Nursing has changed tremendously in the last twenty years. Advanced degrees at the master’s and doctoral levels, as well as advanced practice nursing, have created expanding opportunities for nurses to contribute to health care, education, research, public awareness, and health and social policy in unprecedented ways. Nursing research has blossomed. Nurses hold prominent positions, both appointed and elected, in government, philanthropy, and social policy institutes. One of these, the National Institutes of Health’s National Institute for Nursing Research (NINR), is focused on nursing research. Nursing issues are prominent on the agendas of Congress, the United Nations, and such influential private organizations as the Robert Wood Johnson Foundation, the Pew Charitable Trusts, and the RAND Corporation.

In the initial review of the Code of Ethics of 1985, it was recognized that the previous Provision 7 (“The nurse participates in activities that contribute to the ongoing development of the professional’s body of knowledge.”) required expansion and clarification for several reasons. First, this provision placed emphasis on the importance of knowledge development without acknowledging the many other ways nurses can advance the nursing profession. The current formulation recognizes the multifaceted complexity of contemporary nursing practice and seeks to make the provision relevant to nurses in all settings and roles. Second, the individual nurse has just as much of an obligation to the profession as the profession has to the individual nurse. This reciprocity was not addressed in the previous formulation, but it is a significant aspect of the current formulation. Third, education, practice, and administration, as well as knowledge development are inherently interdependent. Little forward movement in the profession can be made if new knowledge is not translated into practice. Educators must be aware of the realities of practice as well as the latest advances in research. Administrators must create an environment that is supportive of the
ongoing educational needs of nurses and conducive to rapid implementation of innovation. Quality patient care is dependent upon the development of effective educational methods; efficient, cost-effective system administration, and research to guide the provision of nursing care. Finally, patient well-being is dependent upon a vibrant, evolving nursing profession that is responsive and able to anticipate the emerging needs of society and healthcare systems. The profession can only advance through the participation of nurses who are open to learning, and incorporating new knowledge. Clearly, the future of the profession is dependent upon more than the work of a few individuals; it requires the active engagement of all nurses.

Provision 7 challenges the nurse to participate in the profession’s contributions to society by being actively engaged with its progress and development. One purpose of the Code is to reinforce the bonds between the individual who chooses to enter the nursing profession, the practice of the individual nurse, and the social roles and obligations of nurses within society. This provision creates a moral link between the nurse as a person, the individual practice of the nurse, and the nursing profession as a whole. This link is necessary in order for the nurse to hold a coherent sense of professional obligation that complements the individual’s sense of self.

Note how Provisions 4, 5, 8, and 9 are closely linked in Provision 7. The nurse as a moral agent is described in Provision 5. Provision 4 describes the moral obligations of the nurse as a practitioner. Provision 8 describes the nurse’s moral obligation to society. Provision 9 describes the responsibilities of the nursing profession to both the individual nurse and society in general. Provision 7 provides the necessary linkage between individual competence and evolving professional standards of practice, in addition to giving nurses a responsive and collaborative role in health policy for the overall advancement of the profession. It also clarifies the interdependent relationship between the ability of the nursing profession to contribute to society and the well-being and development of the individual nurse and the profession as a whole. Just as a nurse who is undertrained, unsupported, and isolated cannot contribute to the patient’s well-being, a profession that is undeveloped, fragmented, and lacking in the commitment and support of its practitioners will be limited in its ability to benefit society.

It is not expected that the individual nurse will be proficient in all areas of nursing or engaged with each facet of development required for advancement of the profession (education, practice, administration, and knowledge development). However, the nurse cannot afford to be indifferent to the advancement of the profession; our systems of health care change rapidly and nursing as a profession must anticipate and adapt to these changes in order to meet the needs of patients. The expectation laid out in Provision 7 is that the individual nurses will bring their talents and experience to the ongoing conversation about nursing practice and standards that is needed to advance the profession as a whole. Individual competence cannot be maintained without the nurse’s awareness of changes in professional practice, standards, and health policy. Advancements in these areas cannot be attained without input from all areas of nursing practice. The demands of nursing exceed the capacity of any individual working in isolation. The interdependence between nurses, their practice, the profession, and the many facets of nursing knowledge is implicit in both Provisions 7 and 9.

The three interpretive statements are like the layers of an onion and serve to amplify the meaning of Provision 7 and illustrate its application to nursing practice. Each exposes a different layer of involvement for the nurse. It is this layered component of practice that provides for a vibrant, flourishing profession. As you peel back the layers, you expose the center of nursing—patient care. Yet without these outer layers to protect it, the center could not survive. So, while the initial provisions of the Code explicitly focus on patient care as the center of nursing, succeeding provisions also have the patient at the center.

The first interpretive statement directs the nurse to the outermost layer of interaction between the profession and society; it calls on the nurse to be actively involved in health policy and the organizations that serve as an interface between nursing practice and the public. The second interpretive statement directs the nurse to the regulation and scope of individual professional practice; it calls on the nurse to be actively involved in the development and implementation of professional standards. The third interpretive statement shields the center of nursing; it directs the nurse to develop, adapt, and utilize the research necessary for the provision of safe and effective patient care.