Nursing code of ethics: all the things it’s essential know

The Code of Ethics lists nine provisions which are a part of a 64-page online document during which the ANA summarizes the duties, responsibilities and aspirations of thousands and thousands of nurses across the country. On its website, the organization emphasizes the importance of ethics in nursing, calling the code “the non-negotiable ethical standard of the profession.” “The code of ethics helps nurses by giving them a structure on how to take ownership of their nursing practice and also helps them make decisions based on what will provide the most optimal patient care,” said Emily Emma, ​​DNP, RN-BC , NEA-BC, Director of Magnet and Professional Practice at Stony Brook University Hospital (NY). Emma said the code is discussed in nursing school and the NCLEX-RN national licensing exam also includes questions on ethics.

“Having ethical principles in nursing really helps the nurse make the best, most moral decisions on behalf of herself as a doctor and for her patients,” she said.

The importance of ethics in nursing led the ANA to adopt the primary formal Code of Ethics in 1950, in accordance with Online journal of nursing issues (OJ). A decade later, the Code for Professional Nurses contained 17 provisions, which was later amended to 10 in 1968. According to OJIN, the code was frequently updated and was revised in 2015 when the ANA declared the “Year of Ethics” in efforts to lift awareness of nursing ethics within the career. “One of the things this does is support the overall professionalization of nursing,” said Dr. Eric Vogelstein, an associate professor and bioethicist at Duquesne University’s School of Nursing and Department of Philosophy. “It’s probably the one thing that separates a profession from a job or career. “Nursing is a profession, so they need to have that standard aspect of professionalization.” Nursing is distinguished by its long history of ethical guidelines. “Nursing places a special emphasis on ethics,” Vogelstein said. “As we know, nursing is consistently rated as the most trusted profession (in Gallup’s annual Integrity and Ethics Survey). This is primarily due to the fact that nursing has a strong connection with ethics, and the Code of Ethics serves society in this capacity as much as the profession of nursing itself. In 2015 presentationThe ANA explained that the first three provisions of the Code of Nursing Ethics concern direct patient care and describe the most fundamental values ​​and obligations of a nurse. Regulations include:

• Precept 1: The nurse acts with compassion and respect for the inherent dignity, worth, and unique qualities of each person.
• Precept 2: The nurse’s primary commitment is to the patient, whether the patient is an individual, family, group, community, or population.
• Rule 3: The nurse promotes, advocates for, and protects the patient’s rights, health, and safety.

In provisions 4-6, the ANA explains the boundaries and obligations of loyalty to nurses. Regulations include:

• Provision 4: The nurse has authority, responsibility and accountability for the practice of nursing; makes decisions; and takes action consistent with its obligation to promote health and provide optimal care.
• Provision 5: The nurse has the same responsibilities to self and others, including responsibility to promote health and safety, maintain integrity of character and integrity, maintain competence, and continue personal and professional development.
• Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves an ethical workplace environment and conditions of employment that are conducive to safe and high-quality health care.

According to the ANA, the three latest regulations focus on obligations beyond individual patient encounters.

• Provision 7: The nurse, regardless of role or setting, advances the profession through research and scholarship, the development of professional standards, and the creation of nursing and health policy.
• Provision 8: The nurse collaborates with other health care professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
• Article 9: The nursing profession, collectively through its professional organizations, must express nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

In addition to the nine principles, nurses can take guidance from four ethical principles – respect for autonomy, nonmaleficence, beneficence and justice – that optimize patient care and outcomes. Respect for autonomy demonstrates that patients have the ability to make their own decisions, while nonmaleficence is best described as “do no harm.” Beneficence in nursing means acting with compassion, and justice in nursing means treating patients fairly and impartially. Together, the Code of Ethics and the four ethical principles offer nurses a way to deal with difficult ethical decisions. “It provides guidance on what to do in a situation or dilemma where the nurse needs clarity,” Emma said. However, ethical decisions often haven’t any easy answers. “You can’t just look up the answer to a complicated ethical dilemma in the code and say, ‘Oh, that’s what I should do,’” Vogelstein said. “These principles should be applied. There are many justifications behind such cases. That’s why health care ethics is a solid area of ​​research and why I teach an entire class on it. The Code won’t solve the problem, but it will get me started.” The use of the code in nursing practice is not reserved only for extreme cases. “Ethical questions also arise in everyday life,” Vogelstein said. According to test in the Journal of Advanced Nursing, the most common ethical problems affecting nurses include:

• Protection of patients’ rights
• Autonomy and informed consent to treatment
• Violation of patient confidentiality or right to privacy
• Advanced care planning
• Surrogate decision making
• Decisions about the end and beginning of life
• Genetic testing and counseling
• Organ donation and transplantation
• Resource allocation
• Staffing patterns that negatively impact work

At Stony Brook, Emma said, “Most ethical dilemmas/ethics cases that nurses call have to do with the goals of patient care. This may be monitoring the patient’s pain level or discussing code status with the patient, family, and interprofessional teams after a poor prognosis. As the nurse provides continuity of patient care, it is important that the nurse feels empowered and supported by her patient. Ethics consultation provides her support.” Vogelstein said that in his graduate nursing classes, his students often demonstrate how much thought and reasoning they put into ethical dilemmas. “I have some assignments that require them to describe an ethical issue that has arisen in their practice,” he said. “You can see that they are just demanding to publish it. Some of them write twice or three times as much as the assignment requires.” Where can nurses turn when an ethical decision is made? According to Vogelstein, some people immediately engage a supervisor. Emma’s colleagues at Stony Brook can call an ethics consultant 24/7 with a member of the facility’s regulatory affairs department. “They will establish an institutional ethics committee composed of nursing staff and other interprofessional team members to help provide guidance,” she said. Ethics consultations and committees are often common in healthcare settings across the country. However, according to Vogelstein, these services are often underutilized. Some nurses “only call when things get tougher,” he said. “It would be worth a call [for an ethics consultation] before he gets there. It’s harder to figure it out later.”