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Review and skim through the American Nurses Association (ANA) Code of Ethics (PDF attached) to address the questions below in your discussion post this week.Address the questions below in your discussion post this week:Does the ‘Code of Ethics’ require you to respond in disaster situations?Do RNs have a contractual responsibility to respond in disaster situations?Are you familiar with your state’s laws regarding disaster response?APA7 format
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Code of Ethics
for Nurses
with Interpretive
Statements
Silver Spring, Maryland 2015
The American Nurses Association is the only full-service professional organization
representing the interests of the nation’s 3.1 million registered nurses through its
constituent/state nurses associations and its organizational affiliates. ANA advances
the nursing profession by fostering high 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 healthcare issues affecting
nurses and the public.
American Nurses Association
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910-3492
1-800-274-4ANA
www.Nursingworld.org
Published by Nursesbooks.org
The Publishing Program of ANA
www.Nursesbooks.org
Copyright © 2015 American Nurses Association. All rights reserved. Reproduction
or transmission in any form is not permitted without written permission of the
American Nurses Association (ANA). This publication may not be translated without
written permission of ANA. For inquiries, or to report unauthorized use, email
[email protected].
Library of Congress Cataloging-in-Publication available on request: [email protected].
ISBN-13: 978-1-55810-599-7
First printing: January 2015.
SAN: 851-3481
01/2015
Contributors and
Acknowledgments
This revision of the Code of Ethics for Nurses with Interpretive Statements was
informed by over 7,800 responses from 2,780 nurses in an online public
survey of the 2001 Code. After a revised code was drafted, it was posted for
public comment to which more than 1,500 additional responses,
representing approximately 1,000 nurses were posted. The contributions of
these nurses are gratefully acknowledged.
The revisions were implemented by a steering committee convened to revise
the 2001 Code. The members of that committee represented a variety of
nursing roles and settings and were drawn from across the United States. The
following persons were members of the Steering Committee for the Revision
of the Code of Ethics for Nurses with Interpretive Statements:
Margaret Hegge, EdD, RN, FAAN – Chair
Marsha Fowler, PhD, MDiv, MS, RN, FAAN
Dana Bjarnason, PhD, RN, NE-BC
Timothy Godfrey, SJ, DNP, RN, PHCNS-BC
Carla Lee, PhD, APRN-BC, FAAN
Lori Lioce, DNP, FNP-BC, CHSE, FAANP
Margaret Ngai, BSN, RN
Catherine Robichaux, PhD, RN, CNS
Kathryn Schroeter, PhD, RN, CNOR, CNE
Josephine Shije, BSN, RN
Elizabeth Swanson, DNP, MPH, APRN-BC
Mary Tanner, PhD, RN
Elizabeth Thomas, MEd, BS, RN, NCSN, FNASN
Lucia Wocial, PhD, RN
Karen Zanni, MSN, FNP-C
Contributors and Acknowledgements • Code of Ethics for Nurses with Interpretive Statements • i
The Steering Committee was staffed by Laurie Badzek, LLM, JD, RN, FAAN,
Director of ANA’s Center for Ethics and Human Rights (Co-Chair), and Martha
Turner, PhD, RN-BC, Assistant Director for ANA’s Center for Ethics and Human
Rights, who served as content editor, revision coordinator, and co-lead writer.
Committee member Marsha Fowler, PhD, MDiv, MS, RN, FAAN, who was named
Historian and Code Scholar, served as co-lead writer.
