Professional Documents
Culture Documents
Code of Ethics
for Nurses
with Interpretive Statements
CONTENTS
2001 Edition
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Code of Ethics
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for Nurses
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174’.2–dc21
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2001046340
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The American Nurses Association (ANA) is a national professional association. ANA’s Code of Ethics for
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Nurses and the accompanying Interpretive Statements reflect the thinking of the nursing profession
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on various issues and should be reviewed in conjunction with state board of nursing policies and
practices. State law, rules, and regulations govern the practice of nursing, while the Code of Ethics
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guides nurses in the application of their professional skills and personal responsibilities.
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Published by Nursesbooks.org
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1-800-274-4ANA
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www.Nursingworld.org
The American Nurses Association (ANA) is the only full-service professional organization representing
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the interests of the nation’s 3.1 million registered nurses through its constituent member nurses as-
sociations and its organizational affiliates. The ANA advances the nursing profession by fostering high
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standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive
and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care
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©2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or
utilized in any form or any means, electronic or mechanical, including photocopying and recording, or
by any information storage and retrieval system, without permission in writing from the publisher.
First eBook publication, January 2011.* (First paper publication, August 2001.)
* This eBook is derived from the December 2010 reprinting, which was re-typeset with a new cover
and an expanded index. All other content other than this page is unchanged from that which was first
published in August 2001 and subsequent reprints.
CONTENTS
Acknowledgments
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Members of the Code of Ethics
Project Task Force
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Barbara Daly, PhD, RN (Chairperson)
Elaine Connolly, MS, RN, ANA (Board of Directors)
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Theresa Drought, PhD, RN
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ANA Staff
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Angela Thompson
Ethics Coordinator (1997–2001)
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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CONTENTS
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
CONTENTS
Contents
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Code of Ethics for Nurses 7
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Preface 9
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Provision 1 11
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1.1 Respect for human dignity
1.2 Relationships to patients
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1.3 The nature of health problems
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Provision 2 14
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2.3 Collaboration
2.4 Professional boundaries
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Provision 3 16
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3.1 Privacy
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3.2 Confidentiality
3.3 Protection of participants in research
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Provision 4 21
4.1 Acceptance of accountability and responsibility
4.2 Accountability for nursing judgment and action
4.3 Responsibility for nursing judgment and action
4.4 Delegation of nursing activities
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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CONTENTS
Provision 5 23
5.1 Moral self-respect
5.2 Professional growth and maintenance of competence
5.3 Wholeness of character
5.4 Preservation of integrity
Provision 6 25
6.1 Influence of the environment on moral virtues and values
6.2 Influence of the environment on ethical obligations
6.3 Responsibility for the healthcare environment
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Provision 7 27
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7.1 Advancing the profession through active involvement in nursing
and in healthcare policy
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7.2 Advancing the profession by developing, maintaining, and
implementing professional standards in clinical, administrative, and
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educational practice
7.3 Advancing the profession through knowledge development,
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Provision 8 28
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Provision 9 29
9.1 Assertion of values
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professional associations
9.3 Intraprofessional integrity
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Afterword 31
Timeline: 33
The Evolution of Nursing’s Code of Ethics
Index 35
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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CONTENTS
Code of Ethics
for Nurses
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Provision 1
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The nurse, in all professional relationships, practices with compassion and respect
for the inherent dignity, worth and uniqueness of every individual, unrestricted by
considerations of social or economic status, personal attributes, or the nature of As
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health problems.
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Provision 2
The nurse’s primary commitment is to the patient, whether an individual, family,
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group or community.
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Provision 3
The nurse promotes, advocates for and strives to protect the health, safety and
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Provision 4
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The nurse is responsible and accountable for individual nursing practice and deter-
mines the appropriate delegation of tasks consistent with the nurse’s obligation to
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Provision 5
The nurse owes the same duties to self as to others, including the responsibility
to preserve integrity and safety, to maintain competence and to continue personal
and professional growth.
Provision 6
The nurse participates in establishing, maintaining and improving healthcare
environments and conditions of employment conducive to the provision of qual-
ity health care and consistent with the values of the profession through individual
and collective action.
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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CONTENTS
Code of Ethics For Nurses
Provision 7
The nurse participates in the advancement of the profession through contributions
to practice, education, administration, and knowledge development.
Provision 8
The nurse collaborates with other health professionals and the public in promoting
community, national, and international efforts to meet health needs.
