Table Of Content2
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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. The 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 health care issues affecting nurses and the public.
American Nurses Association
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910-3492
1-800-274-4ANA
http://www.Nursingworld.org
Published by Nursesbooks.org
The Publishing Program of ANA
http://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].
Cataloging-in-Publication Data on file with the Library of Congress
eISBN-13 ePub: 978-1-55810-605-5
eISBN-13 mobi: 978-1-55810-606-2
SAN: 851-3481
First published: March 2015.
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Dedication
To my family
Donald, Katherine,
Robert, Allison,
Ætley, Laura
Raven, Tucker, Wolfgang, Hero
Y Gwir yn erbyn y Byd, A oes Heddwch?
Calon wrth Galon, A oes Heddwch?
Gwaedd uwch Adwaedd, A oes Heddwch?
The Truth against the World: is there Peace?
Heart to Heart, is there Peace?
Shout above resounding Shout, is there Peace?”
Gorsedd Beirdd Ynys Prydain
Liturgy of the Bardic Ceremony of the
Unsheathing of the Grand Sword
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Contents
Acknowledgments v
Author’s Preface. Review and Renewal: The Half-Life of a Code vii
Preface 2015. Nursing’s 2015 Code of Ethics xi
Anne J. Davis, PhD, DS, MS, RN, FAAN
Preface 2008. The Initiating Edition of Guide to the Code xiii
Anne J. Davis, PhD, DS, MS, RN, FAAN
Foreword XV
Patricia Benner, PhD, RN, FAAN
Introduction. Provisions, Decisions, and Cases: XXIV
Getting to What is Right and Good
The Nursing Process, Models of Ethical Decision-Making, and Using the Cases xxix
Suggested Questions for Case Discussions xx
Concluding Remarks xxvi
Provision 1. Affirming Health through Relationships of Dignity and Respect 1
Introduction 1
1.1 Respect for Human Dignity 7
1.2 Relationships with Patients 10
1.3 The Nature of Health 13
1.4 The Right to Self-Determination 15
1.5 Relationships with Colleagues and Others 18
Provision 2. The Patient as Nursing’s Foundational Commitment 25
Introduction 252.1 2.1 Primacy of the Patient’s Interests 26
2.2 Conflict of Interest for Nurses 32
2.3 Collaboration 33
2.4 Professional Boundaries 35
Provision 3. Advocacy’s Geography 41
Introduction 41
3.1 Protection of the Rights of Privacy and Confidentiality 41
3.2 Protection of Human Participants in Research 46
3.3 Performance Standards and Review Mechanisms 50
3.4 Professional Responsibility in Promoting a Culture of Safety 50
3.5 Protection of Patient Health and Safety by Action on Questionable Practice 51
3.6 Patient Protection and Impaired Practice 53
Provision 4. The Expectations of Expertise 59
Introduction 59
4.1 Authority, Accountability, and Responsibility 62
4.2 Accountability for Nursing Judgments, Decisions, and Actions 64
4.3 Responsibility for Nursing Judgments, Decisions, and Actions 65
4.4 Assignment and Delegation of Nursing Activities or Tasks 68
Provision 5. The Nurse as Person of Dignity and Worth 73
Introduction 73
5.1 Duties to Self and Others 78
5.2 Promotion of Personal Health, Safety, and Well-Being 79
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5.3 Preservation of Wholeness of Character 81
5.4 Preservation of Integrity 85
5.5 Maintenance of Competence and Continuation of Professional Growth 88
5.6 Continuation of Personal Growth 90
Provision 6. The Moral Milieu of Nursing Practice 95
Introduction 95
6.1 The Environment and Moral Virtue 102
6.2 The Environment and Ethical Obligation 104
6.3 Responsibility for the Healthcare Environment 105
Provision 7. Diverse Contributions to the Profession 113
Introduction 113
7.1 Contributions through Research and Scholarly Inquiry 115
7.2 Contributions through Developing, Maintaining, and Implementing Professional Practice Standards 122
7.3 Contributions through Nursing and Health Policy Development 122
Provision 8. Collaboration to Reach for Greater Ends 129
Introduction 129
8.1 Health Is a Universal Right 131
8.2 Collaboration for Health, Human Rights, and Health Diplomacy 132
