Ethics in Nursing

About this course

Nurses are often obligated to make ethical decisions. It is vital that nurses have the analytical thinking ability and skills to be able to appropriately respond to the vast everyday decisions regarding a patient’s well-being that must be made. With the use of ethical principles, theories, and codes, nurses and patients are better able to make informed decisions in care. To prepare and assist the nurse in making ethical decisions, the American Nurse Association and the International Council for Nurses independently developed Codes of Ethics to use as a guide when ethical dilemmas arise. Ethical terminology, and each of the codes of ethics are discussed through case study review.

Learning objectives

• Describe ethics and its impact on the nursing profession
• Review the history of ethics within nursing
• Describe the American Nurse Association’s position on Ethics within Nursing
• Review the International Councils for Nurses global influence on Ethics in Nursing

Course outline

59 sections · finish in any order across devices

1. 1

   Introduction

   Nurses save lives. But helping others goes far beyond providing medical treatment. Every day, nurses deal with matters of ethics and human rights. To help nurses address these often-complicated issues, the American Nurses Association and the International Council for Nurses have independently develo

   4 min

2. 2

   Ethics

   A philosophical study discipline: ethics is an approach to understanding, analyzing, and comparing right vs wrong. Ethical determinations are used through theories and codes of conduct. Ethical directives are not always evident, and some will disagree about what is right, and what is wrong. These fa

   4 min

3. 3

   Ethical Terminology

   Amoral: Refers to actions normally judged as immoral, but with lack of concern for outcomes/remorse.

   4 min

4. 4

   Beneficence: To take an action that benefits the welfare of another.

   Casuistry: An approach that is used to make decisions based on the analysis and evaluation of individual cases, such as landmark cases to which similar cases are compared for guidance. This approach is often used by healthcare ethics committees to analyze ethical issues ‘from the bottom up’ as oppos

   8 min

5. 5

   History of the Nurses Code of Ethics

   Professional nursing education began in the 1800’s at Florence Nightingale’s school in England, it focused on professions-shaping ethical concepts and values. Modern nursing was established at the end of the 1800’s, and during that time ethics became a major topic in nursing. In 1899, the Internatio

   4 min

6. 6

   1.1 Respect for Human Dignity

   Respect for the inherent dignity, unique attributes, worth, and human rights of all individuals are the core of the nursing practice. The nurse must support the right to dignity by respecting the values and needs of each individual that they encounter, whether that person is a colleague or a patient

   4 min

7. 7

   1.2 Relationships with Patients

   Nurses establish patient relationships of trust by setting aside all biases and prejudices while providing services. This trust includes respecting patient decisions and supporting patient choices. Factors such as culture, religious or spiritual beliefs, value systems, lifestyle, sexual orientation

   4 min

8. 8

   1.3 The Nature of Health

   Nurses assist patients in achieving the goal of living with the greatest sense of well-being possible. Nurses are leaders who help patients achieve the goal by optimizing the health and well-being of patients in their care and minimizing unwanted and unwarranted treatments and interventions regardle

   4 min

9. 9

   1.4 The Right to Self-Determination

   Respect for human dignity requires the recognition of specific patient rights, which include the right to self-determination. Patients have the legal and moral right to determine what will be done with and to their own body and to be given accurate, understandable, and complete information in a way

   4 min

10. 10

    1.5 Relationships with Colleagues and Others

    Nurses help build ethical, compassionate, and effective medical environments by maintaining respectful, professional, and caring relationships with colleagues and by collaborating with other healthcare providers to meet shared goals of providing compassionate, transparent, and effective health servi

    4 min

11. 11

    Provision 1 Case Study Example

    Mrs. Simpson is a 49-year-old who has stage IV lung cancer. Mrs. Simpson was diagnosed with lung cancer 12 months ago, and after receiving chemotherapy and surgical intervention, the cancer has aggressively returned. With the presence of the entire healthcare team, Mrs. Simpson was notified that her