Provision 9
The profession of nursing, as represented by associations and their members, is
responsible for articulating nursing values, for maintaining the integrity of the
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profession and its practice and for shaping social policy.
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Preface
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Ethics is an integral part of the foundation of nursing. Nursing has a distinguished
history of concern for the welfare of the sick, injured, and vulnerable and for social
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justice. This concern is embodied in the provision of nursing care to individuals
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and the community. Nursing encompasses the prevention of illness, the allevia-
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tion of suffering, and the protection, promotion, and restoration of health in the
care of individuals, families, groups, and communities. Nurses act to change those
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aspects of social structures that detract from health and well-being. Individuals who
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become nurses are expected not only to adhere to the ideals and moral norms of
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the profession but also to embrace them as a part of what it means to be a nurse.
The ethical tradition of nursing is self-reflective, enduring, and distinctive. A code
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of ethics makes explicit the primary goals, values, and obligations of the profession.
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to society.
There are numerous approaches for addressing ethics; these include adopting
or subscribing to ethical theories, including humanist, feminist, and social eth-
ics, adhering to ethical principles, and cultivating virtues. The Code of Ethics for
Nurses reflects all of these approaches. The words “ethical” and “moral” are used
throughout the Code of Ethics. “Ethical” is used to refer to reasons for decisions
about how one ought to act, using the above mentioned approaches. In general,
the word “moral” overlaps with “ethical” but is more aligned with personal belief
and cultural values. Statements that describe activities and attributes of nurses in
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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CONTENTS
PReface
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policy developer, or other. Thus, the values and obligations expressed in this Code
of Ethics apply to nurses in all roles and settings.
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The Code of Ethics for Nurses is a dynamic document. As nursing and its
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social context change, changes to the Code of Ethics are also necessary. The Code
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of Ethics consists of two components: the provisions and the accompanying
interpretive statements. There are nine provisions. The first three describe the
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most fundamental values and commitments of the nurse; the next three address
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boundaries of duty and loyalty, and the last three address aspects of duties beyond
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individual patient encounters. For each provision, there are interpretive statements
that provide greater specificity for practice and are responsive to the contemporary
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nurses to use in ethical analysis and decision-making. The Code of Ethics estab-
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lishes the ethical standard for the profession. It is not negotiable in any setting nor
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ethical heritage of nursing, a guide for nurses now and in the future.
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Code of Ethics
for Nurses with
Interpretive Statements
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Provision 1
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ent worth, dignity, and human rights of every individual. Nurses take into account
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The need for health care is universal, transcending all individual differences.
The nurse establishes relationships and delivers nursing services with respect for
human needs and values, and without prejudice. An individual’s lifestyle, value
system and religious beliefs should be considered in planning health care with and
for each patient. Such consideration does not suggest that the nurse necessarily
agrees with or condones certain individual choices, but that the nurse respects
the patient as a person.
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
11
CONTENTS
Provision 1
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care aims to maximize the values that the patient has treasured in life and extends
supportive care to the family and significant others. Nursing care is directed toward
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meeting the comprehensive needs of patients and their families across the con-
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tinuum of care. This is particularly vital in the care of patients and their families
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at the end of life to prevent and relieve the cascade of symptoms and suffering that
are commonly associated with dying.
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Nurses are leaders and vigilant advocates for the delivery of dignified and
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humane care. Nurses actively participate in assessing and assuring the respon-
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hydration, aggressive pain and symptom management and advance directives are
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increasingly evident. The nurse should provide interventions to relieve pain and
other symptoms in the dying patient even when those interventions entail risks
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of hastening death. However, nurses may not act with the sole intent of ending a
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patient’s life even though such action may be motivated by compassion, respect for
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patient autonomy and quality of life considerations. Nurses have invaluable expe-
rience, knowledge, and insight into care at the end of life and should be actively
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burdens, and available options in their treatment, including the choice of no treat-
ment; to accept, refuse, or terminate treatment without deceit, undue influence,
duress, coercion, or penalty; and to be given necessary support throughout the
decision-making and treatment process. Such support would include the oppor-
tunity to make decisions with family and significant others and the provision of
advice and support from knowledgeable nurses and other health professionals.
Patients should be involved in planning their own health care to the extent they
are able and choose to participate.
