Running Head: NURSING CODE OF ETHICS

Renee Latoures
Nursing Code of Ethics
San Francisco State University

Running Head: NURSING CODE OF ETHICS

Introduction
One of the hallmarks of a profession is a tangible and enforceable code
of ethics. A professions code of ethics helps distinguish it from other
vocations and establishes the standards each member of the profession is
held accountable to. In the profession of nursing this is the American Nurses
Association (ANA) Code of Ethics. Members of the profession subscribe to
their code of ethics when joining the profession. In nursing this is the time of
licensure. Violation of the code of ethics can be grounds for disciplinary
action or revocation of license. The ANA has outlined nine ethical provisions
in Guide to the Code of Ethics for Nurses; Interpretation and Application for
the nursing profession.
Provision 1:
The nurse, in all professional relationships, practices with
compassion and respect for the inherent dignity, worth, and
uniqueness of every individual, unrestricted by considerations of
social or economic status, personal attributes, or the nature of
health problems.
Provision one states that nurses should always conduct themselves
professionally and practice with caring and respect for others thoughts,
wishes, and perspectives irregardless of prejudice for individual
characteristics such as race, cleanliness, ability to pay, illness, etc. Under
this provision lie the tenets of providing all patients with inherent respect for
their worth as a person, respecting the rights of all persons, and maintaining

Running Head: NURSING CODE OF ETHICS

a nurse patient relationship that is not affected by the patients

individualities or health issues. Furthermore, the respect, compassion and
caring relationship the nurse is expected to demonstrate in their practice is
not reserved only for patients but also for colleagues and all individuals
encountered by the nurse.
This is important to nursing because individual prejudice and bias
regarding race, religious beliefs, lifestyle, illness, disability, functional status,
age, etc. should not affect the care given to any patient. Their worth as a
human being should transcend any personal bias or feelings the nurse has.
By eliminating such influences from the planning and delivery of care we
maintain the patients individual autonomy and rights. However, this does
not mean that we ignore each individuals uniqueness, but rather they
prevent it from negatively affecting the care they receive.
As a student during my psychiatric clinical rotation I was in charge of
facilitating a daily group meeting in a psychiatric treatment facility. Many of
the group participants had been homeless, were drug addicts, etc. and some
had relapsed to the program multiple times (the veterans) while others were
there for the first time. When some of the counselors conducted the group
they relied on people who had been there before for input and involved them
more since they had been through this before. The veterans did have past
experience to contribute but when conducting the group I did not look at
each of them by these labels but treated them all equal affording each the
same opportunity to share, ask questions and participate. They were all

Running Head: NURSING CODE OF ETHICS

worthy of the same amount of care and help I could provide and I divided my
care to each as equitably as possible.
Provision 2:
The nurses primary commitment is to the patient, whether an
individual, family, group, or community.
Provision two states the nurses responsibility is first and foremost to
his/her patient. It is important to realize that the term patient does not only
refer to an individual or individuals, but families and communities as well.
Patient in this context refers to any recipient of nursing care. Additionally,
this commitment to the patient should drive the nurse to include any
members of the interdisciplinary team that might benefit the patients care.
This is important to nursing because families, other practitioners,
institutions, etc. may compete for the nurses loyalty or persuasion and the
nurse must remember their primary responsibility is to be an advocate to
and for their patient not these competing influences. In doing so the nurse
prevents other factors or people from influencing their decisions, actions,
and care for their patient. It focuses the nurses perspective to that of the
patient not competing issues.
Recently during my capstone, a patients family did not want me to
give their family member pain medications indicating that she was only
uncomfortable when she moved and she wasnt moving. When present, the
patient deferred such choices to her family. To me, the nurse, the patient was
in visible discomfort and trying to stay still was not a reasonable pain