    4 min

12. 12

    Provision 1 Case Study Example Response

    The Nurse assigned to Mrs. Simpson must follow the ANA code of ethics 1.4; The right to self-determination, which states in part ‘Patients have the legal and moral right to determine what will be done with and to their own body and to be given accurate, understandable, and complete information in a

    4 min

13. 13

    2.1 Primacy of the Patient’s Interests

    The nurse’s primary commitment is to the patient. Nurses provide patients with opportunities to participate in planning and implementing care and support and have honest discussions about treatment options. When the patient’s wishes conflict with family members, the nurse will help to resolve the co

    4 min

14. 14

    2.2 Conflict of Interest for Nurses

    Nurses can experience conflict from competing loyalties in the workplace. When a conflict occurs, nurses must examine the conflicts that arise between their own personal and professional values, the values of the patient, and the values of others who are also responsible for patient care and healthc

    4 min

15. 15

    2.4 Professional Boundaries

    Although the professional work of nursing is personal, nurses must recognize and maintain appropriate personal relationship boundaries. At their foundation, nurse-patient and nurse-colleague relationships promote, restore, and protect health. Nurses are responsible for maintaining professional bound

    4 min

16. 16

    Provision 2 Case Study Example

    Susan Wilson is a seasoned travel nurse who was recently hired in the Trauma Intensive Care Unit. Susan has extensive trauma experience, working in the emergency room, intensive care unit, and travel nursing. She began travel nursing after experiencing a tumultuous divorce. Three weeks ago, Charles

    4 min

17. 17

    Provision 2 Case Study Example Response

    According to the American Nurses Associations Code of Ethics with Interpretive Statements, Susan broke principles in provision 2.4 Professional Boundaries which states “Although the professional work of nursing is personal, nurses must recognize and maintain appropriate personal relationship boundar

    4 min

18. 18

    3.1 Protection of the Rights of Privacy and Confidentiality

    The need for health care does not justify unnecessary, unwanted, or unwarranted intrusion into one’s life. Privacy is described as the right to control access to, and disclosure or nondisclosure of, information pertaining to oneself and to control the timing, circumstances, and extent to which infor

    4 min

19. 19

    3.2 Protection of Human Participants in Research

    Stemming from the principle of respect for persons, autonomy, and respect for self-determination, people have the right to choose whether to participate in research as human subjects. Participants in research must be given enough information to make informed decisions, and to understand that they ha

    4 min

20. 20

    3.3 Performance Standards and Review Mechanisms

    The process of education is inherent to professional nursing. The process involves the ongoing development of knowledge, acquisition of skills, practice experiences, commitment, and personal integrity that is necessary for professional practice. Whether in academics or direct care settings, nurses m

    4 min

21. 21

    3.4 Professional Responsibility in Promoting a Culture of Safety

    Nurses must participate in the creation, implementation, and review of policies that emphasize patient health and safety and reduce errors. When a near miss or error occurs, the nurse must follow the institutional guidelines in reporting the event to the appropriate authority and ensure that the pat

    4 min

22. 22

    3.6 Patient Protection and Impaired Practice

    Nurses have an obligation to protect the patient, the public, and the profession from potential harm when another’s practice appears to be impaired. The nurse’s duty is to protect patients and to ensure that the impaired healthcare provider receives assistance. Assistance includes consulting supervi

    4 min

23. 23

    Provision 3 Case Study Example

    Jessica Robinson is a Nurse Practitioner in the emergency room. While working in triage, one of Jessica’s friends informs her that her sister-in-law is having severe abdominal pain and will arrive to the emergency room shortly. Upon arrival, Jessica evaluates the sister-in -law, prescribes medicatio

    4 min

24. 24

    Provision 3 Case Study Example Response

    Jessica must not divulge any information regarding the sister-in-law to her friend. Although the friend may have good intentions in providing health information to her brother, Jessica has an obligation to the sister-in-law and must follow the ANA Code of Ethics with interpretive statements provisio