Each nurse has an obligation to be knowledgeable about the moral and legal
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rights of all patients to self-determination. The nurse preserves, protects, and
supports those interests by assessing the patient’s comprehension of both the
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information presented and the implications of decisions. In situations in which
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the patient lacks the capacity to make a decision, a designated surrogate decision-
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maker should be consulted. The role of the surrogate is to make decisions as the
patient would, based upon the patient’s previously expressed wishes and known
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values. In the absence of a designated surrogate decision-maker, decisions should be
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made in the best interests of the patient, considering the patient’s personal values
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to the extent that they are known. The nurse supports patient self-determination
by participating in discussions with surrogates, providing guidance and referral
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recognition that people of some cultures place less weight on individualism and
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nizes that there are situations in which the right to individual self-determination
may be outweighed or limited by the rights, health and welfare of others, particu-
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Provision 2
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The nurse’s primary commitment is to the patient,
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whether an individual, family, group, or community.
of the plan. Addressing patient interests requires recognition of the patient’s place
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in the family or other networks of relationship. When the patient’s wishes are in
conflict with others, the nurse seeks to help resolve the conflict. Where conflict
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economic self-interest and professional integrity. The use of bonuses, sanctions, and
incentives tied to financial targets are examples of features of healthcare systems
that may present such conflict. Conflicts of interest may arise in any domain of
nursing activity including clinical practice, administration, education, or research.
Advanced practice nurses who bill directly for services and nursing executives with
budgetary responsibilities must be especially cognizant of the potential for conflicts
of interest. Nurses should disclose to all relevant parties (e.g., patients, employers,
colleagues) any perceived or actual conflict of interest and in some situations should
withdraw from further participation. Nurses in all roles must seek to ensure that
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employment arrangements are just and fair and do not create an unreasonable
conflict between patient care and direct personal gain.
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2.3 Collaboration
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Collaboration is not just cooperation, but it is the concerted effort of individu-
als and groups to attain a shared goal. In health care, that goal is to address the
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health needs of the patient and the public. The complexity of healthcare delivery
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the strong support and active participation of all the health professions. Within
this context, nursing’s unique contribution, scope of practice, and relationship with
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among the healthcare team, shared decision-making about patient care, and
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open dialogue among all parties who have an interest in and a concern for health
outcomes. Nurses should work to assure that the relevant parties are involved
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and have a voice in decision-making about patient care issues. Nurses should see
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that the questions that need to be addressed are asked and that the information
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the availability and accessibility of quality health services to all persons who have
needs for health care.
Intra-professional collaboration within nursing is fundamental to effectively
addressing the health needs of patients and the public. Nurses engaged in non-
clinical roles, such as administration or research, while not providing direct care,
nonetheless are collaborating in the provision of care through their influence and
direction of those who do. Effective nursing care is accomplished through the
interdependence of nurses in differing roles—those who teach the needed skills, set
standards, manage the environment of care, or expand the boundaries of knowl-
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
edge used by the profession. In this sense, nurses in all roles share a responsibility
for the outcomes of nursing care.
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health of patients. In this way, nurse-patient and nurse-colleague relationships
differ from those that are purely personal and unstructured, such as friendship.
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The intimate nature of nursing care, the involvement of nurses in important and
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sometimes highly stressful life events, and the mutual dependence of colleagues
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working in close concert all present the potential for blurring of limits to pro-
fessional relationships. Maintaining authenticity and expressing oneself as an
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individual, while remaining within the bounds established by the purpose of the
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all encounters, nurses are responsible for retaining their professional boundaries.
When those professional boundaries are jeopardized, the nurse should seek assis-
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Provision 3
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3.1 Privacy
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The nurse safeguards the patient’s right to privacy. The need for health care does
not justify unwanted intrusion into the patient’s life. The nurse advocates for an
environment that provides for sufficient physical privacy, including privacy for
discussions of a personal nature and policies and practices that protect the confi-
dentiality of information.
3.2 Confidentiality
Associated with the right to privacy, the nurse has a duty to maintain confidenti-
ality of all patient information. The patient’s well-being could be jeopardized and
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
the fundamental trust between patient and nurse destroyed by unnecessary access
to data or by the inappropriate disclosure of identifiable patient information. The
rights, well-being, and safety of the individual patient should be the primary factors
in arriving at any professional judgment concerning the disposition of confidential
information received from or about the patient, whether oral, written or electronic.
The standard of nursing practice and the nurse’s responsibility to provide quality
care require that relevant data be shared with those members of the healthcare
team who have a need to know. Only information pertinent to a patient’s treatment
and welfare is disclosed, and only to those directly involved with the patient’s care.
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Duties of confidentiality, however, are not absolute and may need to be modified
in order to protect the patient, other innocent parties, and in circumstances of
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mandatory disclosure for public health reasons.
