Although ethics is considered a distinct and separate standard of professional performance, it is a concept that is an inherent component of all of the standards of professional practice and performance, as well as across all nursing roles and settings. Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) is the ethical standard and framework for the nursing profession. The document guides nurses who encounter everyday ethical issues as well as more challenging ethical situations such as end-of-life decisions. Ethics occur within the context of relationships with others. The relationships include those of nurse to healthcare consumer, nurse to physician, nurse to other members of the interprofessional team, nurse to nurse, nurse to employer, nurse to profession, nurse to nursing students, and nurse to society. The concept of ethics also occurs within the context of nurses’ personal and professional values and the core values of the profession.

The Code of Ethics for Nurses, which has evolved over time, is a dynamic document that is revised periodically to remain current with the advances in the profession and in the healthcare environment. The Code reflects the profession’s central and enduring values, which include service to and duties toward those for whom we care, as well as to ourselves. The values of the profession provide a frame of reference for priority setting and for ethical decision-making.
Those shared professional values are inherent in the professions code of ethics. In contrasting the profession’s ethical standard with its legal standard (nurse practice acts), actions that are ethical may not be considered to be legal. In turn, what is legal may not be perceived as being ethical and may be in conflict with one’s personal values. The Code of Ethics for Nurses is a resource for nurses when faced with difficult situations.

As stated in the Code of Ethics for Nurses, “ethics is an integral part of the foundation of nursing” (ANA, 2001, p. 5). This foundation, by which the nursing profession fulfills its commitment to serve the interests of society by embracing and acting according to a strong code of ethics, is an integral component of nursing’s social contract (ANA, 2010a, p. 5). In whatever role or setting, nurses share a commitment to ethical practice and to service as ethical role models for others. Nursing’s relationship with patients (whether an individual, family, group, or community receiving nursing care and services) is based on the social contract between society and the profession.

The terms ethics and morals are often used interchangeably. Morality usually refers to one’s personal behavior related to distinguishing right from wrong. Although ethics are central to the concept of morality when making ethical choices and decisions, one often must choose between options where there is more than one right choice or where there are equally less than acceptable choices. Many of the ethical issues encountered daily by nurses relate to protecting the rights of patients and families, upholding their autonomy, ensuring informed consent, and assisting patients and families in the expression of self-determination such as advanced directive decisions. Nurses also confront legal and regulatory issues, such as deciding when and how to question inappropriate behaviors of other healthcare professionals or practices that affect the quality of patient care and safety. Those issues, along with others associated with safe staffing and its effect on quality of care, are associated with caregiver stress, job satisfaction, and retention (Ulrich et al., 2010). Having the ability to deal effectively with such everyday ethical issues—in addition to the more serious life-and-death and end-of-life issues—comprises the competencies that nurses must possess as part of the professional performance standard that is related to ethics. In turn, administrators in practice settings where nurses work are responsible for creating healthy work environments by providing adequate resources and organizational mechanisms such as ethics committees, consultants, and education to assist nurses who address ethical concerns.

In the standard of professional performance related to ethics, several competencies identify the nurse’s role in advocating for—and protecting the rights of—those for whom we care and provide services, whether they are
individuals, family members, communities, groups, systems, or other stakeholders. Additional competencies include participation in interdisciplinary teams and in organizational mechanisms that address and inform ethical decisions and outcomes. Collaboration with others in influencing resource allocation and in advocating for patients is itself an ethical process.

Ethical nursing practice, as a part of the foundation of nursing, provides the basis for nurses’ commitment to society to provide and ensure safe and quality patient care. In doing so, nurses in all areas of practice settings and roles demonstrate the value that society places in the profession. Over the past several years, the annual Gallup poll survey about honesty and ethics in professions has placed nurses at the top.