    4 min

25. 25

    4.1 Authority, Accountability, and Responsibility

    The scope of nursing practice is continuously evolving. The nurse is responsible for the quality of nursing care that a patient receives and is accountable for their own practice. Nurses must exercise sound judgment when accepting responsibilities, seeking out consultation, and assigning activities

    4 min

26. 26

    4.2 Accountability for Nursing Judgments, Decisions, and Actions

    Nurses follow a code of ethical conduct that includes moral principles and adhere to the scope and standards of nursing practice. Every nurse is individually accountable for their own decisions made and actions taken. Systems and technologies that aide in clinical practice should not replace the nur

    4 min

27. 27

    4.3 Responsibility for Nursing Judgments, Decisions, and Actions

    Nurses are responsible for assessing their own competence and can accept or reject specific role demands and assignments based on their knowledge and experience, as well as their assessment for risk to patient safety. When the needs of the patient are beyond the competence of a nurse, the nurse has

    4 min

28. 28

    4.4 Assignment and Delegation of Nursing Activities or Tasks

    Nurses are responsible for the delegation of select nursing interventions and must make a reasonable effort to assess competence when delegating a nursing activity that is consistent with state practice acts. Nurses are also responsible for monitoring the activities delegated and evaluating the outc

    4 min

29. 29

    Provision 4 Case Study Example

    Judy Song is a new graduate RN who has just been hired to the Labor and Delivery unit. Judy has just arrived to work to start her first shift after orientation and proctorship. During her first rounds of assessments, Judy notices that one of her newborns has what she believes to be a heart murmur. J

    4 min

30. 30

    Provision 4 Case Study Example Response

    Judy’s decision making did not exemplify competence when caring for the newborn. Judy was unsure if she auscultated a heart murmur in the newborn, and instead of seeking consultation or guidance from a more experienced nurse or physician, she chose to ignore her assessments findings. Judy clearly di

    4 min

31. 31

    5.3 Preservation of Wholeness of Character

    Authentic expression of one’s own moral point of view is a duty to self. Sound ethical decision-making requires the respectful and open exchange of views between the nurse and anyone with relevant interests. As moral agents, nurses are an important part of the community and have an obligation to exp

    4 min

32. 32

    5.4 Preservation of Integrity

    Nurses must be treated with respect and should never tolerate abuse. In any healthcare environment, nurses can face threats to their integrity such as requests to deceive patients, to withhold information, or to falsify records. Expectations that nurses will make decisions that are inconsistent with

    4 min

33. 33

    5.5 Maintenance of Competence and Continuation of Professional Growth

    Nurses must maintain competence and strive for excellence in their nursing practice. Competence affects not only the quality of care that is rendered, but also one’s self-esteem, self-respect, and the meaningfulness of work. Nurses are responsible for developing criteria for practice evaluation, and

    4 min

34. 34

    Provision 5 Case Study Example

    Michael Davidson has been working in ICU for the last 5 years. Michael is interested in earning the CCRN certificate. After studying for 1 month, Michael took the test and successfully passed. He is excited for three reasons; he can now be nationally recognized as having the specialty certificate, h

    4 min

35. 35

    Provision 5 Case Study Example Response

    Yes, according to provision 5.5 Maintenance of Competence and Continuation of Professional Growth, Michael’s passing of the CCRN exam exemplified his competence in nursing practice. According to the code of ethics, “Nurses must maintain competence and strive for excellence in their nursing practice.