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Information used for purposes of peer review, third-party payments, and other
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quality improvement or risk management mechanisms may be disclosed only under
defined policies, mandates, or protocols. These written guidelines must assure
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that the rights, well-being, and safety of the patient are protected. In general, only
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Stemming from the right to self-determination, each individual has the right to
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the patient should be informed of how the data will be protected. The patient has
the right to refuse to participate in research or to withdraw at any time without
fear of adverse consequences or reprisal.
Research should be conducted and directed only by qualified persons. Prior to
implementation, all research should be approved by a qualified review board to
ensure patient protection and the ethical integrity of the research. Nurses should
be cognizant of the special concerns raised by research involving vulnerable groups,
including children, prisoners, students, the elderly, and the poor. The nurse who
participates in research in any capacity should be fully informed about both the
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
subject’s and the nurse’s rights and obligations in the particular research study
and in research in general. Nurses have the duty to question and, if necessary, to
report and to refuse to participate in research they deem morally objectionable.
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ensure that basic competencies are achieved and to promote a commitment to
professional practice prior to entry of an individual into practice. Nurse admin-
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istrators are responsible for assuring that the knowledge and skills of each nurse
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in the workplace are assessed prior to the assignment of responsibilities requiring
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preparation beyond basic academic programs.
The nurse has a responsibility to implement and maintain standards of profes-
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sional nursing practice. The nurse should participate in planning, establishing,
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must ensure that nurses have access to and inclusion on institutional ethics
committees. Nurses must bring forward difficult issues related to patient care
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and/or institutional constraints upon ethical practice for discussion and review.
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errors, and address both environmental system factors and human factors that
present increased risk to patients. In addition, when errors do occur, nurses
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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federal, state and local laws and regulations, and the employing organization’s
policies and procedures.
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When the nurse is aware of inappropriate or questionable practice in the provi-
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sion or denial of health care, concern should be expressed to the person carrying
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out the questionable practice. Attention should be called to the possible detrimen-
tal affect upon the patient’s well-being or best interests as well as the integrity of
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nursing practice. When factors in the healthcare delivery system or healthcare
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organization threaten the welfare of the patient, similar action should be directed
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unethical, illegal, or impaired practice within the employment setting so that such
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reporting can go through official channels, thereby reducing the risk of reprisal
against the reporting nurse. All nurses have a responsibility to assist those who
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jeopardize patient well-being and safety, the problem should be reported to other
appropriate authorities such as practice committees of the pertinent professional
organizations, the legally constituted bodies concerned with licensing of specific
categories of health workers and professional practitioners, or the regulatory agen-
cies concerned with evaluating standards or practice. Some situations may warrant
the concern and involvement of all such groups. Accurate reporting and factual
documentation, and not merely opinion, undergird all such responsible actions.
When a nurse chooses to engage in the act of responsible reporting about situations
that are perceived as unethical, incompetent, illegal, or impaired, the professional
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
organization has a responsibility to provide the nurse with support and assistance
and to protect the practice of those nurses who choose to voice their concerns.
Reporting unethical, illegal, incompetent, or impaired practices, even when done
appropriately, may present substantial risks to the nurse; nevertheless, such risks
do not eliminate the obligation to address serious threats to patient safety.
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The nurse extends compassion and caring to colleagues who are in recovery from
illness or when illness interferes with job performance. In a situation where a
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nurse suspects another’s practice may be impaired, the nurse’s duty is to take action
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designed both to protect patients and to assure that the impaired individual receives
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assistance in regaining optimal function. Such action should usually begin with
consulting supervisory personnel and may also include confronting the individual
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in a supportive manner and with the assistance of others or helping the individual
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by personal circumstances. Nurses in all roles should advocate for colleagues whose
job performance may be impaired to ensure that they receive appropriate assis-
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tance, treatment and access to fair institutional and legal processes. This includes
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supporting the return to practice of the individual who has sought assistance and
is ready to resume professional duties.
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whether the individual has sought help, the nurse must take action to report the
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from negative consequences. Advocacy may be a difficult process and the nurse
is advised to follow workplace policies. If workplace policies do not exist or are
inappropriate—that is, they deny the nurse in question access to due legal process
or demand resignation—the reporting nurse may obtain guidance from the profes-
sional association, state peer assistance programs, employee assistance program
or a similar resource.