ii • Code of Ethics for Nurses with Interpretive Statements • Contributors and Acknowledgements
Contents
Contributors and Acknowledgments
i
Provisions of the Code of Ethics for Nurses with
Interpretive Statements
v
Preface
vii
Introduction
xi
Provision 1
1
1.1
1.2
1.3
1.4
1.5
Respect for Human Dignity
Relationships with Patients
The Nature of Health
The Right to Self-Determination
Relationships with Colleagues and Others
Provision 2
2.1
2.2
2.3
2.4
Primacy of the Patient’s Interests
Conflict of Interest for Nurses
Collaboration
Professional Boundaries
Provision 3
3.1
3.2
3.3
3.4
3.5
3.6
5
9
Protection of the Rights of Privacy and Confidentiality
Protection of Human Participants in Research
Performance Standards and Review Mechanisms
Professional Responsibility in Promoting a Culture of Safety
Protection of Patient Health and Safety by Acting on Questionable Practice
Patient Protection and Impaired Practice
Contents • Code of Ethics for Nurses with Interpretive Statements • iii
Provision 4
15
4.1 Authority, Accountability, and Responsibility
4.2 Accountability for Nursing Judgments, Decisions, and Actions
4.3 Responsibility for Nursing Judgments, Decisions, and Actions
4.4 Assignment and Delegation of Nursing Activities or Tasks
Provision 5
19
5.1 Duties to Self and Others
5.2 Promotion of Personal Health, Safety, and Well-Being
5.3 Preservation of Wholeness of Character
5.4 Preservation of Integrity
5.5 Maintenance of Competence and Continuation of Professional Growth
5.6 Continuation of Personal Growth
Provision 6
23
6.1 The Environment and Moral Virtue
6.2 The Environment and Ethical Obligation
6.3 Responsibility for the Healthcare Environment
Provision 7
27
7.1 Contributions through Research and Scholarly Inquiry
7.2 Contributions through Developing, Maintaining, and
Implementing Professional Practice Standards
7.3 Contributions through Nursing and Health Policy Development
Provision 8
31
8.1 Health Is a Universal Right
8.2 Collaboration for Health, Human Rights, and Health Diplomacy
8.3 Obligation to Advance Health and Human Rights and Reduce Disparities
8.4 Collaboration for Human Rights in Complex, Extreme, or
Extraordinary Practice Settings
Provision 9
9.1
9.2
9.3
9.4
35
Articulation and Assertion of Values
Integrity of the Profession
Integrating Social Justice
Social Justice in Nursing and Health Policy
Afterword
39
Glossary
41
Timeline: The Evolution of Nursing’s Code of Ethics
47
Index
49
iv • Code of Ethics for Nurses with Interpretive Statements • Contents
Provisions of the Code
of Ethics for Nurses with
Interpretive Statements
Provision 1 | The nurse practices with compassion and respect for the
inherent dignity, worth, and unique attributes of every person.
Provision 2 | The nurse’s primary commitment is to the patient, whether an
individual, family, group, community, or population.
Provision 3 | The nurse promotes, advocates for, and protects the rights,
health, and safety of the patient.
Provision 4 | The nurse has authority, accountability, and responsibility for
nursing practice; makes decisions; and takes action consistent with
the obligation to promote health and to provide optimal care.
Provision 5 | The nurse owes the same duties to self as to others, including
the responsibility to promote health and safety, preserve
wholeness of character and integrity, maintain competence,
and continue personal and professional growth.
Provision 6 | The nurse, through individual and collective effort, establishes,
maintains, and improves the ethical environment of the work
setting and conditions of employment that are conducive to
safe, quality health care.
Provision 7 | The nurse, in all roles and settings, advances the profession
through research and scholarly inquiry, professional
standards development, and the generation of both nursing
and health policy.
Provision 8 | The nurse collaborates with other health professionals and the
public to protect human rights, promote health diplomacy, and
reduce health disparities.
Provision 9 | The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the
integrity of the profession, and integrate principles of social
justice into nursing and health policy.
Provisions of Code of Ethics for Nurses • Code of Ethics for Nurses with Interpretive Statements • v
Preface
The Code of Ethics for Nurses with Interpretive Statements (the Code)
establishes the ethical standard for the profession and provides a guide for
nurses to use in ethical analysis and decision-making. The Code is
nonnegotiable in any setting. It may be revised or amended only by formal
processes established by the American Nurses Association (ANA). The Code
arises from the long, distinguished, and enduring moral tradition of modern
nursing in the United States. It is foundational to nursing theory, practice,
and praxis in its expression of the values, virtues, and obligations that shape,
guide, and inform nursing as a profession.
Nursing encompasses the protection, promotion, and restoration of health
and well-being; the prevention of illness and injury; and the alleviation of
suffering, in the care of individuals, families, groups, communities, and
populations. All of this is reflected, in part, in nursing’s persisting
commitment both to the welfare of the sick, injured, and vulnerable in
society and to social justice. Nurses act to change those aspects of social
structures that detract from health and well-being.
Individuals who become nurses, as well as the professional organizations
that represent them, are expected not only to adhere to the values, moral
norms, and ideals of 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 of ethics for the nursing profession makes
explicit the primary obligations, values, and ideals of the profession. In fact, it
informs every aspect of the nurse’s life.
Preface • Code of Ethics for Nurses with Interpretive Statements • vii
The Code of Ethics for Nurses with Interpretive Statements serves the
following purposes:
n
n
n
It is a succinct statement of the ethical values, obligations, duties,
and professional ideals of nurses individually and collectively.
