2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Let's get Ethical: An Update on the
ANA Code of Ethics for Nurses
Kathryn Schroeter, PhD,
RN, CNOR, CNE
Assistant Professor – Marquette University
College of Nursing
Adjunct Assistant Professor – Center for
Bioethics & Medical Humanities –
Medical College of Wisconsin
Nurse Scientist & Clinical Ethicist - Froedtert
Hospital & Medical College of Wisconsin
Editor – Journal of Trauma Nursing
Principles of Bioethics
Objectives
1. Identify four principles of bioethics.
2. Review the nine provisions in the ANA
Code of Ethics for Nurses.
3. Discuss the revisions to the ANA Code
of Ethics for Nurses.
Principles of Bioethics


Beneficence
– the principle of doing good. Health care
providers strive to do good for their
patients, to benefit or to act in the best
interests of the patient(s).
Nonmaleficence
– directs health care providers to do no
harm.

Autonomy - the self-determination of an
individual, encompassing respect for persons.
Autonomy allows individuals to make voluntary,
uncoerced decisions about life situations.

Justice - treats individuals according to what
is fair. Patients in the hospital expect to be
treated fairly and to receive equal care.
FIDELITY
The individual’s obligation to be
faithful to commitments made to self
& others
In health care, includes the
professional’s faithfulness or loyalty
to agreements & responsibilities
accepted as part of the practice of the
profession
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
VERACITY
 TRUTHFULNESS
 Requires
the health care provider
to tell the truth & not intentionally
deceive or mislead clients
ANA CODE OF ETHICS
FOR NURSES
The Code Applies to All Nurses


The term practice refers to the actions of the
nurse in any role or setting, whether paid or as
a volunteer, including direct care provider,
advanced practice, care coordinator, educator,
administrator, researcher, policy developer, or
other forms of nursing practice.
The values and obligations expressed in the
Code of Ethics for Nurses apply to nurses in all
roles, in all forms of practice, and in all settings.
Code of Ethics for Nurses with
Interpretive Statements
–
–
–
–
–
–
written list of a profession’s values & standards of
conduct
framework for decision making
general statements
offer guidance
periodically revised
consistent violations indicate an unwillingness by the
person to act in a professional manner & license may
be suspended or revoked
As nursing & its social context change, changes
to the Code of Ethics are also necessary.
Purpose:
1. It is a succinct statement of the ethical obligations
and duties of every individual who enters the
nursing profession.
2. It is an expression of nursing’s own understanding
of its commitment to society.
3. It is the profession’s nonnegotiable ethical standard.
The Code of Ethics for Nurses consists of 2
components: the provisions and the
accompanying interpretive statements.
There are nine provisions that contain an
intrinsic relational motif:
nurse to patient, nurse to nurse, nurse to self,
nurse to others, nurse to profession, nurse
and nursing to society.
American Nurses Association. (2001)
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Nine Ethics Provisions
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.
Nine Ethics Provisions
2. The nurse's primary commitment
is to the patient, whether an
individual, family, group, or
community.
American Nurses Association. (2001)
American Nurses Association. (2001)
Gallup Poll 2013
rated = very high / high
Americans selected most honest & ethical professions
Nine Ethics Provisions
3. Nurses promotes, advocates
for, and strives to protect
patients’ health, safety and
rights.
American Nurses Association. (2001)
RNs
Pharmacists
Medical Doctors
Engineers
Dentists
Police officers
College Teachers
Clergy
85%
75%
70%
70%
62%
58%
53%
52%
Gallup Poll 2013
Least honest and ethical professions
Car salespersons
Members of Congress
Advertising practitioners
Stockbrokers
HMO Managers
Senators
Insurance Salespersons
Lawyers
Nine Ethics Provisions
4. Nurses are responsible and
accountable for individual nursing
practice as well as the appropriate
delegation of tasks consistent with
the obligation to provide optimum
patient care.
American Nurses Association. (2001)
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Nine Ethics Provisions
5. Nurses owe the same duty to self
as to others, including the
responsibility to preserve
integrity and safety, to maintain
competence, and to continue
personal/professional growth.
Nine Ethics Provisions
6. The nurse participates in
establishing, maintaining, and
improving healthcare environments
& conditions of employment
conducive to the provision of
quality health care & consistent
with the values of the profession.
American Nurses Association. (2001)
Nine Ethics Provisions
7. The nurse participates in the
advancement of the
profession through
contributions to practice,
education, administration, and
knowledge development.
Nine Ethics Provisions
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.
Nine Ethics Provisions
8. The nurse collaborates with
other health professionals and
the public in promoting
community, national, and
international efforts to meet
health needs.
ANA Code of Ethics for Nurses
It is non-negotiable in any
setting, neither is it subject
to revision or amendment
except by formal process of
revision by the ANA.
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
ANA structures -
ANA structures
All RN applicants must be ANA members
Professional Issues Panels to drive toward
informed decision-making, member engagement
and active dialogue with members.
Panels will be convened around specific practice
and policy questions as approved by the ANA
Board of Directors.
Each Panel will include both a Steering Committee
and an Advisory Committee to ensure sufficient
rigor while also allowing for broad feedback from
a full range of practice arenas and interests.
Steering Committee – The Steering Committee
will typically include up to 15 ANA members who
will do a deep dive into the topic. This committee
will meet intensively via conference call for a
specific period, depending on the topic.
Advisory Committee - The Advisory Committee
will provide additional information, feedback &
advice to ANA & the Steering Committee by
responding online to specific questions,
documents and dialogue
Process of the Revision