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Provision 4
The nurse is responsible and accountable for individual nursing
practice and determines the appropriate delegation of tasks
consistent with the nurse’s obligation to provide optimum patient care
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responsibilities such as teaching, research, and administration. In each instance,
the nurse retains accountability and responsibility for the quality of practice and
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for conformity with standards of care.
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Nurses are faced with decisions in the context of the increased complexity and
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changing patterns in the delivery of health care. As the scope of nursing practice
changes, the nurse must exercise judgment in accepting responsibilities, seeking con-
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sultation, and assigning activities to others who carry out nursing care. For example,
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some advanced practice nurses have the authority to issue prescription and treatment
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orders to be carried out by other nurses. These acts are not acts of delegation. Both
the advanced practice nurse issuing the order and the nurse accepting the order are
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responsible for the judgments made and accountable for the actions taken.
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Accountability means to be answerable to oneself and others for one’s own actions.
In order to be accountable, nurses act under a code of ethical conduct that is
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grounded in the moral principles of fidelity and respect for the dignity, worth, and
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by those whom they supervise and instruct. The nurse must not engage in prac-
tices prohibited by law or delegate activities to others that are prohibited by the
practice acts of other healthcare providers.
Individual nurses are responsible for assessing their own competence. When
the needs of the patient are beyond the qualifications and competencies of the
nurse, consultation and collaboration must be sought from qualified nurses, other
health professionals, or other appropriate sources. Educational resources should
be sought by nurses and provided by institutions to maintain and advance the
competence of nurses. Nurse educators act in collaboration with their students to
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assess the learning needs of the student, the effectiveness of the teaching program,
the identification and utilization of appropriate resources, and the support needed
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for the learning process.
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4.4 Delegation of nursing activities
Since the nurse is accountable for the quality of nursing care given to patients,
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nurses are accountable for the assignment of nursing responsibilities to other nurses
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and the delegation of nursing care activities to other healthcare workers. While
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delegation and assignment are used here in a generic moral sense, it is understood
that individual states may have a particular legal definition of these terms.
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ers. This assessment involves evaluating the knowledge, skills, and experience of
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the individual to whom the care is assigned, the complexity of the assigned tasks,
and the health status of the patient. The nurse is also responsible for monitoring
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the activities of these individuals and evaluating the quality of the care provided.
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Nurses may not delegate responsibilities such as assessment and evaluation; they
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may delegate tasks. The nurse must not knowingly assign or delegate to any mem-
ber of the nursing team a task for which that person is not prepared or qualified.
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Employer policies or directives do not relieve the nurse of responsibility for making
judgments about the delegation and assignment of nursing care tasks.
Nurses functioning in management or administrative roles have a particular
responsibility to provide an environment that supports and facilitates appropriate
assignment and delegation. This includes providing appropriate orientation to staff,
assisting less experienced nurses in developing necessary skills and competencies, and
establishing policies and procedures that protect both the patient and nurse from the
inappropriate assignment or delegation of nursing responsibilities, activities, or tasks.
Nurses functioning in educator or preceptor roles may have less direct rela-
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Provision 5
The nurse owes the same duties to self as to others, including
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the responsibility to preserve integrity and safety, to maintain
competence, and to continue personal and professional growth.
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5.1 Moral self-respect
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Moral respect accords moral worth and dignity to all human beings irrespective of
their personal attributes or life situation. Such respect extends to oneself as well;
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the same duties that we owe to others we owe to ourselves. Self-regarding duties
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refer to a realm of duties that primarily concern oneself and include professional
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ing professional growth involves the control of one’s own conduct in a way that is
primarily self-regarding. Competence affects one’s self-respect, self-esteem, pro-
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fessional status, and the meaningfulness of work. In all nursing roles, evaluation
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of one’s own performance, coupled with peer review, is a means by which nursing
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practice can be held to the highest standards. Each nurse is responsible for par-
ticipating in the development of criteria for evaluation of practice and for using
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express moral perspectives, even when they differ from those of others, and even
when they might not prevail.
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This wholeness of character encompasses relationships with patients. In situ-
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ations where the patient requests a personal opinion from the nurse, the nurse is
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generally free to express an informed personal opinion as long as this preserves
the voluntariness of the patient and maintains appropriate professional and moral
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boundaries. It is essential to be aware of the potential for undue influence attached
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to the nurse’s professional role. Assisting patients to clarify their own values in
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ents the nurse with particularly troubling threats to integrity. Threats to integrity
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also may include an expectation that the nurse will act in a way that is inconsistent
with the values or ethics of the profession, or more specifically a request that is in
direct violation of the Code of Ethics. Nurses have a duty to remain consistent with
both their personal and professional values and to accept compromise only to the
degree that it remains an integrity-preserving compromise. An integrity-preserving
compromise does not jeopardize the dignity or well-being of the nurse or others.