It is the profession’s non-negotiable ethical standard.
It is an expression of nursing’s own understanding of its commitment
to society.
Statements that describe activities and attributes of nurses in this code of
ethics and its interpretive statements are to be understood as normative or
prescriptive statements expressing expectations of ethical behavior. The
Code also expresses the ethical ideals of the nursing profession and is, thus,
both normative and aspirational. Although this Code articulates the ethical
obligations of all nurses, it does not predetermine how those obligations
must be met. In some instances nurses meet those obligations individually;
in other instances a nurse will support other nurses in their execution of
those obligations; at other times those obligations can only and will only
be met collectively. ANA’s Code of Ethics for Nurses with Interpretive
Statements addresses individual as well as collective nursing intentions and
actions; it requires each nurse to demonstrate ethical competence in
professional life.
Society recognizes that nurses serve those seeking health as well as those
responding to illness. Nurses educate students, staff, and others in healthcare
facilities. They also educate within communities, organizations, and broader
populations. The term practice refers to the actions of the nurse in any role or
setting, whether paid or as a volunteer, including direct care provider,
advanced practice registered nurse, care coordinator, educator, administrator,
researcher, policy developer, or other forms of nursing practice. Thus, the
values and obligations expressed in this edition of the Code apply to nurses in
all roles, in all forms of practice, and in all settings.
ANA’s Code of Ethics for Nurses with Interpretive Statements is a dynamic
document. As nursing and its social context change, the Code must also
change. The Code consists of two components: the provisions and the
accompanying interpretive statements. The provisions themselves are broad
and noncontextual statements of the obligations of nurses. The interpretive
statements provide additional, more specific, guidance in the application of this
viii • Code of Ethics for Nurses with Interpretive Statements • Preface
obligation to current nursing practice. Consequently, the interpretive statements
are subject to more frequent revision than are the provisions—approximately
every decade—while the provisions may endure for much longer without
substantive revision.
Additional ethical guidance and details can be found in the position and
policy statements of the ANA or its constituent member associations and
affiliate organizations that address clinical, research, administrative,
educational, public policy, or global and environmental health issues.
The origins of the Code of Ethics for Nurses with Interpretive Statements reach
back to the late 1800s in the foundation of ANA, the early ethics literature of
modern nursing, and the first nursing code of ethics, which was formally
adopted by ANA in 1950. In the 65 years since the adoption of that first
professional ethics code, nursing has developed as its art, science, and practice
have evolved, as society itself has changed, and as awareness of the nature and
determinants of global health has grown. The Code of Ethics for Nurses with
Interpretive Statements is a reflection of the proud ethical heritage of nursing
and a guide for all nurses now and into the future.
Preface • Code of Ethics for Nurses with Interpretive Statements • ix
Introduction
In any work that serves the whole of the profession, choices of terminology
must be made that are intelligible to the whole community, are as inclusive
as possible, and yet remain as concise as possible. For the profession of
nursing, the first such choice is the term patient versus client. The term patient
has ancient roots in suffering; for millennia the term has also connoted one
who undergoes medical treatment. Yet, not all who are recipients of nursing
care are either suffering or receiving medical treatment. The root of client
implies one who listens, leans upon, or follows another. It connotes a more
advisory relationship, often associated with consultation or business.
Thus, nursing serves both patients and clients. Additionally, the patients and
clients can be individuals, families, communities, or populations. Recently,
following a consumerist movement in the United States, some have preferred
consumer to either patient or client. In this revision of the American Nurses
Association’s (ANA’s) Code of Ethics for Nurses with Interpretive Statements (the
Code), as in the past revision, ANA decided to retain the more common,
recognized, and historic term patient as representative of the category of all
who are recipients of nursing care. Thus, the term patient refers to clients or
consumers of health care as well as to individuals or groups.
A decision was also made about the words ethical and moral. Both are
neutral and categorical. That is—similar to physical, financial, or historical—
they refer to a category, a type of reflection, or a behavior. They do not
connote a rightness or goodness of that behavior.
Within the field of ethics, a technical distinction is made between ethics
and morality. Morality is used to refer to what would be called personal
values, character, or conduct of individuals or groups within communities
and societies. Ethics refers to the formal study of that morality from a wide
range of perspectives including semantic, logical, analytic, epistemological,
and normative. Thus, ethics is a branch of philosophy or theology in which
Introduction • Code of Ethics for Nurses with Interpretive Statements • xi
one reflects on morality. For this reason, the study of ethics is often called
moral philosophy or moral theology. Fundamentally, ethics is a theoretical and
reflective domain of human knowledge that addresses issues and questions
about morality in human choices, actions, character, and ends.
