Graduates of nursing school take the Nightingale pledge during the pinning ceremony; this pledge indicates a commitment to ethical action throughout the entirety of one’s nursing practice.
Regardless of when nurses take the Nightingale Pledge, they promise to act in accordance with its principles. The importance of this pledge warrants a reminder of what it entails.
Code of Ethics in Nursing
The Code of Ethics for Nurses with Interpretive Statements often referred to as ‘The Code’ forms “…the social contract that nurses have with the U.S. public. It exemplifies our profession’s promise to provide and advocate for safe, quality care for all patients and communities. It binds nurses to support each other so that all nurses can fulfill their ethical and professional obligations” (Ethics and Human Rights, n.d.).
Nurses use the Code as a guide to provide safe, ethical, and consistent nursing care. Though individual values may differ, the Code entitles patients to receive similar quality of care from nurse to nurse.
Nursing school curriculum includes guidance on four ethical principles: autonomy, beneficence, justice, and non-maleficence. These principles guide nurses and the actions they take in day-to-day practice.
Autonomy involves the patient’s right to make an informed decision regarding their care. For example, if a patient requires an appendectomy, nurses provide all options, including risks, benefits, and potential complications. The patient then has the right to decide if the surgery serves their individual needs.
When a patient decides about their healthcare, various factors influence that decision. Examples include gender, sexual orientation, culture, age, overall health, and support system (Gaines, 2021).
Nurses “…have a duty to refrain from maltreatment, minimize harm, and promote good towards patients,” also known as beneficence (Haddad & Geiger, 2021).
Beneficence involves more than just treating patients kindly; it also guides nurses to keep patients safe, such as putting up bed rails before leaving the room and putting slip-resistant socks on patients.
Justice indicates that nurses practice with fairness. Nurses must provide the same medical care to all patients, despite their financial situation, sexual orientation, gender, race, or religion (Gaines, 2021). Nursing practice can be challenging when nurses disagree with patients, but nurses have an obligation to remember that all patients deserve the same care.
The last principle, non-maleficence, means that nurses do not harm patients. Non-maleficence guides care by ensuring that selected interventions provide the least harm to achieve a positive outcome for the patient (Gaines, 2021).
History of the Code
The Code has been in effect, in some variation, since the late 1800s. The Code, sometimes referred to as the “Nightingale Pledge,” takes its name from Florence Nightingale and stands as a modification of the Hippocratic Oath.
Formally adopted in the 1950s, the Code, has undergone various changes since then, with the most radical change in 2015. The 2015 modification included interpretive statements to guide nursing practice (Gaines, 2021).
In 2015, The Code of Ethics for Nurses with Interpretive Statements expanded on the principles to further assist nurses in making ethical decisions.
The updated Interpretive Statements include the following:
- The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
- The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
- The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
- The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and acts consistent with the obligation to provide optimal patient care.
- 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.
- 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.
- 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.
- The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
- The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
The healthcare climate changes regularly, and updates to nursing ethics and laws allow nurses to enact these changes and embody them in their practice.
The nursing response to the COVID-19 pandemic stands as an issue at the forefront of change. Though nurses pledge to provide ethical care to patients, the pandemic has brought forth issues that nurses may find difficult due to their personal beliefs.
Nursing researchers in Jordan sought to investigate nurses’ ethics during the care of COVID-19 patients. The researchers studied ten nurses and identified the following themes:
- The obligation of nurses to provide care, despite medical diagnoses
- The dilemma with vaccination
- Nurses’ self-care
The study, though small, identified that nurses wonder, ethically, if “…during pandemics, such as the COVID-19 pandemic, . . .whether nurses can refuse to provide patient care to protect themselves” (Alloubani et al., 2021).
The Bottom Line
Nurses pledge to act ethically and have an ethical duty to stay informed about updates to nursing ethics and laws that can impact nursing practice.
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Krysti Ostermeyer is an RN, Certified Diabetes Care and Education Specialist (CDCES), and a freelance writer. She enjoys writing about health, wellness, and nursing. She dreams about being a full-time writer when she grows up.
When Krysti isn’t working, she enjoys mountain biking, hiking, taking walks, practicing yoga, reading, and drinking copious amounts of iced coffee.
Alloubani, A., Khater, W., Akhu-Zaheya, L., Almomani, M., & Alashram, S. (2021). Nurses’ Ethics in the Care of Patients During the COVID-19 Pandemic. Frontiers in Medicine. https://www.frontiersin.org/articles/10.3389/fmed.2021.589550/full
Ethics and Human Rights. (n.d.). American Nurses Association. Retrieved January 16, 2022, from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/
Gaines, K. (2021, July 22). What is the nursing code of ethics? Nurse.org. https://nurse.org/education/nursing-code-of-ethics/
Haddad, L. M., & Geiger, R. A. (2021, August 30). Nursing ethical considerations. NCBI; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/