Integrity-preserving compromise can be difficult to achieve, but is more likely to
be accomplished in situations where there is an open forum for moral discourse
and an atmosphere of mutual respect and regard.
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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against formal or informal penalty. The nurse who decides not to take part on the
grounds of conscientious objection must communicate this decision in appropriate
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ways. Whenever possible, such a refusal should be made known in advance and in
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time for alternate arrangements to be made for patient care. The nurse is obliged to
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provide for the patient’s safety, to avoid patient abandonment, and to withdraw only
when assured that alternative sources of nursing care are available to the patient.
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Where patterns of institutional behavior or professional practice compromise
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the integrity of all its nurses, nurses should express their concern or conscientious
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Provision 6
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values central to nursing. Both virtues and excellences, as aspects of moral char-
acter, can be either nurtured by the environment in which the nurse practices or
they can be diminished or thwarted. All nurses have a responsibility to create,
maintain, and contribute to environments that support the growth of virtues and
excellences and enable nurses to fulfill their ethical obligations.
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obligations. Environments of practice include observable features, such as working
conditions, and written policies and procedures setting out expectations for nurses,
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as well as less tangible characteristics such as informal peer norms. Organizational
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structures, role descriptions, health and safety initiatives, grievance mechanisms,
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ethics committees, compensation systems, and disciplinary procedures all con-
tribute to environments that can either present barriers or foster ethical practice
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and professional fulfillment. Environments in which employees are provided fair
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and are justly treated allow for the realization of the values of the profession and
are consistent with sound nursing practice.
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to assure that employees are treated fairly and that nurses are involved in deci-
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sions related to their practice and working conditions. Acquiescing and accepting
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unsafe or inappropriate practices, even if the individual does not participate in the
specific practice, is equivalent to condoning unsafe practice. Nurses should not
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remain employed in facilities that routinely violate patient rights or require nurses
to severely and repeatedly compromise standards of practice or personal morality.
As with concerns about patient care, nurses should address concerns about the
healthcare environment through appropriate channels. Organizational changes are
difficult to accomplish and may require persistent efforts over time. Toward this
end, nurses may participate in collective action such as collective bargaining or
workplace advocacy, preferably through a professional association such as the state
nurses association, in order to address the terms and conditions of employment.
Agreements reached through such action must be consistent with the profession’s
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
standards of practice, the state law regulating practice, and the Code of Ethics for
Nurses. Conditions of employment must contribute to the moral environment, the
provision of quality patient care and professional satisfaction for nurses.
The professional association also serves as an advocate for the nurse by seek-
ing to secure just compensation and humane working conditions for nurses. To
accomplish this, the professional association may engage in collective bargaining
on behalf of nurses. While seeking to assure just economic and general welfare
for nurses, collective bargaining, nonetheless, seeks to keep the interests of both
nurses and patients in balance.
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Provision 7
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The nurse participates in the advancement of the
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profession through contributions to practice, education,
administration, and knowledge development.
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ership, activities, and the viability of their professional organizations. Nurses can
also advance the profession by serving in leadership or mentorship roles or on
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can advance the profession by serving as role models for professional integrity.
Nurses can also advance the profession through participation in civic activities
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sionalism, and nurse researchers are responsible for active contribution to the body
of knowledge supporting and advancing nursing practice.
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and guidelines and assuring quality care for those whom nursing serves.
The nurse educator is responsible for promoting and maintaining optimum
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standards of both nursing education and of nursing practice in any settings where
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planned learning activities occur. Nurse educators must also ensure that only those
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students who possess the knowledge, skills, and competencies that are essential to
nursing graduate from their nursing programs.
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refine, and expand the body of knowledge that forms the foundation of its discipline
and practice. In addition, nursing knowledge is derived from the sciences and from
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Provision 8
The nurse collaborates with other health professionals
and the public in promoting community, national,
and international efforts to meet health needs.
needs of individual patients but also of broader health concerns such as world
hunger, environmental pollution, lack of access to health care, violation of human
rights, and inequitable distribution of nursing and healthcare resources. The avail-
ability and accessibility of high quality health services to all people require both
interdisciplinary planning and collaborative partnerships among health profes-
sionals and others at the community, national, and international levels.