Have there been changes in the
world/society/profession/practice environment
that warrant revisions?
Survey of all nurses in the USA was sought
online
Call went out last summer 2013 for
applications for steering committee and
advisory committee for the ANA code of ethics.
Process of the Revision
Process of the Revision



Appointments were made to both the steering
committee and the code revision advisory
committee.
Meeting were held via conference calls and
work groups were utilized for specific
assignments.
One face-to-face meeting was held at ANA
headquarters in Washington, DC area.




Sections revised: Preface, Provisions,
Glossary, Links
Revisions posted for public comment on ANA
website in June 2014.
Work continued with committees w/public
comment.
Conference calls with final product completed
in September 2014.
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Process of the Revision



Revision Disclaimer!
Revised ANA Code of Ethics forwarded
to the ANA Board of Directors for
approval in November 2014.
If approved new code will be available
in the beginning of 2015.
New ANA code and glossary will be
utilized in other ANA products such as
the ANA Scope and Standards.
Because the proposed
revisions have not yet been
approved, I can only discuss
rather generically what may
be in the final product.
Altered standards of care

Some Areas of Revision…
Altered standards of care / Human rights
Social media
3. Civility / Managers-Administrators
5. Students/Educators
6. Global perspectives
7. Conscientious objection
8. Leadership
9. Research
1.
2.


Nurses must engage in discernment, carefully
assessing their intentions, reflectively weighing
all possible options and rationales, and
formulating a clear moral justification for their
actions.
Only under extreme and exceptional conditions,
while conforming to international standards and
engaging in an appropriate and transparent
process of authorization, may nurses
subordinate human rights concerns to other
considerations.

Human rights may be jeopardized in extraordinary
contexts related to fields of battle, pandemics,
political turmoil, regional conflicts or
environmental catastrophes where nurses must
necessarily practice under altered standards of
care.
Nurses must always stress human rights
protection under all conditions, with particular
attention to preserving the human rights of
vulnerable groups such as women, children, the
elderly, prisoners, refugees and socially
stigmatized groups. All actions, and omissions
risk unintended consequences with implications
for human rights.
Disaster ethics
Duty to self v. duty to care
Altered standards of care
State of WI
Ethics of Health Care Disaster
Preparedness
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Social Media
Civility
Nurses function in many roles and many
settings…In every role, the nurse creates a
moral environment and culture of civility and
kindness, treating others, colleagues,
employees, co-workers, and students with
dignity and respect.
This standard of conduct includes an affirmative
duty to act to prevent harm. Disregard for the
effect of one’s actions on others, bullying,
harassment, manipulation, threats or violence
are always morally unacceptable behaviors.
Because of the rapidly evolving means of
communication and the porous nature
of social media nurses must maintain
vigilance regarding commentary that
intentionally and/or unintentionally
breaches their obligation to maintain
and protect patients' right to privacy
and confidentiality.
Students
All nurses, through organizations and
accrediting bodies involved in nurse
formation and development, must firmly
anchor students in nursing's professional
responsibility to address unjust systems and
structures, modeling the profession's
commitment to social justice and health
through content, clinical and field
experiences, and critical thought.
Students

