON has an advisory opinion statement on the role of nurses in maintaining the confidentiality of
patient information (Kentucky Board of Nursing, 2013). This
statement refers to Provision 3 of the Code, which addresses
the duty to maintain confidentiality of patient information
and to protect patients’ rights to privacy and confidentiality.
Although an advisory opinion statement is not a BON regulation, it provides a guideline for safe nursing practice.
Conclusion
Because of its history and significance, its articulation of the
core values and ethical obligations of the profession, and its
role in guiding the profession in self-regulation, the Code is an
essential resource for BON members, employers, and all nurses
practicing in the United States, making decisions on legal and
ethical violations.
References
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docs/nurs/610-X-8.pdf
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first revision of Code since 2001. News Release, January 6, 2015.
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Benton, D. (2012). Advocating globally to shape policy and strengthen
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Bettinardi-Angres, K., & Bologeorges, S. (2011). Addressing chemically
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Clark, C. (2015). Conversations to inspire a more civil workplace. American Nurse Today, 10(11), 18–23. Retrieved from https://americannursetoday.com/cne-civility/
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Cropley, S. (2015). Nursing fatigue: Avoiding patient safety risks. Texas
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District of Columbia. (2004). 17 D.C. Municipal Regulations Chapter 54,
§5416.1 & Chapter 55, §5516.1. Retrieved from http://doh.dc.gov/
sites/default/files/dc/sites/doh/publication/attachments/registered_
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Dunn, D. (2005). Substance abuse among nurses: Defining the issue.
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Epstein, B., & Turner, M. (2015, May). The nursing code of ethics: Its
value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2).
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Fowler, M. (2015). Guide to the code of ethics for nurses with interpretive statements (2nd ed.). Silver Spring, MD: American Nurses Association.
Geiger-Brown, J., & Trinkoff, A. M. (2010). Is it time to pull the plug on
12-hour shifts? Part 1. The evidence. Journal of Nursing Administration, 40(3), 100–102. doi:10.1097/NNA.0b013e3181d0414e
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Kentucky Board of Nursing. (2013). Advisory opinion: Role of nurses in
maintaining confidentiality of patient information. Retrieved from
http://kbn.ky.gov/practice/Documents/aos34.pdf
Lachman, V. D. (2007). Patient safety: The ethical imperative. MedicalSurgical Nursing, 16(6), 401–403.
Longo, J. (2012). Bullying in the workplace: Reversing a culture. Silver
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health care executives. Prepared for Columbia University under a grant
provided by the National Heart, Lung, and Blood Institute.
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FinalPrimerDoc.pdf
Maxfield, D., Grenny, G., McMillan, R., Patterson, K., & Switzler, A.
(2005). Silence kills: The seven critical conversations in healthcare. American Association of Critical Care Nurses and VitalSmarts. Retrieved
from www.aacn.org/WD/Practice/Docs/PublicPolicy/
SilenceKillsExecSum.pdf
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333.16223. Impairment of licensee, registrant, or applicant; report; exception; liability. Retrieved from www.legislature.mi.gov/
(S(1toi5cfil3qfoyethki1hlgp))/mileg.aspx?page=getobject&objectNa
me=mcl-333-16223
Monroe, T., & Kenaga, H. (2011). Don’t ask don’t tell: Substance abuse
and addiction among nurses. Journal of Clinical Nursing, 20(3–4),
504–509. doi:10.1111/j.1365-2702.2010.03518.x
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unite to provide guidelines on social media and networking for nurses.
Retrieved from www.nursingworld.org/FunctionalMenuCategories/
MediaResources/PressReleases/2011-PR/ANA-NCSBN-GuidelinesSocial-Media-Networking-for-Nurses.pdf
National Council of State Boards of Nursing. (2011b). A nurse’s guide to the
use of social media. Retrieved from www.ncsbn.org/3739.htm
National Council of State Boards of Nursing. (2011c). Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs. Retrieved from www.ncsbn.org/
SUDN_11.pdf
Olson, L. L. (2012). ANA Standard 7: Ethics. In K. M. White & A.
O’Sullivan (Eds.), The essential guide to nursing practice: Applying
ANA’s scope and standards in practice and education (pp. 113–122). Silver Spring, MD: American Nurses Association.
Oregon Administrative Rules. (2012). Oregon Administrative Rule §851045-0070(m). Retrieved from http://arcweb.sos.state.or.us/pages/
rules/oars_800/oar_851/851_045.html
Rushton, C. H., Broome, M., & The Nursing Ethics for the 21st Century
Summit Group. (2014, November). A blueprint for 21st century nursing ethics: Report of the National Nursing Summit. Retrieved from www.
bioethicsinstitute.org/nursing-ethics-summit-report
Russell, K. A., & Radtke, B. K. (2014). An evidence-based tool for regulatory decision making: The regulatory decision pathway. Journal of
Nursing Regulation, 5(2), 5–9. doi:http://dx.doi.org/10.1016/S21558256(15)30078-8
Skarbek, A. J., Johnson, S., & Dawson, C. M. (2015). A phenomenological study of nurse manager interventions related to workplace bullying. Journal of Nursing Administration, 45(10), 492–497.
