As the most trusted professionals in the U.S. who regularly make critical decisions that can impact the life and death of their patients, nurses are in tremendous positions of power. But with this power, there are significant obligations and responsibilities.
“Real-world health care practice is complicated, and nurses find themselves facing ethical dilemmas on a regular basis,” says Elaina Mahlan, MSN, faculty member of Purdue Global’s School of Nursing. “These issues are not always black and white.”
When faced with these kinds of tough decisions, nurses need a lodestar — something that all nurses can use to guide them toward ethical decisions that are consistent across the profession. That’s where the nursing code of ethics comes into play.
The American Nurses Association (ANA) first developed its Code of Ethics for Nurses in the 1950s to serve as “a moral compass to promote high levels of care, an ethical standard for those entering the nursing profession, and a commitment to society affirming the responsibilities of the registered nurse.” Since that time, it’s been consistently updated and revised to reflect advances in nursing, society, and technology.
The ANA has summarized the major tenets of the nursing code of ethics into four principles:
- Autonomy
- Beneficence
- Justice
- Nonmaleficence
To this list, Mahlan recommends adding three more principles:
- Accountability
- Fidelity
- Veracity
“Nurses have to rely on these principles not only to achieve the best and most ethical outcomes but also to prevent the health care system from collapsing because nobody trusts it,” Mahlan says. “This ethical principle framework helps them to make ethical decisions, but it also relieves them as a human being from ethical distress.”
While there are seven core principles, most of them can be considered in pairs as they complement each other, while the final principle — justice — is the ethical umbrella that covers the rest.
Beneficence and Nonmaleficence
Beneficence and nonmaleficence are two sides of the same coin. At their basic level, beneficence is doing good, while nonmaleficence is doing no harm. When applied to ethics in nursing, this means nurses should offer kindness while using care to do no harm.
“Beneficence is the very essence of nursing,” Mahlan says. “Caring for others is what calls people to the profession to begin with.”
A beneficent nurse is one who considers the patient’s best interest. This could include providing medications in a timely manner, offering comfort to a dying patient and their loved ones, or even just providing a listening ear.
A nurse who embodies nonmaleficence, meanwhile, works to minimize harm, ensuring they make every effort to keep patients safe and improve patient outcomes. Examples include reporting or fixing safety hazards in the clinic, withholding medication due to adverse reactions, or pausing a treatment strategy that seems to be causing the patient more harm than good.
Autonomy and Accountability
In regard to nursing ethics, autonomy has a couple of meanings. Autonomy is the need for nurses to be able to act independently within the scope of their practice. It also refers to the duty of the nurse to provide enough information to the patient so that they can make their own decisions.
For example, if the patient gets all of the information on an approved treatment plan and decides not to move forward because of their own beliefs and values, they have the autonomy to do so, no matter what the nurse would do in their situation.
On the other hand, a nurse may decide to temporarily withhold an order that they've received from a physician if they see something within that order that doesn't make sense to them.
“I have to be able to act independently as an autonomous professional and require my other health care partners to clarify the treatment plan,” says Mahlan. “There could be errors in the system or a miscommunication. But I need to be able to say, ‘Something doesn’t seem right here, so we need a timeout.’”
But one can’t have autonomy without also being held accountable for their actions and decisions.
“One of the first things that you learn in nursing school is if you’re asked why you’re doing something, you may never answer, ‘Because the doctor ordered it,’” Mahlan says. “It may be true, of course, but it's not an acceptable answer because to be accountable, you have to understand what you’re doing and why — as well as the ramifications of that decision.”
Fidelity and Veracity
In order for autonomy and accountability to work, nurses must be trusted by both the public and their interprofessional colleagues. This is where fidelity and veracity come into play.
Fidelity is keeping your word to your patients, while veracity is being open and honest with them — even if the truth is difficult to hear.
For example, you told a patient that you would call them with their treatment options, but none of the options have a completely ideal outcome. Still, you call them at the scheduled time and explain everything in detail so they can make an informed decision.
In this case, you kept your word about calling the patient with their treatment options despite knowing it would be an uncomfortable conversation. You were also completely honest with them about the outcomes of those options, even though none of them were ideal.
Justice
Justice is the ethical principle that says what you do as a nurse, you are going to do impartially and without favoritism. That means being impartial about a patient’s ethnicity, religion, age, economic status, or sexual orientation. It also means making decisions without respect to who your employer is or who is funding the research.
“Let's say you’re a nurse manager. If you show favoritism among members of your staff, such as with rewards and benefits or disciplinary actions in the workplace, you are not operating under the ethical principle of justice,” says Mahlan.
When it comes to patient care, justice could also be advocating for a patient who may need extra assistance due to a disability or economic hardship.
“Justice is a component of equity and inclusion because justice is blind,” Mahlan says. “All of the prior six ethical principles have to operate like justice with the same impartiality. Nurses serve people equitably in a way that does the most good.”
Bolster Your Nursing Career With a Degree from Purdue Global
“Year after year for decades now, a Gallup Poll on the most trusted professions places nurses at the top,” Mahlan says. “It's critical that the profession doesn't rest on those laurels; we have to continuously nurture that trust by questioning how we’re conducting ourselves.
“We can't afford to give up protecting that trust because once it’s gone, it's extremely hard to rebuild,” she says.
If you’re ready to take your nursing career to the next level while helping to further the nation’s trust in the profession, consider an online nursing degree or certificate from Purdue Global. Our nursing programs include an online RN-to-BSN degree and an online MSN degree. Request information about our online programs today.
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