Running Head: NURSING CODE OF ETHICS

management strategy. I also suspected the family did not want pain
medication given because it made the patient drowsy and they wanted to
visit with her. I told the family I needed to check her surgical site and asked
them to step out of the room for a moment. Once they had left I offered the
patient pain medication again in private and she said yes and thanked me.
This made the patient more comfortable and eliminated her having to go
against her familys wishes in their presence. My priority as a nurse was to
my patient and helping control her pain not to her family requesting no pain
medication.
Provision 3:
The nurse promotes, advocates for, and strives to protect the
health, safety, and rights of the patient.
Provision three states that the nurse focuses not only on the care given
but promotes the rights, safety and protection of health of patients. This
provision extends beyond the patient the nurse is caring for more globally
covering patient care in general. In provision three, the term protect is
purposely used to point out how the nurse acts as a gatekeeper for the
patient or patient groups. Furthermore, Included in this provision is patient
confidentiality, research ethics, and reporting of impaired coworkers who
jeopardize patient care.
This is important to nursing because it focuses the nurses actions and
encounters with the patient specifically. Such principals are used to drive

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protocols and promote the well being, protection, and autonomy of all
patients and improves all patient care.
During a clinical rotation the nurse I worked with and I observed that
the nurse we took report from had not given medications on time for any of
her patients and had not given some medications all together. Upon
discussion with the charge nurse we learned this was not the first time this
had happened. We completed an incident report regarding her substandard
care not only for the specific patients we had but in order to protect future
patients the nurse may care for, as this was not an isolated incident.
Provision 4:
The nurse is responsible and accountable for individual nursing
practice and determines the appropriate delegation of tasks
consistent with the nurses obligation to provide optimum patient
care.
Provision four states that the nurse is responsible for their individual
actions (their practice) and decisions including the delegation of patient care
responsibilities. The two key concepts of this provision are responsibility and
accountability. The nurse is responsible for the patient care given and
accountable for their own practice.
This is important to nursing practice because it makes nurses
accountable for the care they give and responsible for providing appropriate
care. This provision provides consistency about the patient care outcomes
when the responsibility of a task is transferred to another person by keeping

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the nurse accountable for the outcome or completion of a task they

delegated to an appropriately qualified person.
In my capstone I had competing patient interests. I placed a patient on
a bedpan and left the room to give her privacy. I needed to assist another
patient at that time so I asked the CNA to take the patient off the bedpan in
five minutes. Ten minutes later I had not seen the CNA because she was busy
elsewhere so I went to make sure the patients bedpan had been removed. I
delegated this task to the CNA but I was still responsible for the outcome of
ensuring it was completed.
Provision 5:
The nurse owes the same duties to self as to others, including the
responsibility to reserve integrity and safety, to maintain
competence, and to continue personal and professional growth.
Provision five highlights the professions focus on service to those who
need care while remembering that the nurse must also focus on self care.
Provision five states that nurses have an obligation to take care of
themselves and keep themselves safe. This applies both physically, mentally,
spiritually, educationally, and so forth. This provision also specifically points
out educational and professional growth as a responsibility the nurse owes
themselves.
This provision is important to nursing because if nurses only focus on
their patients they may neglect themselves and overextend themselves.
When their own personal care is neglected the care they give also

Running Head: NURSING CODE OF ETHICS

diminishes. It is a reminder that nurses must take care of themselves in order

to be able to take care of others and neglecting to do so puts patient care at
risk.
My capstone preceptor works eight hour PM shifts. One shift the nurse
manager came and asked if she could stay through the eight hour night shift
because they were having staffing problems. My preceptor stated that she
was scheduled to work the PM shift the following day. She told the nurse
manager that she could work tonights night shift for a total of sixteen hours
worked at once, but she would need to have the following days PM shift off.
At first the nurse manager resisted giving her the following day off but my
preceptor was adamant she could only work one of the two shifts and left it
to the nurse manager to decide which. My preceptor was making sure to take
care of herself first, so that she was able to provide the level of care
expected of her and did not fold and take both shifts. She has a duty to care
for herself and she did so in a difficult situation where they wanted her to
work sixteen hours on, eight hours off, then another eight hours on.
Provision 6:
The nurse participates in establishing, maintaining, and improving
health care environments and conditions of employment conducive
to the provision of quality health care and consistent with the
values of the profession through individual and collective action.
Provision six states that through individual or group action the nurse
promotes the professional values of nursing in the healthcare environment.

