Ethical Responsibilities of Nurses (2023)

Providing nursing care to patients of all ages invariably presents nurses with thorny ethical dilemmas lacking clear or easy resolution. As part of their training, nurses study the nonnegotiable Code of Ethics of the American Nurses Association, or ANA, to prepare them for difficult challenges ahead that may involve matters of life and death.

Nurses take their ethical responsibilities seriously, which has earned them public trust. A 2020 Gallup Poll ranked nursing as the most ethical and honest profession ahead of 15 other occupations including doctors, pharmacists, teachers, journalists, police officers and lawyers. Members of Congress and car salespeople tied for last place in this same poll.

Defining Nursing Ethics

Nursing ethics are core values, beliefs, principles and rules of conduct deemed essential to the practice of licensed nursing. Nurses rely on the ethical codes of their profession to help them resolve ethical dilemmas that surface in their daily work. Ethical choices are more complicated than moralistically discerning what’s right and wrong. An ethical dilemma occurs when a decision must be made in the face of competing ethical principles. For example, a nurse must consider whether to "do no harm" and pressure a young patient into continuing chemotherapy, or respect that patient’s autonomy to stop treatment and enter hospice care.

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History of Nursing Ethics

Written in 1893, the “Nightingale pledge” is a modified version of the Hippocratic Oath that doctors have recited for centuries, according to the Healthy Workforce Institute. The pledge is named after the founder of the American nursing profession, Florence Nightingale. Many nursing schools today still require graduating nurses to takes a modern version of the Nightingale pledge at their pinning ceremony to reinforce the ethical duties and principles that nurses must uphold to retain their license.

The American Nurses Association crafted a formal ethical code for nurses in the 1950s. Interpretive statements were later added to provide clarity. According to, nursing ethical standards of practice have implications for the legal responsibility of nurses. For example, unintended or malicious acts such as breaching confidentiality causing harm to the patient violates ethical standards of nursing care and data privacy laws of the Health Insurance Portability and Accountability Act, or HIPAA. The Code of Ethics for Nurses includes several provisions that are continually updated to reflect emerging issues and diverse perspectives.

Respect Autonomy

Ethical nurses understand and respect patient autonomy and the right to self-determination. They educate patients on health care conditions and disease progression to help them make informed decisions about their medical care. The nurse might suggest matters that patients may wish to discuss their doctor to better understand treatment options, risks and possible side effects. Respecting autonomy requires understanding the patient’s age, pain level, cultural background, spiritual beliefs and other factors that may influence the patient’s views and choices.

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Support Social Justice

Just and ethical nurses show utmost respect for the worth and dignity of all patients. They provide nonjudgmental, quality nursing care in any setting, as explained in “Nursing Ethical Considerations.” That same positive regard is extended to friends and family who are involved in the patient’s life. Ethical nurses believe in social justice and treating patients fairly. Illegal, discriminatory practices are not tolerated. They push for equitable health care delivery systems and advocate for health programs that reach underserved populations.

Act With Beneficence

A nurse is first and foremost an advocate for care that directly benefits the patient and supports recovery. When opinions of doctors, family members and social workers conflict, the nurse should bring the discussion back to the patient’s priorities and wishes. Ethical nurses understand that patients have the right to participate in treatment planning and implementation, assuming the patient is of sound mind to do so.

Refrain From Conflict of Interests

Core values of ethical nurses include honesty, integrity, trustworthiness, objectivity and impartiality. They do not compromise their professional standards for any reason. For example, the ethical responsibility of a nurse collecting forensic evidence is to take whatever time is needed to do the job right even if cases are piling up. Nurses also have an ethical duty to disclose a conflict of interest and remove themselves from situations if they cannot remain impartiality and fulfill their ethical obligations.

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Maintain Professional Boundaries

Nurses provide unwavering support and comfort to vulnerable patients who may experience long-term stays in nursing homes or hospitals. Patients and family often feel deeply grateful to a compassionate nurse and may offer inappropriate and excessive gifts like expensive jewelry. Patients may develop a strong attachment to a favorite nurse, or even romantic feelings. Ethical obligations in nursing require boundary setting in these foreseeable emotional situations by maintaining a warm but professional distance.

Do No Harm

Patient safety is a primary legal responsibility of nurses. The nurse is a mandatory reporter of suspected abuse or maltreatment of patients. Medication errors on the part of a nursing colleague must be reported to the supervisor. Nurses must also practice within the scope of their license. For example, an LPN must not perform RN duties just because the nursing facility is short-staffed. Similarly, an RN cannot administer treatments that are the responsibility of a nurse practitioner. A patient could be harmed by an unqualified nurse – or one who is impaired by drugs or alcohol – constituting a serious ethical violation on the part of the nurse.

