ANA President Mary E. Foley, MS, RN, states that the code “has always been a key guiding document for the nursing profession. This new code will serve the profession even more efficiently because it clearly explains the mission of nursing in society and how nurses partner with the public with regard to health promotion, patient recovery, and illness prevention.“

Foley adds, “It is also expected that the 2001 code will better serve nurses involved in legal challenges, as well as strengthen nurses’ rights in collective bargaining and workplace advocacy situations.”

This is the first time in 25 years that the code of ethics has been revised and the second time in 50 years that an entirely new document has been produced. The result of five years of labor by members of the Code of Ethics Project Task Force, as well as an advisory board, state liaisons, and ANA staff, the new code is the culmination of 10 field reviews and also incorporates comments from hundreds of nurses across the United States and abroad. The code serves as a guide for all nurses and is particularly useful at the beginning of the 21st century for several reasons.

The code reiterates the fundamental values and commitments of the nurse. (See provisions 1-3.) The code begins with the time-honored, traditional obligation of the nurse to “practice 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 health problems.” This obligation has shaped nursing’s mission to treat individuals for their own sakes and not merely as means to the objectives of others. Nurses regard individual patients as the center of nursing activities but also treat families and communities as loci of interest and recipients of care. Nurses should always be concerned about the health, safety, and rights of patients. This portion of the code emphasizes the importance of patient autonomy and also considers the idea that members of some cultures “place less weight on individualism and may choose to defer to family or community values in decision making.”

The code discusses conflicts of interest and personal boundaries and notes that there may be situations in which public health considerations override individual rights. According to the code, ethical principles such as justice, beneficence, and patient autonomy should dictate nursing practice, along with virtues such as honesty, compassion, courage, wisdom, confidentiality, and respect for privacy.

The code identifies the boundaries of duty and loyalty. (See provisions 4-6.) The management strategies and cost containment efforts that characterize inpatient facilities, as well as the variety of settings in which nurses practice, present ethical challenges for nurses, who must have the ability and authority to make professional judgments, plan and prioritize the use of their time, and ensure that the work environment supports them in these efforts. Nurses need to be able to delegate tasks appropriately, continue to grow as health care professionals, and preserve personal integrity. The code supports nurses in their efforts to improve the workplace and working conditions, whether through collective bargaining or the use of workplace advocacy strategies.

There are times when nurses will become aware of impaired or inappropriate practice among colleagues. The code supports nurses in whistleblowing or acting in response to incompetent, unethical, illegal, or impaired practice by any member of the health care team. It also supports the nurse’s right (with stipulations) to refuse to participate in specific treatments, interventions, or practices that are morally objectionable to her.

The code describes nursing duties beyond individual patient encounters. (See provisions 7-9.) Nurses work in many arenas, including practice, research, administration, and education. It’s critical that nurse researchers develop new knowledge while protecting the rights and interests of their subjects and minimizing risks. Nurse administrators assume the responsibility of facilitating professional nursing practice and ensuring the delivery of high quality care. Nurse educators are stewards of professional practice for the future. The code stipulates that they ensure that only those students who possess the required knowledge, skills, and competencies graduate from nursing programs.

Nursing has always been, and will continue to be, highly interdisciplinary. In addition, nursing practice extends to the community, the nation, and the world and addresses concerns such as world hunger, environmental pollution, access to health care, and violation of human rights. The new code beckons nurses toward global awareness and reinforces the need for participation in professional associations to achieve these ends.

It’s necessary to read the code and its interpretive statements carefully to appreciate its breadth, sophistication, and utility. Nurses now share the responsibility of disseminating and implementing this new code by:

1. informing nursing colleagues of its availability;
2. learning its major provisions and interpretive statements;
3. incorporating it into practice environments through dialogue and the development of relevant in-service and continuing education programs;
4. advising colleagues in other disciplines about the availability of this new code;
5. encouraging its adoption throughout nursing education settings and by authors of relevant textbooks;
6. underlining its utility to those who are crafting new collective bargaining agreements for nurses or implementing strategies to improve the workplace; and
7. stimulating scholarship and research about its application to practice. The Code of Ethics for Nurses with Interpretive Statements is an important tool that can be used now as leverage to a better future for nurses, patients, and health care.

Gladys White is director of the ANA Center for Ethics and Human Rights.

Code of Ethics for Nurses-Provisions

Voted on and accepted by the ANA House of Delegates on June 30, 2001.

1. 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 health problems.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
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.
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.
6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

The Code of Ethics for Nurses is available for sale from American Nurses Publishing at (800) 637-0323 or www.nursesbooks.org

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