An Updated Code of Ethics for Nurses as a Call to Action

By Katheren Koehn, MA, RN, executive director of the Minnesota Organization of Registered Nurses (MNORN) and a member of AJN‘s editorial board.

In January, the American Nurses Association declared 2015 to be “The Year of Ethics,” to highlight the first revision to the Code of Ethics for Nurses with Interpretive Statements since 2001. Last week, in Baltimore, ANA hosted an Ethics Symposium to facilitate a dialogue about just what the Code means to nursing practice.

This was not your typical esoteric ethics conference, with terms like beneficence, nonmaleficence, fidelity, and utilitarianism floating throughout the sessions. At this symposium the Code of Ethics became a unifying “Call to Action” for the profession.

In welcoming comments, Patricia Davidson, dean of Johns Hopkins School of Nurses, spoke of how ethical practice is critical for improving health care, especially with the move to person-centered care. She reminded us of the moral imperative to address entrenched health disparities, including access to care, and urged each of us to summon our own courageous leadership as we advocate for patients and families and question “entrenched beliefs.”

ANA President Pam Cipriano gave an overview of the Code of Ethics for Nurses, which articulates the ethical obligations and duties of every nurse. The Code binds us together, according to President Cipriano, no matter what practice setting we work in, or job title we hold. It is our nonnegotiable ethical standard, expressing our profession’s understanding of our commitment to society. There is no “opt-out” from the Code—no exceptions, no days when it just doesn’t apply.

The fundamentals are unchanged. The nine provisions of the Code of Ethics will be familiar, because they did not change with this newest revision.

• Provisions 1–3 are about the “fundamental values and commitments” of the nurse, and include concepts of compassion, respect, advocacy, protection and safety.
• Provisions 4–6 describe the “boundaries of duty and loyalty,” and include concepts of authority, accountability, responsibility, self, and ethical environment(s).
• Provisions 7–9 describe “duties beyond patient encounters,” including research, scholarly inquiry, human rights, health disparities, social justice and the integrity of the profession.

What’s new? While the provisions didn’t change, there is new language about nursing leadership, social and health policy, and global health, as well as updated language and concepts. There is also, for the first time, a helpful glossary of terms. These revisions occurred after an inclusive process including 7,800 responses from nurses to the initial inquiry about what should be updates, and 3,000 comments after the draft document was sent out for field review.

Call to action. After the overview, Diana Mason, president of the American Academy of Nursing, returned us to the concept of the Code of Ethics as a call to action, as she highlighted “action” words and phrases located in the nine provisions, including:

• Promotes, advocates for, and protects
• The obligation to promote health and provide optimum care
• Applies to the nurse, in all roles and settings
• Protect human rights, promote health diplomacy, and reduce health disparities

Was nursing’s current focus, she went on to ask, really on promoting the health of people? What might we do to change the focus of health care from one that is based on health rather than illness? She reminded us that, as nurses, we have an ethical responsibility to work towards the health of communities and all people.

The two-day symposium’s many sessions drew upon the theme of a call to action with titles such as “Integrity: Creating, Sustaining, and Changing Ethical Environments,” “Moral Courage: Building Resilience,” “Evolving Ethics: Implications of Technology,” and “Relieving Suffering: Boundaries of Ethical Practice.”

Many speakers emphasized that the Code of Ethics must be foundational, a shared commitment, as a profession, to society, and in her closing remarks, Pam Cipriano of the ANA reminded us that we have a moral obligation to work toward solutions to current challenges, such as health equity and safe staffing. These actions demand courage, moral integrity, hope and leadership, but “we can stand together, using the authority of the Code as our ‘true North.'”

As she reminded us, every single one of us can be courageous in small and large ways.