    4 min

36. 36

    6.1 The Environment and Moral Virtue

    Virtues are attributes of moral character, such as knowledge, skill, compassion, wisdom, patience, and honesty, that allow nurses to meet their own moral obligations and do what is right. These attributes describe a morally “good nurse.” For virtues to develop, they must be supported by a moral mili

    4 min

37. 37

    6.2 The Environment and Ethical Obligation

    Nurses must create a culture of excellence and maintain environments that support each other in the fulfillment of their ethical obligations. Many factors contribute to a healthcare environment that can either cause barriers or promote ethical practice, such as disciplinary procedures, ethics commit

    4 min

38. 38

    6.3 Responsibility for the Healthcare Environment

    Nurses must always be treated fairly and be allowed to be involved in decisions related to their practice and working conditions. Nurses are responsible for contributing to a moral environment that expects respectful interactions among colleagues and peers, and openly identifies difficult issues, in

    4 min

39. 39

    Provision 6 Case Study Example

    James Mickelson is an Oncology nurse new to the night shift. James is just finishing his last round of assessments on his patients prior to the change of shift handoff reports. While checking the infusion rates of his medications, James realizes that he administered antibiotics to the wrong patient.

    4 min

40. 40

    Provision 6 Cast Study Example Response

    Yes, James followed the Code of Ethics with Interpretive Statements according to the ANA, namely provision 6.2 The Environment and Ethical Obligation. This provision recognizes that “Many factors contribute to a healthcare environment that can either cause barriers or promote ethical practice, such

    4 min

41. 41

    7.1 Contributions through Research and Scholarly Inquiry

    Nursing knowledge contributes to the sciences and humanities through scholarly inquiry, clinical and educational innovation, and interprofessional collaboration. Nurses must participate in the advancement of the profession through knowledge development, application, and evaluation of practice. Knowl

    4 min

42. 42

    7.3 Contributions through Nursing and Health Policy Development

    Nurses must serve, mentor, and lead on institutional or agency policy committees within the practice setting. Nurses must also function as advocates or appointed representatives in civic activities related to health care through local, regional, state, national, or global initiatives and promote evi

    4 min

43. 43

    Provision 7 Case Study Example

    Lisa Stokes has a PH.D. in nursing and has conducted a vast amount of research on the geriatric population. Recently, she was asked to be a mentor for nursing research that focused on geriatric autonomy when accessing the healthcare system. Lisa has some ethical concerns about the research topic, su

    4 min

44. 44

    Provision 7 Case Study Review Response

    Yes, Lisa’s decision not to participate in the research is correct. According to the ANA Code of Ethics with Interpretive Statements 7.1 Contributions through Research and Scholarly Inquiry “Nurses engage in scholarly inquiry to increase knowledge that advances the theory and practice of the nursing

    4 min

45. 45

    8.1 Health Is a Universal Right

    Health is a universal human right, and the World Health Organization states “…the highest attainable standard of health is a fundamental right of every human being.” The right to health has economic, social, political, and cultural dimensions. It includes access to health care, emergency and trauma

    4 min

46. 46

    8.2 Collaboration for Health, Human Rights, and Health Diplomacy

    All nurses must commit to advancing health, safety, and welfare. This commitment reflects the nurse’s intent to achieve and maintain health so that individuals and communities can live with dignity. Ethics, nursing, and human rights converge as a formidable instrument for social health diplomacy and

    4 min

47. 47

    Provision 8 Case Study Example

    Ming Hua is a 7-year-old who is being discharged from the emergency room. Ming was originally brought to the emergency room by her mother who speaks little English. Ming’s mother brought Ming to the emergency room after Ming experienced one week of nausea, vomiting, and severe abdominal pain. During

    4 min

48. 48

    Provision 8 Case Study Example Review

    The nurse did not follow 8.1 Health Is a Universal Right which states in part “The right to health has economic, social, political, and cultural dimensions. It includes access to health care, emergency and trauma care, basic sanitation, education, treatment, and control of prevailing health problems

    4 min

49. 49

    9.1 Articulation and Assertion of Values

    Nurses are represented by their professional associations and organizations, and these groups give a united voice to the nursing profession. The nursing profession collectively has a responsibility to communicate and promote shared values both to the public and within the profession. It is essential

