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What Are The Elements Of The Code Of Ethics In Nursing?

The nursing code of ethics was established by the American Nurses Association (ANA) and serves as a guide for all healthcare workers in the United States. As the name suggests, it is a code of ethics that describes how a nurse should conduct themselves, and it's something that all nursing students should learn.

The History of the Nursing Code of Ethics

The code of ethics dates back to something known as the Nightingale Pledge, which comes from a similar pledge first used in ancient Greece.

The Nightingale Pledge was named for Florence Nightingale, the "Lady with the Lamp".

Nightingale was a British nurse trainer and manager during the Crimean War in the 19th century. She provided care to wounded soldiers and became a legendary figure in Victorian England, eventually becoming known as the founder of modern nursing.

The pledge that bears her name was a modified version of the Hippocratic Oath, which was named for an ancient Greek physician and written nearly 2500 years ago. The Nightingale Pledge was created in part by Lystra Gretter, a Canadian-born American who was just as important to nursing in America as Nightingale was to nursing in Britain.

Both the Hippocratic Oath and Nightingale Pledge have passages where nurses swear to perform their duties loyally, with devotion, and in the best interests of the patient.

They also have religious elements, with the Nightingale Pledge beginning by swearing "before God" and the Hippocratic Oath calling to "Apollo the physician" and "all the gods and goddesses".

The first formal code of ethics for US nurses was created by the American Nurses Association (ANA) in the 1950s. They used many of the principles included in the aforementioned pledges and continued to amend them and add to them as the practice of nursing developed.

In 2015, this code underwent its biggest change to date. This is when the ANA nursing ethics received the 9 statements/provisions for which they are known today.

What are the Principles of Ethics for Nurses?

There are four main principles of ethics for nurses: Autonomy, Beneficence, Justice, and Nonmaleficence. These ethical values form the foundation of the ANA's code of ethics and were also integral to the original Hippocratic Oath:


Autonomy declares that all patients should receive the level of care that is best for them and have a right to determine their own fates. They must be included in the decision-making process and provided with all information relating to their condition.

Nurses must support the patient with their wishes while also acting as health advocates.


As echoed by the Nightingale Pledge ("I shall be loyal to my work and devoted towards the welfare of those committed to my care") beneficence morally obliges nurses to act with compassion and provide benefits that outweigh risks.


Nonmaleficence is the idea that nurses should "do no harm". They should not kill, cause pain/suffering, or commit any offense against the patient.

These ideas are central to all medical ethics and were also a major part of the Nightingale Pledge ("I shall abstain from whatever is deleterious and mischievous and shall not take or knowingly administer any harmful drug") and the Hippocratic Oath ("I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan").


Justice in the context of nursing care requires everyone to be treated equally and fairly. It states that the patient's race, religion, finances, sexual orientation, and gender should not determine their position in the queue.

What are the 9 Codes of Ethics for Nurses?

The ANA code of ethics added 9 provisions in 2015. These statements provide specific guidelines for nursing practice and add some clarity to the ethical decision-making process.

These provisions state that all nurses and other health professionals should:

  1. Practice with compassion and consideration for the unique traits and attributes of all patients.
  2. Commit to the needs of the patient, whether they are an individual, family, or a larger community.
  3. Promote health, protect rights, and ensure the continued safety of the patient.
  4. Provide optimal nursing care at all times, acting as an authority and taking responsibility for the health of the patient.
  5. Promote health in themselves as well as others; improve their education and understanding and keep their competence levels high.
  6. Maintain ethical obligations in the workplace and ensure that it remains a safe, secure, and beneficial environment at all times.
  7. Advance the nursing profession through everyday practice, research, standards development, and the advancement of safe healthcare.
  8. Collaborate with other health professionals, as well as the general public, to promote healthcare ethics, protect human rights, and reduce disparities in healthcare.
  9. Maintain professional integrity and promote social justice and health care policies.

Should I Consult the Code of Ethics Before Every Decision?

It's important to understand the code of ethics and to abide by these principles in everyday practice. However, that doesn't mean you need to consult the code of ethics before you make every decision. In fact, you may already be following these terms without fully realizing it.

For instance, if you hold the hand of a dying patient to keep them comfortable, you're probably acting out of compassion. It's a very human thing to do and it's something that feels right at the time. But it's also something prescribed by the ANA code of ethics.

The same applies to those moments when you console a family member, provide pain medication to a suffering patient, or act as an advocate for a patient who needs additional care.

Summary: Nursing Ethics in the United States

The code of ethics helps nurses in their everyday practice and ensures they abide by moral values that have governed professional practice for millennia. Nurses can't always make complex decisions based on this code of ethics, though, and there may come a time when they need to consult with an ethics committee or acquire additional resources before going any further.

find nursing schools near you

find nursing schools near you