Introduction

From the moment a nurse enters into professional practice she or he is bound by strict standards of professional conduct. The standards of conduct expected of professional nurses are stated publicly in a range of documents including formally endorsed professional codes of conduct, codes of ethics, competency standards and guidelines and position statements formulated on a range of issues relevant to the profession and ethical practice of nursing. For example, nurses in Australia are bound by the standards of conduct expressed in the following documents published by the Nursing and Midwifery Board of Australia (NMBA):

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  Code of conduct for nurses (2018a)

  
  
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  Nurse practitioner standards for practice (2014)

  
  
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  Registered nurse standards for practice (2016).

(Note: These and other documents, such as policies, guidelines, case studies and position statements, can be viewed by visiting http://www.nursingmidwiferyboard.gov.au/ and following the links under ‘Professional Codes & Guidelines’ ( https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx ).)

Nurses in New Zealand, meanwhile, are bound by the standards of conduct expressed in various documents published respectively by the Nursing Council of New Zealand (NCNZ) and the New Zealand Nurses Organisation (NZNO), such as:

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  Code of conduct for nurses ( NCNZ 2012a )

  
  
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  Code of ethics ( NZNO 2013 )

  
  
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  Competencies for nurse practitioners ( NCNZ 2012b )

  
  
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  Competencies for registered nurses ( NCNZ 2016 )

  
  
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  Guidelines for cultural safety, the Treaty of Waitangi and Māori health in nursing education and practice ( NCNZ 2011 )

  
  
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  Guidelines: professional boundaries ( NCNZ 2012c )

  
  
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  Guidelines: social media and electronic communication ( NCNZ 2012d ).

(Note: This and other documents can be viewed by visiting: http://www.nursingcouncil.org.nz/Publications/Standards-and-guidelines-for-nurses and http://www.nzno.org.nz/resources/nzno_publications .)

Nurses working in other countries (e.g. Canada, Hong Kong, India, Korea, Singapore, Thailand, United Kingdom (UK) and the United States of America (USA)) are likewise bound by the standards of conduct and related policies and guidelines developed, endorsed and published by their respective national nurse organisations and regulating authorities, such as nursing associations, boards and councils (see Box 1.1 ).

In addition, in countries where national nursing organisations are also in membership with the International Council of Nurses (ICN) (currently the ICN represents over 20 million nurses worldwide in more than 130 countries), nurses are also bound by the codes, policy and position statements published and endorsed by the ICN. Of particular note are the ICN’s:

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  The ICN code of ethics for nurses (2012a)

  
  
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  Position and policy statements on a range of issues relating to:

  
  
  
  
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    nursing roles in health care service

    
    
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    nursing profession

    
    
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    socioeconomic welfare of nurses

    
    
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    health care systems

    
    
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    social issues.

  
  

(Note: these can be viewed at: http://www.icn.ch .)

A range of resources including fact sheets, position statements, and guidelines have been devised in relation to each of the above issues, which can all be viewed via the ICN web pages. (For a comprehensive examination of The ICN code of ethics for nurses and related position statements, and their application as a guide to ethical decision-making in nursing, see Fry & Johnstone 2008 .)

In Australia, the obligation to uphold the ICN Code and related guidelines is more specific owing to the NMBA, the Australian Nursing and Midwifery Federation (ANMF) and the Australian College of Nurses (ACN) conjointly agreeing to abandon the Australian Code of ethics for nurses in Australia ( NMBA 2008a , first published in 1993) in favour of adopting The ICN code of ethics for nurses (2012a) as the guiding document for ethical decision-making for nurses in Australia. Due to the formal adoption of the ICN Code by the Australian nursing organisations, upon its coming into effect 1 March 2018 the extant Code of ethics for nurses in Australia ( NMBA 2008a ) and Code of professional conduct for nurses in Australia ( NMBA 2008b ), both of which had been developed specifically for application in the cultural context of Australia, ¹ were superseded and are now redundant. (The NMBA’s abandonment of its code of ethics and shift to a more managerial and regulatory approach to professional conduct will be considered further in Chapter 2 of this book.)

The requirement to uphold exemplary standards of conduct

The requirement for nurses to be ethical and to uphold the highest standards of conduct when practising in a professional capacity is not unique to nursing. It is generally expected that, when performing their duties and conducting their affairs, professionals (of all fields) will uphold exemplary standards of conduct – which is commonly taken to mean standards that are higher than, and not generally expected of, lay people or the ‘ordinary person on the street’. A key reason underpinning this expectation relates to the potential vulnerability of clients and an associated expected ‘special obligation’ on the part of professionals to reduce this vulnerability by conforming to ‘particularly high ethical standards both in their professional and non-professional lives’ ( Freckelton 1996 : 142). This expectation also relates to what Mortensen (2002 , p 166) describes in the context of the legal profession as the ‘overarching principle’ of qualifications to practise – notably, protecting the public and providing assurance to the public that those registered to practise can be trusted to do so safely. To this end a ‘thicker’ standard other than that set by law is required – notably, moral standards of character, competency and commitment involving a deep appreciation in moral terms of how the public interest is best served ( Mortensen 2002 , p 175). Such are these and related expectations that exemplary standards of ethical conduct have historically been cited as one of the key hallmarks of professionalism and indeed as a necessary feature of professions generally ( Bayles 1981 ).

Nurses are also expected to uphold exemplary standards of ethical conduct in their personal or ‘non-professional’ lives. The main reason for this is that engaging in unethical conduct in their personal lives risks bringing both themselves and the nursing profession into disrepute, thereby losing the trust of the public.

A notable feature of the respective standards, policies and guidelines that have been operationalised by Australian, New Zealand and other national nursing organisations around the world is that they function as ‘companion codes’. When taken together, these companion codes provide a framework for legally and professionally accountable and responsible nursing practice in all its domains including clinical, management, leadership, governance and administration, education, research, advice / consultation and policy development. The standards contained in the codes work by setting the ‘ethical baseline’ against which a nurse’s conduct can be measured and evaluated. Thus, if a nurse engages in conduct that breaches the agreed standards of the profession (i.e. fails literally to ‘measure up’ to the standards in question), this may be deemed as unethical professional conduct or professional misconduct and may result in a notification being made to a nurse regulating authority. (The requirement to make notifications of unprofessional conduct or professional misconduct to a nurse regulating authority is discussed in more depth in Chapter 12 of this book.)