8.3 Obligation to Advance Health and Human Rights and Reduce Disparities 137
8.4 Collaboration for Human Rights in Complex, Extreme, or Extraordinary Practice Settings 140
Provision 9. Social Justice: Reaching Out to a World in Need of Nursing 151
Introduction 151
9.1 Articulation and Assertion of Values 155
9.2 Integrity of the Profession 155
9.3 Integrating Social Justice 159
9.4 Social Justice in Nursing and Health Policy 160
Appendix A. Code of Ethics for Nurses with Interpretive Statements (2015) 171
Index 211
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Acknowledgments
No book is the work of one person. Even single-author works owe a debt of gratitude to all those who went
before them, as well as those who helped along the way. This book is indebted to the nurses who, from the
inception of modern nursing to the present, have devoted themselves both to nursing and to its ethical
tradition and have sought to build that tradition. Florence Nightingale, Isabel Robb, Charlotte Aikens,
Charlotte Talley, Sara Parsons, Rose Helené Vaughn, Patricia Goodall, and Lystra Gretter are some of the
names that any student of nursing ethics history will come to know. It is upon the remarkable foundation that
their work laid that nursing ethics continues to develop.
In the present there are many colleagues whose commitment to nursing ethics is enduring, rigorous,
scholarly, and always ultimately directed toward the recipients of nursing care, while also with a heart for
nurses themselves. A number of persons are deserving of special acknowledgement in the preparation of this
work. In particular, Col. Martha Turner, PhD, RN-BC, USAF NC (Ret.) who read and critiqued the
manuscript with great knowledge, insight, and wisdom, and who responded to all my annoying late night
queries with alacrity. I also acknowledge the invaluable assistance of Denise Gehring, MS (LIS), MA who
used her magical librarian skill to scour the globe for obscure articles that were needed to support the research
for this volume. I firmly believe, and have written elsewhere, that a good librarian is the right arm of a
researcher. There have been many over the years who have been faithful nursing colleagues and friends of
inflorescent dignity (see Chapter 1) who also possessed just the right balance of humor, imagination, curiosity,
scholarship, and eccentricity: Anne Davis, Verena Tschudin, Patricia Benner, Marilyn Flood, Sonya Grypma,
Marianne Hattar, Barb Pesut, Sheryl Reimer-Kirkham, Rick Sawatzky, and Beth Johnston Taylor. Co-
conspirators though they may have been over the years, the blame for any “dodgy bits” in this manuscript
belong solely to me and not to them. Thanks also to Eric Wurzbacher, editor extraordinaire at ANA, who
was intrepid in his efforts to bring this work ever so rapidly to print.
Finally, to my dear family, friends, personal trainer, dogs, hens, bicycle, and garden, which were sorely
neglected during this process, I apologize and promise to mend my ways.
Marsha Fowler
Thanksgiving Day 2014
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Author’s Preface.
Review & Renewal: The Half-Life of a Code
A code of nursing ethics cannot be static, neither can it be unstable. It must be enduring and rooted in the
core of nursing identity, but must also be responsive to the growth, development, and context of practice.
Thus, approximately every decade a profession’s code of ethics must be reviewed for datedness, fit with
practice, and inclusion of emerging concerns and directions. However, the central importance of this code of
ethics requires that its periodic revision be undertaken with great care and with attention to the voices from all
of nursing’s specialties and settings. Thus the 2001 ANA Code of Ethics for Nurses with Interpretive Statements
(the Code) underwent a four-year process of revision that led to the renewed Code of Ethics for Nurses with
Interpretive Statements, 2015. The process began in 2010 and concluded in August 2014 after which it was
approved by the Ethics Advisory Board and the Board of Directors of the ANA for formal adoption.
