How Ethics in Nursing Impacts Patient Care

Nursing demands acute healthcare knowledge and technical skills, but that’s not all. The profession also requires something substantially more internal: a clear moral compass and nursing code of ethics to direct it.

From navigating cultural beliefs to practicing patient confidentiality, nursing ethics operate as the framework from which decisions are made and care is provided.

But what are the primary ethics in nursing, and how can they enhance patient outcomes and care?

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The Core Principles of Nursing Ethics

Established by the American Nurses Association (ANA) in the 1950s, the Code of Ethics for Nurses with Interpretive Statements functions as a reference point and set of moral principles that inform patient care.¹

While the Code of Ethics is continually updated to remain relevant amidst changing societal beliefs, technological advances, and new frontiers in all levels of nursing, it maintains several of its original ethical values, chiefly:

Autonomy – Autonomy in nursing is two-fold: It refers to a nurse’s ability to make clinical decisions that fall within the scope of their practice as defined by their state and healthcare organization, as well as the patient’s right to make informed decisions about their care—even if such choices are not aligned with their healthcare team’s recommendations.
Beneficence – Simply put, beneficence is a nurse’s pledge to provide care that’s in the patient’s best interest.² This involves (but certainly is not limited to) honoring their patients’ wishes about their care, helping patients uphold their dignity, and providing care that will promote their patients’ well-being.
Justice – “Justice” refers to equality of nursing care, regardless of the patient’s sexual orientation, gender, age, religion, ethnicity, or financial status. Justice assures that every patient is treated with the same level of respect and attention—and aims to minimize disparities in patient care across demographics.
Nonmaleficence – In its purest terms, nonmaleficence—one of the most fundamental tenets in nursing ethics—means “do no harm” or steering clear of actions that may have a negative outcome. This entails assessing the potential risks and benefits clinical decisions may have on a patient, such as scarring from surgery or the possibility of experiencing an adverse reaction to a medication.

These may be the four most common and essential principles, but ethics in nursing also asks nurses to demonstrate accountability, veracity, and fidelity—or remaining steadfast in their responsibilities and working from a place of honesty and integrity.³

Ethical Decision-Making in Nursing Practice

Nursing ethics is not merely a theory but an ongoing practice. And yet, even the most experienced, ethically sound nurses encounter dilemmas that challenge both their understanding of the Code of Ethics and their deeply held values.

To that end, the Nursing Service Organization recommends using a systematic approach originally crafted by the American Counseling Association (ACA) when faced with situations that have no clear right or wrong solution.⁴ The seven-step process involves the following:

Identifying the issue and collecting pertinent information, all while ensuring it is an ethical question—not a legal, professional, or clinical complication
Referring to the Code of Ethics for guidance
Understanding the core of the problem and exploring its nuances and implications
Brainstorming several courses of action
Weighing the possible repercussions of each course of action and determining the best route for moving forward
Assessing the selected solution, particularly with the concept of justice in mind
Implementing the course of action

Naturally, some ethical decisions must be made in the moment. When this occurs, a nurse may pause and reflect on the predominant ethics of nursing—or, if time permits, consult with a manager or nursing mentor.

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Common Ethical Dilemmas in Nursing

Nursing is frequently rated one of the most rewarding occupations in the nation, as there are many benefits of nursing, and yet the profession involves navigating ethical uncertainties with candor, competence—and, again, loyalty to the Code of Ethics.⁵

But what do these ethical dilemmas look like, exactly?

Given the sheer variety of patients nurses see, it’s close to impossible to anticipate every moral challenge a nurse might have to contend with throughout their nursing career. However, a few of the most common include:⁶

