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.

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 Nurse.org, 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.

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.

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.

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. RegisteredNursing.org offers steps that nurses can take to resolve ethical quandaries faced on the job. For example:

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.