As a field of study, ethics is often divided into metaethics, normative ethics,
and applied ethics. Metaethics is the domain that studies the nature of ethics
and moral reasoning. It would ask questions such as “Is there always an
element of self-interest in moral behavior?” and “Why be good?” Normative
ethics addresses the questions of the ought, the four fundamental terms of
which are right and wrong, good and evil. That is, normative ethics addresses
what is right and wrong in human action (what we ought to do); what is good
and evil in human character (what we ought to be); and good or evil in the
ends that we ought to seek.
Applied ethics wrestles with questions of right, wrong, good, and evil in a
specific realm of human action, such as nursing, business, or law. It would ask
questions such as “Is it ever morally right to deceive a research subject?” or
“What is a ‘good nurse’ in a moral sense?” or “Are health, dignity, and wellbeing intrinsic or instrumental ends that nursing seeks?” All of these aspects of
ethics are found in the nursing literature. However, the fundamental concern of
a code of ethics for nursing is to provide normative, applied moral guidance for
nurses in terms of what they ought to do, be, and seek.
Some terms used in ethics are ancient such as virtue and evil, yet they remain
in common use today within the field of ethics. Other terms, such as ethics and
morality, are often—even among professional ethicists—used imprecisely or
interchangeably because they are commonly understood or because common
linguistic use prevails. For example, one might speak of a person as lacking a
“moral compass” or as having “low morals.” Another example is the broader
public use of the term ethical. Ethics is a category that refers to ethical or
nonethical behavior: either a behavior is relevant to the category of ethics, or it
is not. Here, the term unethical has no meaning, although it is commonly used
in lectures and discussions—even by professional ethicists—to mean morally
blameworthy; that is, wrong. The terms should and must are often substituted for
the more precise normative ethical term ought. Ought indicates a moral
imperative. Must expresses an obligation, duty, necessity, or compulsion,
although not an intrinsically moral one. Likewise, should expresses an
obligation or expediency that is not necessarily a moral imperative.
The English language continues to evolve, and the once firm and clearly
understood distinctions between may and can; will and shall; and ought, should,
xii • Code of Ethics for Nurses with Interpretive Statements • Introduction
and must have faded in daily language and have come to be used interchangeably
in both speech or writing, except in rare instances in which the nuance is essential
to an argument. To aid the reader in understanding the terms used, this revision
of ANA’s Code of Ethics for Nurses with Interpretive Statements will, for the first
time, include a glossary of terms that are found within the Code.
This revision also includes another innovation: links to foundational and
supplemental documents. The links to this material are available on ANA’s
Ethics webpage. These documents are limited to works judged by the Steering
Committee as having both timely and timeless value. Nursing’s ethics holds
many values and obligations in common with international nursing and health
communities. For example, the Millennium Development Goals of the United
Nations, the World Medical Association’s Declaration of Helsinki about research
involving human subjects, and the International Council of Nurses’ Code of Ethics
for Nurses are documents that are both historically and contemporaneously
important to U.S. nurses and nursing’s ethics.
The afterword from the 2001 Code has been included and updated to
reflect the 2010–2014 revision process. This Introduction, another new
component of this revision, was added to provide a general orientation to the
terminology and the structure of this document.
The nine provisions of the 2001 Code have been retained with some minor
revisions that amplify their inclusivity of nursing’s roles, settings, and concerns.
Together, the nine provisions contain an intrinsic relational motif: nurse-topatient, nurse-to-nurse, nurse-to-self, nurse-to-others, nurse-to-profession, nurseto-society, and nursing-to-society, relations that are both national and global. The
first three provisions describe the most fundamental values and commitments of
the nurse; the next three address boundaries of duty and loyalty; the final three
address aspects of duties beyond individual patient encounters. This revision also
retains, for each provision, interpretive statements that provide more specific
guidance for practice, are responsive to the contemporary context of nursing, and
recognize the larger scope of nursing’s concern in relation to health.
It was the intent of the Steering Committee to revise the Code in response to
the complexities of modern nursing, to simplify and more clearly articulate the
content, to anticipate advances in health care, and to incorporate aids that
would make it richer, more accessible, and easier to use.
—Steering Committee for the Revision of the
Code of Ethics for Nurses with Interpretive Statements
September 2014
Introduction • Code of Ethics for Nurses with Interpretive Statements • xiii
Provision 1
The nurse practices with compassion and respect
for the inherent dignity, worth, and unique
attributes of every person.
