Running Head: NURSING CODE OF ETHICS
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Renee Latoures
Nursing Code of Ethics
San Francisco State University
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Introduction
One of the hallmarks of a profession is a tangible and enforceable code of ethics. A
profession’s 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 a
nurse patient relationship that is not affected by the patient’s 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.
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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 patient’s individual autonomy and rights. However, this
does not mean that we ignore each individual’s 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 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 nurse’s primary commitment is to the patient, whether an individual, family,
group, or community.
Provision two states the nurse’s 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
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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 patient’s
care.
This is important to nursing because families, other practitioners, institutions, etc.
may compete for the nurse’s 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 nurse’s perspective to that of the
patient not competing issues.
Recently during my capstone, a patient’s family did not want me to give their family
member pain medications indicating that she was only uncomfortable when she moved and
she wasn’t 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 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 family’s 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.
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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 nurse’s actions and encounters
with the patient specifically. Such principals are used to drive 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 patient’s 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 nurse’s 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
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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 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 patient’s 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 profession’s 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.
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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 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 tonight’s night shift for a
total of sixteen hours worked at once, but she would need to have the following day’s 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. The idea behind this
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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.
Provision 7:
The nurse participates in the advancement of the profession through contributions to
practice, education administration, and knowledge development.
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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.
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
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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 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,
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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
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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