Maintain Strict Confidentiality

Patience confidentiality is paramount in all health care fields, including nursing. A nurse is ethically obligated to know and follow state, federal and facility rules on handling confidential patient information and records. Medical records, charts, informed consent forms and patient disclosure forms must be securely maintained. Disclosure of private patient data is grounds for employment termination and legal penalties.

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Demonstrate Professionalism

A nurse is never done with education and training even after passing the NCLEX and obtaining a state nursing license. Nurses have an ethical duty to stay abreast of best practices and revised professional standards. Some states like California require 30 hours of continuing education be met to renew a nursing license. Continuing education requirements of each state's board of nursing can be found on the AAACEUs website.

Address Ethical Issues

Nurses have a responsibility to address ethical issues to protect the health and safety of patients. In addition to relying on their professional code of ethics, nurses can seek consultation when the best course of action is debatable. Many health care facilities have ethics committees that offer guidance to staff. offers steps that nurses can take to resolve ethical quandaries faced on the job. For example:

  1. Define the ethical dimensions of a problem.
  2. Look to professional codes, professional journals and published research for guidance.
  3. Apply ethical principles to the situation at hand.
  4. Generate possible solutions and consider the ramifications of each approach.
  5. Take action and evaluate results to improve future decision making.
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Nursing Education Requirements

Nursing students take foundational classes like anatomy, physiology and psychology along with nursing classes, including nursing ethics. They complete supervised clinical practicums in health care facilities to learn and practice nursing skills. Licensed practical nurse training typically lasts about one year, and RNs minimally need two years of schooling. Graduating nurses must pass a National Council Licensure Examination, or NCLEX, to receive a state nursing license. The U.S. Bureau of Labor Statistics reports that RNs earned a median annual salary of ​$75,330​ as of May 2020, while LPNs earned ​$48,820​, the BLS adds.


What are the 4 main ethical principles in nursing? ›

The American Nurses Association formally adopted the Code of Ethics for Nurses in 1950. There are four principles of ethics: autonomy in nursing, beneficence in nursing, justice in nursing and nonmaleficence in nursing. The Code of Ethics for Nurses has nine provisions.

What are the 7 nursing ethical principles? ›

The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.

What are the 10 nursing ethical values? ›

The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

What are the 9 code of ethics for nurses? ›

What Are The 7 Ethical Principles On Which The Nursing Code Of Ethics Is Based? The 7 ethical principles the Nursing Code of Ethics is based upon include beneficence, nonmaleficence, justice, accountability, autonomy, fidelity, and veracity.

What are the 5 code of ethics in nursing? ›

What are the five codes of ethics in nursing? The 5 nursing ethic codes are: nonmaleficence, beneficence, autonomy, justice, and privacy/confidentiality.

What are the 12 ethics? ›

Generally, there are about 12 ethical principles: honesty, fairness, leadership, integrity, compassion, respect, responsibility, loyalty, law-abiding, transparency, and environmental concerns.

What are the 8 major ethical principles? ›

This analysis focuses on whether and how the statements in these eight codes specify core moral norms (Autonomy, Beneficence, Non-Maleficence, and Justice), core behavioral norms (Veracity, Privacy, Confidentiality, and Fidelity), and other norms that are empirically derived from the code statements.

What are the top 5 ethical issues in healthcare? ›

5 Ethical Issues in Healthcare
  • Do-Not-Resuscitate Orders. ...
  • Doctor and Patient Confidentiality. ...
  • Malpractice and Negligence. ...
  • Access to Care. ...
  • Physician-Assisted Suicide.

What is ethics in nursing examples? ›

Ethical Principles in Nursing

Examples of nurses demonstrating this include obtaining informed consent from the patient for treatment, accepting the situation when a patient refuses a medication, and maintaining confidentiality.

What is a nurse's responsibility to a patient? ›

Nurses are responsible for recognizing patients' symptoms, taking measures within their scope of practice to administer medications, providing other measures for symptom alleviation, and collaborating with other professionals to optimize patients' comfort and families' understanding and adaptation.

What are the 6 main ethical principles? ›

The principles are beneficence, non-maleficence, autonomy, justice; truth-telling and promise-keeping.

What are basic ethics? ›

The expression "basic ethical principles" refers to those general judgments that serve as a justification for particular ethical prescriptions and evaluations of human actions.

What are the 3 major areas of ethics? ›

Normative Ethics, Metaethics and Applied Ethics.

What is a code of ethics in healthcare? ›

Code of Ethics for Healthcare Quality Professionals

A code of ethics clarifies roles and responsibilities within a profession and provides guidance to the professional for addressing common ethical questions.