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about the health status of the community and existing threats to health and safety.
Through support of and participation in community organizations and groups, the
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nurse assists in efforts to educate the public, facilitates informed choice, identifies
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conditions and circumstances that contribute to illness, injury and disease, fosters
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healthy life styles, and participates in institutional and legislative efforts to pro-
mote health and meet national health objectives. In addition, the nurse supports
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initiatives to address barriers to health, such as poverty, homelessness, unsafe living
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The nurse also recognizes that health care is provided to culturally diverse
populations in this country and in all parts of the world. In providing care, the
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nurse should avoid imposition of the nurse’s own cultural values upon others. The
nurse should affirm human dignity and show respect for the values and practices
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associated with different cultures and use approaches to care that reflect aware-
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Provision 9
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9.3 Intraprofessional integrity
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A professional association is responsible for expressing the values and ethics of the
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profession and also for encouraging the professional organization and its members
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to function in accord with those values and ethics. Thus, one of its fundamental
responsibilities is to promote awareness of and adherence to the Code of Ethics
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and to critique the activities and ends of the professional association itself. Values
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and ethics influence the power structures of the association in guiding, correcting,
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and directing its activities. Legitimate concerns for the self-interest of the associa-
tion and the profession are balanced by a commitment to the social goods that
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tion to speak for nurses collectively in shaping and reshaping health care within
our nation, specifically in areas of healthcare policy and legislation that affect
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accessibility, quality, and the cost of health care. Here, the professional associa-
tion maintains vigilance and takes action to influence legislators, reimbursement
agencies, nursing organizations, and other health professions. In these activities,
health is understood as being broader than delivery and reimbursement systems,
but extending to health-related sociocultural issues such as violation of human
rights, homelessness, hunger, violence, and the stigma of illness.
© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Afterword
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The development of the Code of Ethics for Nurses with Interpretive Statements
is a benchmark for both the American Nurses Association and for the profes-
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sion of nursing as a whole. The evolution of the Code dates from 1893 when the
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“Nightingale Pledge” was adopted, and from 1926 and 1940 when tentative Codes
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were suggested but not formally ratified. This is the first time in the last 25 years
that the entire Code has been revised and the second time in the last 50 years that
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an entirely new document has been produced. This Code is the result of five years
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of work on the part of the Code of Ethics Project Task Force, an advisory board,
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state liaisons, and ANA staff. It is the culmination of more than 10 field reviews of
drafts that were circulated in hard copy and made available online, incorporating
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comments from hundreds of nurses across the United States and abroad.
The ethical tradition that has been manifest in every iteration of the Code is
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Code of Ethics is nonnegotiable. This means that the Code supports the nurse in
a steadfast way across various settings and in a variety of nursing roles. This Code
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of Ethics is for all nurses and is particularly useful at the beginning of the twenty-
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first century because it: reiterates the fundamental values and commitments of the
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nurse (Provisions 1–3); identifies the boundaries of duty and loyalty (Provisions
4–6); and describes the duties of the nurse that extend beyond individual patient
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31
CONTENTS
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
CONTENTS
Timeline:
The Evolution of Nursing’s Code of Ethics
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Whatever the version of the Code, it has always been fundamentally concerned with
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the principles of doing no harm, of benefiting others, of loyalty, and of truthfulness. As
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well, the Code has been concerned with social justice and, in later versions, with the
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changing context of health care as well as the autonomy of the patient and the nurse. es
1893 The “Nightingale Pledge,” patterned after medicine’s Hippocratic
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1896 The Nurses’ Associated Alumnae of the United States and Canada
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adopted.
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33
CONTENTS
Timeline
1985 The Code for Nurses with Interpretive Statements retains the
provisions of the 1976 version and includes revised interpretive
statements.
2001 The Code for Nurses with Interpretive Statements is accepted by the
ANA House of Delegates.
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
Index
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Note: A decimal numeral in parentheses (4.1) indicates an interpretive statement
of a given numbered ethical provision (Provision 4).