Global perspective
Politics r/t public health & nursing

Professional nursing organizations
must actively engage in the political
process, particularly addressing those
legislative concerns that most impact
the public's health and the profession
of nursing.
Nurse educators promote and maintain
optimal standards of education and
practice in every setting where learning
activities occur. They must also ensure
that only students possessing the
knowledge, skills, and moral dispositions
that are essential to nursing graduate
from their nursing programs.
Global health, as well as the common
good are ideals that can be realized when
all nurses unite their efforts and energies.
 Consistent with Nightingale's historic
concerns for environmental influences
upon health and the meta-paradigm
concepts of nursing, nursing's advocacy
for social justice extends to eco-justice.

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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Conscientious Objection
Conscientious Objection
When a particular decision or action is
morally objectionable to the nurse,
whether intrinsically so or because it
may jeopardize a specific patient,
family, community or population, or
when it may jeopardize nursing
practice, the nurse is justified in
refusing to participate on moral
grounds.
When nurses are placed in circumstances
that exceed moral limits or violate
professional moral standards, in any
nursing practice setting, they must
express their conscientious objection to
participation.
Conscience-based refusals to participate
exclude personal preference, prejudice,
bias, convenience, or arbitrariness.
Conscientious Objection
Acts of conscientious objection are acts
of moral courage and may not insulate
nurses from formal or informal
consequences.
Nurses are obliged to provide for patient
safety, to avoid patient abandonment, and
to withdraw only when assured that
nursing care is available to the patient.
Nurses should also collectively express
their concerns conscientious objection.
Leadership
Nurses are leaders who actively participate in assuring
the responsible and appropriate use of interventions
in order to optimize the health and well being of those
in their care. This includes acting to minimize
unwarranted or unwanted medical treatment and
patient suffering. Such care must be avoided and
advance care planning throughout many clinical
encounters helps to make this possible.
Nurses are also leaders who collaborate in alleviating
systemic structures that have a negative influence on
individual and community health.
Nurse managers/administrators


Nurses in management or administration
should facilitate open communication with staff
allowing them, without fear of reprisal, to
express concerns or even to refuse an
assignment for which they do not possess the
requisite skills.
Create a safe and supportive environment.
Research
Nurses have a duty to
question and, if
necessary, to report
research that is ethically
questionable and to
decline to participate.
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2014 WNA Convention and Annual Meeting
Let's get Ethical: An Update on the ANA Code of Ethics for Nurses
Summary
The Code of Ethics
EMPOWERS nurses!
The Code of Ethics for
Nurses provides a
framework for nurses to
use in ethical analysis
and decision-making.
References



The code of ethics makes
explicit the primary goals,
values and obligations of
the nursing profession.

American Nurses Association. (2001). Code of ethics for
nurses with interpretive statements. Washington, D.C.,
American Nurses Publishing, 5-7.
Beauchamp, T. and Childress, J.F. (2001). Principles of
biomedical ethics (5th ed.). New York: Oxford University
Press, Inc.
Lo, B. (2005). Resolving ethical dilemmas: a guide for
clinicians (3rd ed.). Baltimore: Williams and Wilkins.
Schroeter, K., Derse, A., Junkerman, C., Scheidermayer, D.
(2002). Practical Ethics for Nurses and Nursing
Students. Frederick: University Publishing Group, Inc.
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