From October 2010 to March 2011, the Ethics Advisory Board (EAB) reviewed the 2001 Code,
recommended that it undergo a review process, and submitted this request to both the ANA President and
CEO. The request was approved. A workgroup to review the Code was formed with the following charge:
You will not edit the Code provisions or Interpretive Statements but will seek input by preparing a request
for public comment to determine need for clarification, change, or addition. Recommendations will be to a)
allow current Code of Ethics for Nurses to stand or b) form a committee to draft edits based on comments
and review.1
The Code Review Workgroup reviewed the Code itself and, via NursingWorld (NursingWorld.org),
conducted an online public survey of nurses and interested persons who also reviewed the Code and suggested
revisions. The Workgroup analyzed approximately 2,800 suggestions for revision that were made on the
survey and via other communications. The Code Review Workgroup then recommended to the EAB that the
Code be revised and that the EAB communicate this recommendation to the ANA President and CEO.
The recommendation and request were received and subsequently a 15-member steering committee for the
revision of the Code was formed with the following charge:
To complete a revision of the Code of Ethics for Nurses based upon the recommendations of the Code of
Ethics Review Workgroup recommendations to retain what is possible of the 2001 Code, make changes to
the content of interpretive statements to improve organization, streamline the wording, expand to be
inclusive of new/current concepts, and update the vocabulary.2
The steering committee met monthly by conference call between September 2013 and April 2014 to draft a
revision that incorporated public comment. That draft was posted for public comment between May and June
2014. Approximately 1,500 comments and suggestions were received on the draft. In a meeting in Silver
Spring, Maryland, the steering committee evaluated the suggestions and prepared a final draft for submission
to the EAB for their vote of approval and with a recommendation that it be sent on to the Board of Directors
for approval. The EAB received the final draft and approved it in October 2014. It was then forwarded to the
ANA Board of Directors who approved it for adoption on November 12, 2014.
In 1950, the Code for Professional Nurses referred only to the provisions of that Code. At that time there were
no interpretive statements, although a series of articles on the Code was subsequently published in the
American Journal of Nursing. The 1960 Code consisted of 17 provisions that were accompanied by interpretive
statements that were explanatory in nature. With reference to the 1950, 1960, and 1968 Codes, the title Code
for Professional Nurses applied only to the provisions themselves. The 1976 revision of the Code was a turning
point in two major ways. First, the number of provisions was significantly reduced. Second, the interpretive
statements took on new force as they shifted from explanatory to interpretive, and the nature of the language
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changed from permissive to mandatory. From 1985 onward (2001, 2015), the interpretive statements become
the definitive interpretation of the provisions with the force of standards. Thus, today, the Code of Ethics for
Nurses with Interpretive Statements, including both provisions and interpretive statements, forms the non-
negotiable moral standard for the profession.
The Code of Ethics for Nurses with Interpretive Statements is remarkable in its breadth and compass. It retains
nursing’s historical and ethical values, obligations, ideals, and commitments, while extending them into the
ever-growing art, science, and practice of nursing in 2015. As a foundational ethical standard of practice, the
Code should also be a source of “pride of profession.”
Marsha D.M. Fowler, PhD, MDiv, MS, RN, FAAN
Professor of Ethics
Senior Fellow, Institute for Faith Integration
Azusa Pacific University, Azusa, CA
Assistant Pastor, New Hope Presbyterian Church, Pasadena, CA
Member, ANA Committee on Ethics, 1985–87; Chairwoman, 1987–89
Member, project team for the evaluation of the 1985 Code for Nurses with Interpretive Statements, for revision,
1995
Member, Task Force for the Revision of the 1985 Code for Nurses with Interpretive Statements, 1996–2001
Member, ANA 2001 Code of Ethics for Nurses with Interpretive Statements Revision Workgroup, 2012–2013
Historian and Code Scholar, co-lead writer, ANA Steering Committee for the Revision of the 2001 Code of
Ethics for Nurses with Interpretive Statements, 2013–2014
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