    4 min

50. 50

    9.2 Integrity of the Profession

    The ethics and values of the nursing profession should be declared in all professional and organizational relationships. The nursing profession must continually emphasize the values of fairness, respect, and caring within the nursing communities to promote health in the population. A fundamental res

    4 min

51. 51

    9.3 Integrating Social Justice

    It is the shared responsibility of professional nursing organizations to represent nurses and collectively shape health care and promulgate change for the improvement of health. Nurses must be vigilant recognizing the social determinants of health, and take action to influence leaders, legislators,

    4 min

52. 52

    9.4 Social Justice in Nursing and Health Policy

    The nursing profession must actively participate in solidarity with the global nursing community and health organizations to represent the voices of U.S. nurses around the world. Professional nursing organizations must actively participate in the political process, that affect the public’s health an

    4 min

53. 53

    Provision 9 Case Study Example

    Brandon Fisher has just been hired to work with the World Health Organization (WHO) as a public health nurse. His role in the new position will be to teach communities in India about HIV and AIDS prevention, transmission, and treatments. The new position is a lifelong dream of Brandon’s, and he beli

    4 min

54. 54

    Provision 9 Cast Study Example Review

    Brandon is abiding by provision 9.4 Social Justice in Nursing and Health Policy which states in part “The nursing profession must actively participate in solidarity with the global nursing community and health organizations to represent the voices of U.S. nurses around the world. Professional nursin

    4 min

55. 55

    International Council for Nurses: Code of Ethics for Nurses

    Inherent in nursing is a respect for human rights, that includes cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful and makes no considerations to age, race, creed, culture, disability or illness, gender, sexual orientation, nationali

    4 min

56. 56

    Discussion

    Common threads exist between the nine provisions of the ANA code (2015) and the four elements of the ICN code (2012). The codes, which apply to all nurses in all settings and roles, are nonnegotiable ethical nursing standards with a focus on social values, people, relationships, and professional ide

    4 min

57. 57

    Conclusion

    The ANA outlined 9 nonnegotiable provisions through nonnormative ethics and deontology that serves as the basis for the nurse’s ethical decision making. The first 3 provisions focus on the nurse-patient relationship, the second 3 provisions focus on the accountability of practice toward others, ones

    4 min

58. 58

    Ethics in Nursing Posttest

    Amoral refers to actions normally judged as immoral, but with lack of concern for outcomes/remorse.

    7 min

59. 59

    Ethics in Nursing Posttest Answers

    A philosophical study discipline, ethics is an approach to understanding, analyzing, and comparing right vs wrong. Ethical determinations are used through theories and codes of conduct.

    18 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• ANA. (2015). Code of Ethics for Nurses. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
• Bell, L. (2015). Code of Ethics for Nurses With Interpretive Statements. Critical Care Nurse, 35(4), 84-84. doi:10.4037/ccn2015639
• Butts, J. B., & Rich, K. L. (2020). Nursing Ethics: Across the Curriculum and Into Practice. Burlington, MA: Jones & Bartlett Learning.
• Clement, N. (2016). Code of Ethics and Professional Conduct. Essentials of Management of Nursing Service and Education, 620-620. doi:10.5005/jp/books/12694_69
• International Council for Nurses. (2012). The ICN code of ethics for nurses. Retrieved from https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf
• Olson, L. L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses With Interpretive Statements: Resource for Nursing Regulation. Journal of Nursing Regulation, 7(2), 9-20. doi:10.1016/s2155-8256(16)31073-0
• Scott, P. A. (2017). Key Concepts and Issues in Nursing Ethics. Basingstoke, England: Springer.
• Stievano, A., & Tschudin, V. (2019). The ICN code of ethics for nurses: a time for revision. Retrieved from https://onlinelibrary.wiley.com/doi/epdf/10.1111/inr.12525
• Tinnon, E., Masters, K., & Butts, J. (2018). A Pragmatic Approach to the Application of the Code of Ethics in Nursing Education. Nurse Educator, 43(1), 32-36. doi:10.1097/nne.0000000000000407

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