Legal / Ethical

The Nursing Code of Ethics: A Guide

  • NCC concludes it’s Nursing Code of Ethics Breakdown with a complete guide, exploring the history and value of ethical nursing.
  • Overview of the seven ethics of nursing: autonomy, accountability, justice, nonmaleficence, beneficence, fidelity, and veracity. 
  • Understand the importance of the code of ethics in nursing, including examples you can implement in your own practice.

Katy Luggar-Schmit


February 29, 2024
Simmons University

The nursing code of ethics is a tool for nurses at all levels of practice. The code establishes and reiterates the fundamental commitments and values of nurses. It identifies the boundaries of professional nursing practice and loyalties and outlines the duties of nurses extending beyond individual patient encounters. 

According to the American Nurses Association, the code of ethics for nurses is the “social contract that nurses have with the United States public. It represents our profession’s promise to provide and advocate for safe quality care for all patients and communities. It binds nurses to support each other so all nurses can fulfill their ethical and professional obligations.” 

When was the first nursing code of ethics established? 

The origins of the code of ethics for nurses with interpretive statements date back to the late 1800s. The founder of modern nursing, Florence Nightingale established the foundation of ethics and nursing practice. The foundation of ethics she laid included preparing the groundwork for today’s modern ethical standards.  

In 1893, the Nightingale Pledge was created. The following is known as the Nightingale pledge, which to this day is still restated by nursing students during graduation and other nursing ceremonies:

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and as a missioner of health I will dedicate myself to devoted service to human welfare.”





Why is the code of ethics so important in nursing? 

  • The code of ethics for nurses is an expression of a nurse’s understanding of their commitment to patients, the profession, and society. 
  • The nursing code of ethics establishes non-negotiable ethical standards for all nursing roles in all settings. 
  • The code of ethics for nurses helps guide nurses in daily practice as they navigate the healthcare system. 
  • The nursing code of ethics establishes guidelines that stress the importance of nurses participating in continuing education and evidence-based practice. 
  • The provisions outlined in the nursing code of ethics outline broad expectations of nurses and requires all nurses to always act in a professional manner. 

What are the seven ethical principles in nursing? 


Accountability is one of the most important ethical principles in nursing. Each nurse must be responsible for his or her own choices and actions during patient care. Nurses who hold themselves accountable often provide higher-quality patient care. 

Helpful tip to remember: Accountability=Responsibility 



Every nurse is responsible for making care decisions based only on the facts, not on other factors like the patient’s age, ethnicity, religion, socioeconomic status, or sexual orientation. To uphold this principle, nurses should act as fairly and objectively as possible, which can help patients feel more valued. Treating each patient fairly regardless of their circumstances is essential for helping patients accept and participate in their own health care. 

Helpful tip to remember: Justice=Fair, Factual 



This means to do no harm. Nurses have a critical responsibility to prevent further harm from coming to all their patients. Each nurse must take action to prevent harm. This is essential to be safe effective patient care that is delivered to the best of a nurse’s ability. 

Helpful tip to remember: Nonmaleficence=Do no harm  



Each nurse should be able to perform their duties using their own knowledge and professional judgment appropriate for each patient. Nurses must act only within their scope of practice yet continue to provide high-quality nursing care. Autonomy is an essential part of all aspects of nursing practice, helping nurses make appropriate decisions based on critical thinking. This principle goes hand in hand with accountability. 

Helpful tip to remember: Autonomy=Self Govern 



Actions that are performed with the intention of benefiting other people. An example of this is a nurse caring for a patient and putting the patient’s needs above their own in the patient’s best interests.  

Helpful tip to remember: Beneficence=Benefits 



This means keeping your word to your patients. Nurses should be honest and loyal to each patient. Without fidelity, more trusting relationships cannot be formed, which leads to less positive patient outcomes and trust. 

Helpful tip to remember: Fidelity=Keep promises 



Working in healthcare is challenging for many reasons, and in some cases, nurses must communicate unpleasant information to a patient. Veracity in nursing is the ethical principle of being completely open and honest with patients, even if the truth causes distress. Brassy helps patients become more autonomous making decisions for their care based on all relevant and factual information. 

