For nearly two decades, nurses have ranked No. 1 in Gallup’s annual poll of the most honest and ethical professions, surpassing doctors, grade-school teachers, and even clergy. And, as the pandemic continues on, public perception of nurses has only improved.
But nursing’s longstanding title as the most trusted profession isn’t by chance.
Since the days of Florence Nightingale, nurses have adhered to strict codes of ethics and guiding principles to ensure every decision they make is in the best interest of the patients they serve. A commitment to ethics in nursing is also a key distinction among hospitals that have earned the Magnet® designation.
But what does ethics in nursing mean, and what does it look like in practice?
What is the Nursing Code of Ethics?
Often considered the original nursing code of ethics, the “Nightingale Pledge” was developed in the late 1890s. This pledge focuses on abstaining from anything “deleterious,” never knowingly administering harmful drugs, elevating the standard of the profession, and acting as a “missioner of health.” For more than 120 years, graduating nursing students have dutifully recited this pledge.
But, in 1950, the American Nurses Association (ANA) developed a more formal Code of Ethics for Nurses. This document has been modified many times over the past several decades, and, in 2015, the ANA added nine interpretive statements and provisions to add additional clarity (which can be found here).
Additionally, the ANA developed four ethical principles in nursing:
- Respect for Autonomy
Nurses should ensure patients have all the necessary information to make a decision about their medical care and should not attempt to influence their choice.
Nurses should never intentionally do harm or act with negligence and always strive to avoid or reduce risks.
Nurses should act with kindness, charity, and act in ways that benefit others.
Nurses should be fair and impartial regardless of patients’ socioeconomic status, sexual orientation, race, ethnicity, etc.
Understanding the code of ethics can help nurses navigate the everyday complexities of their role. But, for nurses to succeed, it’s crucial they’re supported by their employers. To earn and keep some highly sought-after designations, hospitals usually create an ethics committee (including multiple nurses) to help ensure all nurses are well-schooled in the ANA Code of Ethics for Nurses.
Of course, even after years of training and experience, nurses should never be expected to know precisely what to do in every ethical situation. After all, as we’ve experienced in the past year and a half, broad-reaching and unforeseen circumstances can sometimes muddy the waters and force medical professionals to make impossible decisions.
If a nurse experiences a complicated ethical dilemma, they should consult the code of ethics. If they’re still uncertain, they should consult their organization’s ethics committee.
Common Examples of Ethical Dilemmas in Nursing
Nurses encounter all sorts of challenges on a regular basis. Here are a few common ethical dilemmas in nursing.
- Patients Refusing Treatments
In some cases, and for various reasons, patients may refuse a treatment, medication, or care plan. In these instances, nurses may provide additional information, but should not attempt to influence or coerce the patient. Ultimately, nurses must accept their patients’ decisions.
- Observing Incompetence or Harmful Behavior in a Peer
If a nurse sees a fellow member of a care team behaving in a way that’s unethical, inept, or a threat to patient safety, they must report it. Again, consulting the code of ethics or the organization’s ethics committee are options if you are unsure.
- Establishing Boundaries
Nurses are there for patients during some of their most challenging and vulnerable moments. In some cases, this can lead patients to place unrealistic demands on nurses or attempt to cross professional boundaries. Nurses should not extend themselves beyond their professional capacity, scope of practice, or nurse-patient boundaries — like becoming romantically involved with a patient or accepting personal gifts.
- Respecting Differences in Religious Beliefs and/or Spirituality
Some patients hold religious beliefs or spiritual convictions that may impact how they want to be cared for - for example, some religions restrict life-saving interventions. Additionally, some medical interventions may be outside a nurses’ spiritual or religious beliefs. Regardless of the circumstances, nurses are expected to reduce patient suffering and respect patients’ religious beliefs, lifestyles, and value systems. Nurses must respect others’ choices and beliefs even if they don’t condone them.
Ethics in nursing can be complicated, and, in some scenarios, it can feel like there’s no “right” answer. But, by providing nurses with resources and support, hospitals can ensure their nursing team acts in their patients’ best interest and drives better outcomes.
To learn more about what it takes to earn (and keep) the Magnet designation, check out our eBook, Achieving Nursing Excellence.