Informing a patient of their condition – If a patient has been diagnosed with a terminal condition, their spouse or children may ask their nurse (or nurses) to refrain from telling them.⁷ This may be understandable from an emotional lens, but the principles set forth by the Code of Ethics—namely, fidelity and nonmaleficence—indicate that healthcare professionals have an ethical obligation to tell their patients the truth.
End-of-life care – It is an all too prevalent scenario: A patient at the end of their life may insist they would like to die a serene death without medical intervention, but their family insists on doing whatever it takes to keep them alive. This is where autonomy and beneficence come into play: According to these standards, a nurse must respect their patient’s wishes (especially if there is an advance directive).
Pain management – What should a nurse do if a patient requests additional pain medication? On the one hand, they are ethically obligated to help relieve their patient’s pain (beneficence); on the other hand, honoring their request may place them at risk for addiction (nonmaleficence). The systematic approach outlined above may be the answer— that and consulting with the patient’s primary care physician.
Patient advocacy – One of the main duties nurses have is serving as an advocate for their patients and educating them on their treatment options, recommended procedures, and overall care. If a patient does not appear to grasp the particulars of an urgent treatment, should their nurse delay the procedure, or should they move forward? There is no one-size-fits-all answer to this ethical dilemma, but it may require bringing a family member into the decision process or providing the patient with additional (and clearer) information.

Other frequent ethical dilemmas in nursing also include allocating resources while remaining dedicated to the principle of justice/equal care, reporting an impaired colleague (and other unethical behaviors within a healthcare institution), and the appropriate use of technology. The solutions to these are case-by-case, of course, but nursing ethics must largely inform them.

The Impact of Ethics on Patient Care

The benefits of adhering to nursing ethics extend well beyond the direction they provide and the confidence they inspire. Not only does the Code of Ethics help ensure that all patients are treated fairly, but it also empowers patients to take an active role in their care and fosters better overall engagement.

What’s more, following the ethical principles preserved by the ANA helps nurses build bonds with their patients—and trust and collaboration are at the heart of a positive nurse-patient connection. With such a relationship in place, a patient may experience improved health outcomes and reduced treatment time, while nurses may enjoy enhanced job satisfaction.⁸

Nursing ethics enriches public trust in the nursing profession—and helps healthcare organizations demonstrate that they’re invested in the holistic well-being of their patients.

Preparing for Ethical Challenges in Nursing Education

Have you found yourself wondering about the ethics nursing requires as you consider the profession? If so, you can rest assured that nursing ethics are a substantial part of the educational program.

ӣ��Ƶ gives nursing students an enlightening education that emphasizes the role ethics play in healthcare. From a bachelor of science in nursing to our nursing master's programs, we offer the education you need to approach work-based ethical dilemmas with compassion, self-assurance, and, most importantly, knowledge. Case studies, hands-on experience, and a comprehensive curriculum are all used to prepare you for the vigor—moral and otherwise—of the nursing profession.

To top it all off, we designed our nursing and health sciences programs with the contemporary student in mind and offer a hybrid online/in-person model led by innovative and creative faculty.

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Sources:

“Why Ethics in Nursing Matters: Ethical Principles in Nursing.” ANA, February 12, 2024. . Accessed March 19, 2024.
Werezak, Leona. “What Is Beneficence in Nursing?” Nurse.org, January 20, 2023. . Accessed March 19, 2024.
Faubion, Darby. “7 Main Ethical Principles in Nursing + Why They’re Important.” 7 Ethical Principles in Nursing + Why They’re Important. Accessed March 19, 2024. . Accessed March 19, 2024.
“Ymaws.” Nursing Services Organization. . Accessed March 19, 2024.
20 of the most rewarding careers | indeed.com, June 21, 2023. . Accessed March 19, 2024.
Werezak, Leona. “10 Examples of Ethical Dilemmas in Nursing.” Nurse.org, December 11, 2023. . Accessed March 19, 2024.
Wood, Debra. “Nursing Ethics: 4 Common Ethical Dilemmas: Amn Healthcare.” Nursing Ethics: 4 Common Ethical Dilemmas | AMN Healthcare, November 16, 2023. . Accessed March 19, 2024.
"Nurturing Trust in the Nurse-Patient Relationship.” ANA, February 12, 2024. . Accessed March 19, 2024.

Author

Lisa Radesi

Associate Professor

School of Nursing and Health Sciences

Dr. Lisa Radesi DNP, MSN-Ed, MSN-CNS, RN, PHN, is the Associate Dean/Program Director/Associate Professor for the School of Nursing and...

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