Helpful tip to remember: Veracity=Truth, Honesty 

Why were the provisions of nursing added? 

The code of ethics for nurses was recently modified in 2015 to respond to the modern needs of healthcare. While the concepts remain the same, the interpretations were expanded with the new focus on leadership, social and health policy, and global health.  

These provisions serve as an overall summary and provide examples of the care standards expected from nurses. The American Nurses Association uses the Nursing Code of Ethics provisions to create a definition for consistent nursing practice. 

What are the nine provisions? 

1. “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” 

Example: A nurse has a culturally different patient. The nurse researches the culture and asks the patient about any cultural considerations they should be mindful of. 


2. “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.” 

Example: An elderly patient would like to start hospice care, but the family would like to continue the current treatment plan. The nurse listens to the loved ones’ concerns but puts the patient’s desires ahead of the loved ones. The nurse also explains to the loved ones the patient’s wishes take priority.  


3. “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” 

Example: An elderly patient has increasing levels of pain. The available interventions are no longer effective. The nurse contacts the physician and asks if there are other treatment options available to the patient for pain relief and comfort.  


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.” 

Example: A nurse notices a patient is declining and suspects they will need more assistance. The nurse calls the rapid response team to prevent further decline.  


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.” 

Example: A patient is verbally assaulting the nurse. The nurse informs the patient they will not tolerate this kind of behavior. The behavior continues. The nurse gets their supervisor involved to talk to the patient.  


6. “The nurse, through individual and collective efforts, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality healthcare.” 

Example: A nurse manager notices a staff member is not using proper hand hygiene. The nurse manager approaches the staff members and gently reminds them of proper hand hygiene techniques.  


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.” 

Example: A nurse joins a group responsible for overseeing that the facility is following evidence-based practices. 


8. “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” 

Example: A nurse works with other members of professional organizations to strengthen connections that will be mutually beneficial to their organization and patients. 


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.” 

Example: A nurse joins a group that promotes social justice in healthcare. 

How do the ethical obligations and provisions of nursing assist in guiding nurses to make the right professional choices? 

Nurses work in challenging conditions, including life-and-death situations. The nursing code of ethics and provisions establish standards that help nurses provide the best quality patient care with compassion, respect, and accountability.  

They also guide nurses in making ethical decisions in the best interests of their patients.  

What are some common violations of the nursing code of ethics? 

  • Violations of patient privacy. 
  • Failure to promote a safe health care environment. 
  • Ethical dilemmas regarding informed consent. 
  • Lack of professional growth. 
  • Allowing personal bias and beliefs to interfere with patient care. 
  • Failure to report suspected impairment of a coworker or peer. 
  • Withholding important information from patients about their health. 
  • Avoiding action against questionable practices. 
  • Not accepting responsibility for one’s judgment and nursing actions. 
  • Delegating assignments to an inappropriate person. 

What can be done if a nurse violates the nursing code of ethics? 

Boards of nursing can discipline nurses for unprofessional conduct resulting from a code of ethics violation. It is essential for nurses to be honest with their supervisors. In some cases, they may require the nurse to self-disclose or report a violation of the nursing code of ethics to their board of nursing. 

What are the possible consequences of violating the nursing code of ethics? 

  • Disciplinary action from an employer 
  • Loss of job 
  • Disciplinary action from the State Board of Nursing 
  • Loss of nursing license 
  • May be subject to a civil personal injury claim 
  • Criminal prosecution 
  • Loss of professional relationships 

The Bottom Line

In conclusion, nurses make several important decisions every day regarding patient care. It is essential all nurses understand and are familiar with the nursing code of ethics and provisions to assist them in making patient care decisions.  

Understanding these principles will enable them to provide the highest quality of nursing care possible. Understanding and practicing these principles will also assist in the professional development of the nurse and help them grow in their career goals.  

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