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from www.llr.state.sc.us/pol/nursing/index.
asp?file=positionstatements.htm
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from http://regulations.delaware.gov/AdminCode/title24/1900.
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Stokes, F. (2015). Code of ethics for nurses. District of Columbia Nurse,
12(2), 6. Retrieved from http://doh.dc.gov/sites/default/files/dc/
sites/doh/release_content/attachments/DCNurse_43.pdf
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Tanga, H. Y. (2011). Nurse drug diversion and nursing leader’s responsibilities: Legal, regulatory, ethical, humanistic, and practical considerations. JONA’S Healthcare Law, Ethics and Regulation, 13(1), 13–16.
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Utah State Legislature. (2016). Utah Code Ann. § 58-31b-502(1).
Retrieved from https://le.utah.gov/xcode/Title58/Chapter31B/5831b-S502.html
The West Virginia Board of Examiners for Registered Professional Nurses
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Linda L. Olson, PhD, RN, NEA-BC, FAAN, is Director,
Institute of Regulatory Excellence, National Council of State
Boards of Nursing, Chicago, Illinois. Felicia Stokes, JD, RN,
is Discipline Nurse Consultant, District of Columbia Board of
Nursing.
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Journal of Nursing Regulation
Posttest
The ANA Code of Ethics for
Nurses With Interpretive
Statements: Resource for
Nursing Regulation
Objectives
Discuss the ANA’s Code of Ethics
for Nurses with Interpretive Statements as the profession’s ethical
standard of practice.
⦁ Describe how nurse regulators
use the Code of Ethics to support
decision making.
⦁ Identify the nine provisions of the
Code of Ethics.
⦁
Ce
CE Posttest
If you reside in the United States and
wish to obtain 1.0 contact hour of
continuing education (CE) credit,
please review these instructions.
Instructions
Go online to take the posttest and
earn CE credit:
Members – www.ncsbninteractive.
org (no charge)
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com ($15 processing fee)
If you cannot take the posttest online,
complete the print form and mail it to
the address (nonmembers must
include a check for $15, payable to
NCSBN) included at bottom of form.
Provider accreditation
The NCSBN is accredited as a
provider of CE by the Alabama State
Board of Nursing.
The information in this CE does not
imply endorsement of any product,
service, or company referred to in this
activity.
Contact hours: 1.0
Posttest passing score is 75%.
Expiration: July 2019
Volume 7/Issue 2 July 2016
Please circle the correct answer.
1. When was the first ANA Code of Ethics
formally adopted?
a. 1950
b. 1958
c. 1963
d. 1968
2. Which of the following issues has a new
emphasis in the 2015 ANA Code of
Ethics?
a. Bioethics and life-saving technology
b. Obligation to carry out physician orders
c. Ethical use of social media
d. Duty to uphold professional boundaries
3. What two terms are used to describe the
ANA Code of Ethics?
a. Exciting and modern
b. Expansive and all-encompassing
c. Up-to-date and trendy
d. Dynamic and constant
4. What is the one of the purposes of the
ANA Code of Ethics?
a. Identify strategic nursing actions
b. Create a platform for health policy reform
c. Express nursing’s understanding of its
commitment to society
d. Issue a call to action for quality health
care
5. Which statement best describes the
ANA Code of Ethics?
a. Flowchart for decision making
b. Framework for an ethical standard of
practice
c. Contract for patient- and family-centered
care
d. Interpretation of the professional nursing
law
6. A violation of the nurse practice act for
“patient abuse/unprofessional conduct”
is in direct conflict with which Provision
of the ANA Code of Ethics?
a. Provision 1
b. Provision 3
c. Provision 5
d. Provision 7
7. A violation of the nurse practice act for
“failure to adhere to professional
boundaries/unprofessional conduct” is
in direct conflict with which Provision of
the ANA Code of Ethics?
a. Provision 2
b. Provision 4
c. Provision 6
d. Provision 8
8. An alternative-to-discipline program is
designed to protect the welfare and
safety of the public, which relates to
which Provision of the ANA Code of
Ethics?
a. Provision 3
b. Provision 5
c. Provision 7
d. Provision 9
9. What is the relationship between the
ANA Code of Ethics (the Code) and
nursing laws/regulations?
a. Every jurisdiction directly identifies the
Code in their laws or regulations.
b. All nursing laws include advisory opinion
statements about ethical practice.
c. A few jurisdictions have officially
adopted the Code into their nursing laws/
regulations.
d. Some jurisdictions use the Code to
legally enforce nursing laws/regulations.