What are some examples of ethics? ›

Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from rape, stealing, murder, assault, slander, and fraud. Ethical standards also include those that enjoin virtues of honesty, compassion, and loyalty.

What are the four main types of ethical codes? ›

The main types of codes of ethics include a compliance-based code of ethics, a value-based code of ethics, and a code of ethics among professionals. A focus on climate change has become an integral part of companies' codes of ethics, detailing their commitment to sustainability.

Why is ethics important in healthcare? ›

Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them.

What are nursing ethical dilemmas? ›

An ethical dilemma in nursing is a situation where a nurse must decide between competing values and know that no matter what choice they make, there are consequences. Ethical dilemmas may conflict with the nurse's personal values or with the Code of Ethics for Nurses.

How do nurses deal with ethical dilemmas? ›

Experts contacted for this article suggested several strategies organizations can implement to address ethical issues and reduce nurses' and other clinicians' moral distress:
  1. Support the nursing code of ethics. ...
  2. Offer ongoing education. ...
  3. Create an environment where nurses can speak up. ...
  4. Bring different disciplines together.
3 Mar 2014

› content › 3-principles-health... ›

The language of ethics related to healthcare, also commonly called bioethics, is applied across all practice settings, and four basic principles are commonly ac...
The ethical principles in nursing includes definitions of fidelity, beneficence, autonomy and integrity. Learn more about them.
7. Healthcare organizations that have nurses who exercise ethical nursing principles typically have higher patient satisfaction scores, higher employee satisfac...

What are the 4 principles in medical ethics explain each briefly? ›

Beneficence (doing good) Non-maleficence (to do no harm) Autonomy (giving the patient the freedom to choose freely, where they are able) Justice (ensuring fairness)

What are 4 ethical characteristics? ›

Pierce, Director of the Institute for National Security Ethics and Leadership, the most ethical organizations are the ones that are able to develop these four abilities in their employees: moral awareness, moral courage, moral reasoning and moral effectiveness.

What are the 4 elements of clinical nursing? ›

According to Wiedenbach there are four elements to clinical nursing: (1) philosophy, (2) purpose, (3) practice, and (4) art.

What are the 4 pillars of medical ethics? ›

There are four pillars of medical ethics which are defined as follows:
  • Autonomy – respect for the patient's right to self-determination.
  • Beneficence – the duty to 'do good'
  • Non-Maleficence – the duty to 'not do bad'
  • Justice – to treat all people equally and equitably.
1 Jul 2015

Why are ethical principles important in nursing? ›

The nursing code of ethics helps caregivers consider patient needs from several viewpoints and maintain a safe recovery environment. Ethical guidelines remind caregivers to treat all people equitably and individually, while protecting the privacy rights of patients in ways that may not seem overtly obvious.

What is an example of ethics in healthcare? ›

Ethical decision-making in healthcare.

For example, a patient may refuse care due to cultural/religious views, or may want an unnecessary treatment which may not be in his or her best interests; euthanasia is another example of a provider's sense of morals conflicting with his or her ethical obligations.

What is the most important ethical principle in healthcare? ›

Of the four principles of health care ethics, non-maleficence is the one that is generally the one most commonly prioritized. Non-maleficence means that you as a health care professional must do no harm.

What are the 3 major of ethics? ›

Ethics is traditionally subdivided into normative ethics, metaethics, and applied ethics.

What are the basic ethical? ›

The Fundamental Principles of Ethics. Beneficence, nonmaleficence, autonomy, and justice constitute the 4 principles of ethics. The first 2 can be traced back to the time of Hippocrates “to help and do no harm,” while the latter 2 evolved later.

What are some examples of ethics? ›

Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from rape, stealing, murder, assault, slander, and fraud. Ethical standards also include those that enjoin virtues of honesty, compassion, and loyalty.

What do the 4 P's stand for nursing? ›

It's based on the 4 P's of nursing: Pain, Potty, Position and Periphery.

What are the 8 guiding principles of healthcare ethics? ›

The final Washington e-Health Code of Ethics sets forth guiding principles under eight main headings: candor; honesty; quality; informed consent; privacy; professionalism in online health care; responsible partnering; and accountability.

What are the 4 A's in healthcare? ›

Perhaps a more reliable measure of the goodness of fit between provider and client is whether someone has a regular physician and a regular site of care, since it can be seen as reflecting availability, accessibility, accommodation, and acceptability.

Why is ethics important in healthcare? ›

Why is ethics important in the healthcare profession? Ethics is defined as the moral principles that govern a person's behavior, or how a profession conducts itself. Because healthcare deals with moral dilemmas regarding life and death, it requires a strong ethical code to provide guidance in making decisions.


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