1.1 Respect for Human Dignity
A fundamental principle that underlies all nursing practice is respect for
the inherent dignity, worth, unique attributes, and human rights of all
individuals. The need for and right to health care is universal,
transcending all individual differences. Nurses consider the needs and
respect the values of each person in every professional relationship and
setting; they provide leadership in the development and implementation
of changes in public and health policies that support this duty.
1.2 Relationships with Patients
Nurses establish relationships of trust and provide nursing services according
to need, setting aside any bias or prejudice. Factors such as culture, value
systems, religious or spiritual beliefs, lifestyle, social support system,
sexual orientation or gender expression, and primary language are to be
considered when planning individual, family and population-centered
care. Such considerations must promote health and wellness, address
problems, and respect patients’ or clients’ decisions. Respect for patient
decisions does not require that the nurse agree with or support all
patient choices. When patient choices are risky or self-destructive, nurses
have an obligation to address the behavior and to offer opportunities
and resources to modify the behavior or to eradicate the risk.
1.3 The Nature of Health
Nurses respect the dignity and rights of all human beings regardless of
the factors contributing to the person’s health status. The worth of a
person is not affected by illness, abilitity, socioeconomic status, functional
status, or proximity to death. The nursing process is shaped by unique
Provision 1 • Code of Ethics for Nurses with Interpretive Statements • 1
patient preferences, needs, values, and choices. Respect is extended to all
who require and receive nursing care in the promotion of health,
prevention of illness and injury, restoration of health, alleviation of pain
and suffering, or provision of supportive care.
Optimal nursing care enables the patient to live with as much physical,
emotional, social, and religious or spiritual well-being as possible and
reflects the patient’s own values. Supportive care is particularly important
at the end of life in order to prevent and alleviate the cascade of symptoms
and suffering that are commonly associated with dying. Support is
extended to the family and to significant others and is directed toward
meeting needs comprehensively across the continuum of care.
Nurses are leaders who actively participate in assuring the responsible
and appropriate use of interventions in order to optimize the health and
well-being of those in their care. This includes acting to minimize unwarranted,
unwanted, or unnecessary medical treatment and patient suffering. Such
treatment must be avoided, and conversations about advance care plans
throughout multiple clinical encounters helps to make this possible. Nurses
are leaders who collaborate in altering systemic structures that have a
negative influence on individual and community health.
1.4 The Right to Self-Determination
Respect for human dignity requires the recognition of specific patient rights,
in particular, the right to self-determination. Patients have the moral and
legal right to determine what will be done with and to their own person; to
be given accurate, complete, and understandable information in a manner
that facilitates an informed decision; and to be assisted with weighing the
benefits, burdens, and available options in their treatment, including the
choice of no treatment. They also have the right to accept, refuse, or
terminate treatment without deceit, undue influence, duress, coercion, or
prejudice, and to be given necessary support throughout the decisionmaking and treatment process. Such support includes the opportunity to
make decisions with family and significant others and to obtain advice
from expert, knowledgeable nurses, and other health professionals.
Nurses have an obligation to be familiar with and to understand the
moral and legal rights of patients. Nurses preserve, protect, and support
those rights by assessing the patient’s understanding of the information
presented and explaining the implications of all potential decisions. When
2 • Code of Ethics for Nurses with Interpretive Statements • Provision 1
the patient lacks capacity to make a decision, a formally designated
surrogate 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 values. In the absence of an appropriate
surrogate decision-maker, decisions should be made in the best interests
of the patient, considering the patient’s personal values to the extent that
they are known.
Nurses include patients or surrogate decision-makers in discussions,
provide referrals to other resources as indicated, identify options, and
address problems in the decision-making process. Support of patient
autonomy also includes respect for the patient’s method of decision-making
and recognition that different cultures have different beliefs and
understandings of health, autonomy, privacy and confidentiality, and
relationships, as well as varied practices of decision-making. Nurses should,
for example, affirm and respect patient values and decision-making processes
that are culturally hierarchical or communal.
The importance of carefully considered decisions regarding resuscitation
status, withholding and withdrawing life-sustaining therapies, foregoing
nutrition and hydration, palliative care, and advance directives is widely
recognized. Nurses assist patients as necessary with these decisions. Nurses
should promote advance care planning conversations and must be
knowledgeable about the benefits and limitations of various advance
directive documents. The nurse should provide interventions to relieve
pain and other symptoms in the dying patient consistent with palliative
care practice standards and may not act with the sole intent to end life.