10. Why do nurses have an ethical
responsibility to report medication
errors?
a. Because doing so demonstrates a
commitment to nonmaleficence
b. Because doing so promotes patient
safety
c. Because doing so identifies whom the
board of nursing must punish
d. Because doing so encourages the
patient’s right to self-determination
11. What is one of the basic concepts
associated with Provision 4?
a. Respect for human dignity
b. Responsibility for nursing judgment and
action
c. Influence of the environment on ethical
obligations
d. Wholeness of character
www.journalofnursingregulation.com
19
12. What action exemplifies Provision 7:
Advancement of the Nursing Profession?
a. Decrease workplace incivility
b. Ensure adequate staffing
c. Recognize substance use disorder
d. Perform research and scholarly inquiry
13. Identify one of the core concepts of
Provision 8: Promotion of Community and
World Health.
a. Personal and professional growth
b. Proper supervision for delegated tasks
c. Health as a universal human right
d. Right to privacy and confidentiality
14. Which statement best characterizes
Provisions 4, 5, and 6?
a. These provisions describe the duty of the
profession beyond patient encounters.
b. These provisions identify the boundaries
of duty and loyalty.
c. These provisions emphasize the
fundamental values and commitments of
the nurse.
d. These provisions describe the
collaborative role of nurses.
Evaluation Form (required)
•
1. Rate your achievement of each
objective from 5 (high/excellent) to
1 (low/poor).
•
1
•
Discuss the ANA’s Code of Ethics
for Nurses With Interpretive
Statements as the profession’s
ethical standard of practice.
1
2
3
4
Were the authors knowledgeable about
the subject?
5
Describe how nurse regulators use
the Code of Ethics to support
decision making.
1
2
3
4
•
•
•
Identify the nine provisions of the
Code of Ethics.
1
2
3
4
2
3
4
2
3
4
2
3
4
1
2
3
4
Comments:
2. Rate each of the following items from
5 (very effective) to 1 (ineffective):
Please print clearly
Name
Mailing address
Street
City
State Zip
Home phone
Business phone
Fax
E-mail
Method of payment (check one box)
□ Member (no charge)
□ Nonmembers (must include a check for $15 payable to NCSBN)
PLEASE DO NOT SEND CASH.
Mail completed posttest, evaluation form, registration form, and payment to:
Please allow 4 to 6 weeks for processing.
20
Journal of Nursing Regulation
5
5
5
Was there enough time allotted for this
activity?
5
NCSBN
111 East Wacker Drive
Suite 2900
Chicago, IL 60601-4277
5
Was the article useful to you in your
work?
1
5
4
Was the content relevant to the
objectives?
1
•
3
Were the methods of presentation (text,
tables, figures, etc.) effective?
1
•
2
5
Wk 2 Discussion NRNP 6665
Select one of the following ethical/legal topics:
Autonomy, Beneficence, Justice, Fidelity, Veracity, Involuntary hospitalization and due
process of civil commitment, Informed assent/consent and capacity, Duty to warn,
Restraints, HIPPA, Child and elder abuse reporting, Tort law, Negligence/malpractice.
In the Walden library, locate a total of four scholarly, professional, or legal resources
related to this topic. One should address ethical considerations related to this topic for
adults, one should be on ethical considerations related to this topic for
children/adolescents, one should be on legal considerations related to this topic for
adults, and one should be on legal considerations related to this topic for
children/adolescents.
Briefly identify the topic you selected. Then, summarize the articles you selected,
explaining the most salient ethical and legal issues related to the topic as they concern
psychiatric-mental health practice for children/adolescents and for adults. Explain how
this information could apply to your clinical practice, including specific implications for
practice within your state. Attach the PDFs of your articles.
More to note: you select a topic that has both legal and ethical implications for PMHNP
practice and then perform a literature review on the topic. Your goal will be to identify
the most salient legal and ethical facets of the issue for PMHNP practice, and also how
these facets differ in the care of adult patients versus children. Keep in mind as you
research your issue, that laws differ by state and your clinical practice will be dictated by
the laws that govern your state.
Reading resources
American Nurses Association. (2015). Code of ethics for nurses with interpretive
statementsLinks to an external site.. https://www.nursingworld.org/practicepolicy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/Links to an
external site.
American Psychological Association. (2017). Ethical principles of psychologists and
diagnostic formulationLinks to an external site.. http://www.apa.org/ethics/code/Links to
an external site.
American Academy of Child & Adolescent Psychiatry. (2014). Code of ethicsLinks to an
external site..
https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_portal/aacap
_code_of_ethics_2012.pdfLinks to an external site.
American Psychiatric Nurses Association. (2020). APRN psychiatric-mental health
nursing practiceLinks to an external site..
https://www.apna.org/i4a/pages/index.cfm?pageID=3846Links to an external site.
Anderson, S. L. (2012).Practice parameter on gay, lesbian, or bisexual sexual
orientation, gender nonconformity, and gender discordance in children and
adolescentsLinks to an external site.. American Academy of Child and Adolescent
Psychiatry, 51(9). 957–974. https://www.jaacap.org/action/showPdf?pii=S08908567%2812%2900500-XLinks to an external site.
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent
mental healthLinks to an external site.. American Psychiatric Association Publishing.
Chapter 2, “Addressing Behavioral and Mental Problems in Community Settings”Links
to an external site.
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A.
(2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
Chapter 19, “Legal Issues in the Care and Treatment of Children with Mental Health
Problems”
Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review
manual. Springer.
Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner
Certification Exam”
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