Running Head: NURSING CODE OF ETHICS

The idea behind this provision is that the environment and its morals directly
affects the ethical dilemmas that occur and all nurses are obligated to
contribute to the healthcare environment in a way that supports the ethics of
the nursing profession.
This is important to nursing because it helps establish a standard for
workplace ethics. An ethical work environment both for patients and
coworkers is the responsibility of each professional to establish, uphold and
maintain. Both through individual and collective action an ethical healthcare
environment is created. And once created, reflected in its practice.
On some nursing units I have seen nurses are reluctant to go on a
break until they are completely caught up with their work. However, on a
busy nursing unit completely catching up before the end of the shift if often
very difficult. Where I am precepting, there is a break schedule and the nurse
going on break passes along whatever unfinished or in progress work they
have to the nurse relieving them. The culture of this floor accepts that when
you go on break you will leave work behind to be done by your relief nurse.
While a nurse may try to get a specific task done before their break because
they are more familiar with say the wound dressing, the relief nurse does not
make the nurse feel bad for leaving work behind while on break. This is a
more positive unit culture where it is ok to have work undone and each nurse
contributes to this by not complaining when someone has work to be done
when they go on break. As a result no one hides work that needs to be one
or puts it off.

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Provision 7:
The nurse participates in the advancement of the profession
through contributions to practice, education administration, and
knowledge development.
Provision seven states that the nurse is responsible to contribute to the
progression and development of the profession and field of nursing. This
involves advocacy and policy development, development of standards and
practices, and generation and distribution of knowledge.
This provision is important to nursing because it connects individual
nurses and their practice with nursing as a whole (the profession) and the
social roles and responsibilities of nursing. It helps individuals define a sense
of professional obligation that is individualized to their practice.
I have a BS degree in Gerontology. In my clinical practice I bring my
unique knowledge of the social, biological, and psychological aspects of
aging. I possess an extended understanding of the issues facing this specific
population and by sharing this knowledge with my colleagues I am helping
further the development of practice of our unit as a whole. I can use my
unique knowledge for more than my own practice but share it with others so
they may also use it in their practice as well.
Provision 8:
The nurse collaborates with other health professionals and the
public in promoting community, national, and international efforts
to meet health needs.

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Provision eight states that the nurse collaborates with other health
care personnel and the public to further health needs both locally and
globally.
This is important to nursing because it highlights that while a nurse
needs to be concerned with the health issues of individual patients, the
nurse should also be concerned with broader global health concerns as well.
By incorporating such public health knowledge in their individual practice
nurses will be able to meet known health concerns as well as future health
threats.
During a clinical rotation I was aware of the current Pertussis outbreak
in the bay area. Awareness of this current public health issue improved the
care I was providing to families with newborn babies because we made sure
everyone was currently vaccinated against pertussis and their young children
protected.
Provision 9:
The profession of nursing, as represented by associations and their
members, is responsible for articulating nursing values, for
maintaining the integrity of the profession and its practice, and for
shaping social policy.
Profession nine states that the profession of nursing as a whole via
their professional associations is responsible for preserving the integrity and
practice of the profession and for influencing social policy accordingly. It does
this by conveying the important doctrines of the profession to the association

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members. The professional associations not only inform members but the
public at large about the profession and practice of nursing.
This provision is important to nursing because it focuses on the
profession as a whole rather than the individual nurse like the eight
preceding provisions. Provision nine is a collective provision regarding the
social ethics of the profession of nursing. It places the largest burden of
collective responsibility to associations within nursing and its main focus is
social conditions and policy.
An example of this in practice is when professional associations hold
conferences where many different groups attend (students, faculty,
managers, bedside nurses, researchers, educators, etc.). These conferences
provide and environment that inspires discussion and sharing, supports
critical analysis and reflection, and stimulates change within the profession.
Furthermore, they are ways for the public at large to learn more about the
profession and participate in their discussions.
Conclusion
Ethics is an essential component of the nursing profession. These nine
provisions make up the basics ethical guidelines for nursing and are listed in
order of importance as determined by the ANA. The code of ethics serves as
a concise summary of the ethical obligations each nursing professional is
bound to. These ethical provisions are not fluid guidelines but rather ridged
standards all nurses must uphold. However, they are not statements that
bind nurses to a single course of action no matter the context but rather

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focus on moral concepts to be applied situationally. It informs not only

nurses, but patients, families, communities, etc. of nurses professional
obligations to those they serve.

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References
Fowler, Marsha D.M. (Ed). (2010). Guide to the Code of Ethics for Nurses;
Interpretation and Application. Silverspring, MD: Nursesbooks.org.

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