Nurses have invaluable experience, knowledge, and insight into effective
and compassionate care at the end of life and should actively engage in
related research, scholarship, education, practice, and policy development.
Individuals are interdependent members of their communities. Nurses
recognize situations in which the right to self-determination may be
outweighed or limited by the rights, health, and welfare of others,
particularly in public health. The limitation of individual rights must always
be considered a serious departure from the standard of care, justified only
when there are no less-restrictive means available to preserve the rights of
others, meet the demands of law, and protect the public’s health.
Provision 1 • Code of Ethics for Nurses with Interpretive Statements • 3
1.5 Relationships with Colleagues and Others
Respect for persons extends to all individuals with whom the nurse
interacts. Nurses maintain professional, respectful, and caring relationships
with colleagues and are committed to fair treatment, transparency,
integrity-preserving compromise, and the best resolution of conflicts.
Nurses function in many roles and settings, including direct care provider,
care coordinator, administrator, educator, policy maker, researcher,
and consultant.
The nurse creates an ethical environment and culture of civility and
kindness, treating colleagues, coworkers, employees, students, and others
with dignity and respect. This standard of conduct includes an affirmative
duty to act to prevent harm. Disregard for the effects of one’s actions on
others, bullying, harassment, intimidation, manipulation, threats, or
violence are always morally unacceptable behaviors. Nurses value the
distinctive contribution of individuals or groups as they seek to achieve
safe, quality patient outcomes in all settings. Additionally, they collaborate
to meet the shared goals of providing compassionate, transparent, and
effective health services.
4 • Code of Ethics for Nurses with Interpretive Statements • Provision 1
Provision 2
The nurse’s primary commitment is to the patient,
whether an individual, family, group, community,
or population.
2.1 Primacy of the Patient’s Interests
The nurse’s primary commitment is to the recipients of nursing and
healthcare services—patient or client—whether individuals, families,
groups, communities, or populations. Each plan of care must reflect the
fundamental commitment of nursing to the uniqueness, worth, and
dignity of the patient. Nurses provide patients with opportunities to
participate in planning and implementing care and support that are
acceptable to the patient. Honest discussions about available resources,
treatment options, and capacity for self-care are essential. Addressing
patient interests requires recognition of the patient’s place within the family
and other relationships. When the patient’s wishes are in conflict with those
of others, nurses help to resolve the conflict. Where conflict persists, the
nurse’s commitment remains to the identified patient.
2.2 Conflict of Interest for Nurses
Nurses may experience conflict arising from competing loyalties in the
workplace, including conflicting expectations from patients, families,
physicians, colleagues, healthcare organizations, and health plans. Nurses
must examine the conflicts arising between their own personal and
professional values, the values and interests of others who are also
responsible for patient care and healthcare decisions, and perhaps even
the values and interests of the patients themselves. Nurses address such
conflicts in ways that ensure patient safety and that promote the patient’s
best interests while preserving the professional integrity of the nurse and
supporting interprofessional collaboration.
Conflicts of interest may arise in any domain of nursing activity,
including direct care, administration, education, consultation, policy
development, and research. Nurses in all roles must identify and,
whenever possible, avoid conflicts of interest. Nurses who bill for
Provision 2 • Code of Ethics for Nurses with Interpretive Statements • 5
services and nurse executives with budgetary responsibilities must be
especially aware of the potential for conflicts of interest. Healthcare
financing and delivery systems may create conflict between economic
self-interest and professional integrity. Bonuses, sanctions, and
incentives tied to financial targets may present such conflict. Any
perceived or actual conflict of interest should be disclosed to all
relevant parties and, if indicated, nurses should withdraw, without
prejudice, from further participation.
2.3 Collaboration
The complexity of health care requires collaborative effort that has the
strong support and active participation of all health professions. Nurses
should foster collaborative planning to provide safe, high-quality, patientcentered health care. Nurses are responsible for articulating, representing,
and preserving the scope of nursing practice, and the unique contributions
of nursing to patient care. The relationship between nursing and other
health professions also needs to be clearly articulated, represented, and
preserved.
Collaboration intrinsically requires mutual trust, recognition, respect,
transparency, shared decision-making, and open communication among all
who share concern and responsibility for health outcomes. Nurses ensure
that all relevant persons, as moral agents, participate in patient care decisions.
Patients do not always know what questions to ask or may be limited by a
number of factors, including language or health literacy. Nurses facilitate
informed decision-making by assisting patients to secure the information that
they need to make choices con