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A As
Advocacy for the patient (Provision 3), 16–20
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confidentiality (3.2), 16–17
Abuse, 24, 29
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(confidentiality), 16–17
protection of research participants
Accessibility of health care, 15, 28–29, 30 (3.3), 17–18
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22–23
Alleviation of suffering in nursing, 9, 12, 16
for nursing judgment and action
(4.2), 21 Autonomy
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35
CONTENTS
INdex
Code of Ethics for Nurses, 7–8, 9–10, 31 Decision-making and ethics, 10, 15, 24
development of, 33–34 surrogate, 13, 17
See also Ethical provisions Delegation of nursing activities (4.4), 22–23
Collaboration Dignity and worth of the individual, 11, 12,
with colleagues and others (1.5), 21, 23, 24, 25, 29
13–14, 15 Direct care as nursing role, 14, 15, 21
consultation and, 22 Disclosure as nurse’s responsibility, 15,
with the patient and (2.3), 15–16 16, 18
intraprofessional, 14, 28 Duties to self (Provision 5), 18, 23–25
(Provision 8), 28–29 See also Self-respect and development
Collective action and bargaining by nurses, Duty and duties
25–27
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boundaries of loyalty and, 10
as workplace advocacy, 26–27
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to patient, 16–17, 18, 20
Collegial relations, 13–14, 15, 20, 21–22, to self, 18, 23–25
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26–27
See also Collaboration
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Commitment to the patient (Provision 2),
14–16 E
collaboration and (2.3), 15–16
conflict of interest for nurses (2.2), As
Economic and financial issues, 14, 15, 24,
27, 30
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14–15 Education of nurses, 12, 15, 21, 22, 23,
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Community issues, 9–13, 24, 28–29 as nursing role, 10, 11–14 passim
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Ethics in nursing, 7–10, 31 Interdisciplinary health care, 16, 29
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See also Ethical provisions Interventions, 12, 25
Excellences and virtues of nurses, 25–26
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Intraprofessional collaboration, 13–14, 15
See also Virtues Intraprofessional integrity, (9.3), 30
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F J
Fairness and equity issues, 13, 15, 26, 29
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Judgment (professional), 12, 17, 21, 22
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Families 9, 14, 15 Justice (social), 9, 13, 30
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conflicting interests, 14
nurse’s commitment to patient and L
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Legal issues
Financial and economic issues, 14, 15, 24,
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27, 30 of delegation, 22
of patients, 12–13, 17, 19
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in practice, 19–20
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Prescription authority, 21
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Obligations of nurses, 9, 10, 26, 28 Privacy (3.1), 16
healthcare environment influences on Professional boundaries (2.4), 16
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(6.1), 25–26 Professional issues
for optimal patient care, 21–23 advancement of the profession
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reporting practice irregularities, 19–20 (Provision 7), 27–28
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research and, 18 autonomy, 28
virtues and, 25 intraprofessional integrity (9.2), 30
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See also Responsibilities of nurses professional organizations, 10, 19–20,
Organizational issues, 14, 16, 19, 28 26–27, 29–30
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policies and procedures 16, 17, 20, 21, professional boundaries (2.4), 16
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Organizations for professional nurses, 10, professional vs. personal values, 14–15
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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of nurses, 25
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of patients, 13, 17–18 of patients, 12–14, 16–19, 26–27
Regulatory issues, 19, 27, 28 to self-determination (1.4), 12–13
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nurse access to resources for, 19–20 Risk issues, 12, 17, 18, 20
See also Legal issues; Workplace issues
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Reporting practice and research
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irregularities, 18, 19–20
Research Safety issues, 14, 16–17, 18, 19, 20, 25, 26,
28, 29
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as nursing role, 12, 14, 15, 21, 27
protection of participants in (3.3), 17–18 Scope of nursing practice, 15, 21, 23, 28
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Respect for self. See Self-respect and preservation of integrity (5.4), 24–25
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25–26, 29–30 employment conditions, 15, 25–27
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professional organizations and (9.2), policies and procedures, 16, 17, 20, 21,
30 22, 26
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professional vs. personal, 14, 24, 25, 26 reporting practice problems, 19–20
social/societal, 28, 29
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workplace advocacy, 26–27
See also Promotion of nursing values See also Healthcare environments;
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Violence, 29, 30 Safety issues
Virtues, 25–26 Worth of people. See Dignity
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cultivation of and ethics, 9
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as habits of character, 25
obligations and, 25
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© 2001 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or
mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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II It is a succinct statement of the ethical obligations
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and duties of every individual who enters the nursing
profession.
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II It is the profession’s nonnegotiable ethical standard.
II It is an expression of nursing’s own understanding of its
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commitment to society.
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The Code’s nine ethical provisions are effectively grouped in
threes: the first three describe the most fundamental values
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and commitments of the nurse; the second three address the
boundaries of duty and loyalty; the last three address aspects
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