Ethical Principles in Nursing and Why They Matter

Nurses experience a unique power dynamic in the workplace. Patients, who are often sick or injured, rely on them for compassion and care, which is why it’s crucial for nurses to adhere to clear ethical principles. Reading about these principles of nursing is a great place to start, as all nurses who have a genuine desire to deliver the best care possible to patients and their families know these ethical principles very well and apply them in their work daily.

Studies have shown that nurses and patients alike benefit when nurses strictly abide by the Code of Ethics. A study published in the Journal of Advanced Nursing found that nurses who consistently followed the Nursing Code of Ethics reported better job satisfaction, which resulted in improved quality of patient care. Another study published in the Journal of Professional Nursing found that adherence to the Nursing Code of Ethics was associated with higher patient satisfaction and better communication between nurses and patients.

The Code of Ethics for Nurses with Interpretive Statements (referred to as “the Code”) is an official guide established by the American Nurses Association (ANA) that details nursing responsibilities as they relate to quality of nursing care and the ethical obligations of the profession. Particularly, it governs how nurses behave during the vulnerable moments when patients place their trust, their care, and perhaps even life and death decisions into a nurse’s hands. The Code is revised every decade to keep current with advances in healthcare and technology, greater understanding of global health, inclusivity, and the expansion of nursing into advanced practice roles. While all nurses learn the Code in their nursing education, it’s important to stay up to date on revisions over the years in order to maintain the highest quality of care in an evolving healthcare landscape. The high standards of ethical behavior are necessary because nurses are faced with ethical decisions daily and often walk a line between advocating for patients while also adhering to ethical nursing principles.

Nursing has four overarching ethical principles: autonomy, beneficence, justice, and non-maleficence. These principles provide guidance for nurses to navigate ethical dilemmas and make decisions that promote the well-being of their patients.

• Autonomy acknowledges a patient's right to make their own decisions about their healthcare based on their values and beliefs. Nurses must respect the autonomy of their patients by providing them with the information they need to make informed decisions about their healthcare, by respecting their decisions, and by advocating for their right to informed consent.
• Beneficence requires nurses to always act in the best interest of their patients. Nurses must use their knowledge, skills, and resources to provide high-quality care and promote the well-being of their patients. This may involve actions such as providing comfort and support, administering medication, or collaborating with other healthcare professionals to ensure optimal patient care.
• Justice emphasizes the importance of treating all patients fairly and impartially. Nurses must provide equal care to all patients, regardless of their background, race, gender, or social status. This may involve advocating for the rights of marginalized patients or addressing disparities in healthcare access and outcomes.
• Non-maleficence means "do no harm," which requires nurses to select interventions that are beneficial without causing harm to the patient. Nurses must be knowledgeable about the potential risks and benefits of any interventions they use and must take steps to minimize harm and maximize benefit for their patients. 

Together, these four ethical principles provide a framework for ethical nursing practice and guide nurses in their practice and the healthcare system as a whole.

In addition to the high-level ethical principles in nursing, nurses must also abide by the Code, which includes nine provisions. The provisions emphasize the importance of treating every person with compassion and respect, which is fundamental to the practice of nursing. By treating patients with dignity, nurses can build trusting relationships with their patients and deliver quality patient care.

1. The nurse practices with compassion and respect for every person's inherent dignity, worth, and unique attributes.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.
5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional growth.
6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality healthcare.
7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

When nurses apply ethical principles in their practice, they contribute to a universal standard for strong nurse-patient relationships, which is essential for collaboration in healthcare facilities and quality patient care. The Code of Ethics helps nurses navigate difficult situations and make decisions that are in the best interest of their patients. By following this compass, nurses can balance the need to provide optimal care with respecting the autonomy of patients, nurturing trust and respect between nurses and their patients.