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Nursing ethics: 4 main principles

By Laurie Davies

At a glance

  • The American Nurses Association formally adopted the Code of Ethics for Nurses in 1950.
  • There are four principles of ethics: autonomy in nursing, beneficence in nursing, justice in nursing and nonmaleficence in nursing.
  • The Code of Ethics for Nurses has nine provisions.
  • University of Phoenix offers RN to Bachelor of Science in Nursing degrees designed for nurses with real-world experience.

History of the Nursing Code of Ethics

The Code of Ethics for Nurses establishes ethical principles in nursing. Far more than just words on paper, the code is nursing’s north star. It governs how nurses behave during the vulnerable moments when patients place their trust, their care and perhaps even life and death decisions into their hands.

Established by the American Nurses Association (ANA), the Code of Ethics for Nurses “informs every aspect of the nurse’s life.” As such, the ANA Code of Ethics for Nurses is the profession’s non-negotiable standard.

It’s also a dynamic document, and one that has responded over time to healthcare, technological and social changes.

The origins of nursing ethics reach back to the late 1800s — a far different era when nurses weren’t viewed as valued members of a healthcare team as they are today. And concepts like justice in nursing? Well, let’s just say that wasn’t a thing back then.

Times have changed.

Formally adopted by the ANA in 1950, the Code of Ethics is revised approximately every decade to keep pace with advances in healthcare and technology, greater awareness of global health, greater inclusivity and the expansion of nursing into advanced practice roles, such as the family nurse practitioner. Today, there are four principles of nursing ethics and nine provisions that guide practice.

4 principles of nursing ethics

Nurses make ethical decisions daily. In fact, nurses often walk a line between advocating for patients while also adhering to ethical nursing principles.

The four principles of ethics for nurses guide this sacred charge. These principles are autonomy, beneficence, justice and nonmaleficence.


Autonomy in nursing means that each patient has the right to make their own decisions based on their beliefs and values. According to an article published by the National Center for Biotechnology Information, this means a patient has the right to refuse medications, treatment, surgery or other medical interventions. The nurse must respect this choice.


Beneficence in nursing is not as intimidating as it sounds. The ANA defines it as “actions guided by compassion.” Examples of beneficence include helping a heart patient shower, keeping side rails up to prevent falls or providing medication in a timely manner.


Justice in nursing ethics implies that patients have a right to fair and impartial treatment. This means no matter what a patient’s insurance status or financial resources may be, or what gender identification, age or ethnicity they are, they have the right to fairness in nursing decisions.


What is nonmaleficence in nursing? It simply means “do no harm.” In other words, nonmaleficence in nursing requires that nurses select interventions that can be beneficial without causing harm.

It’s not difficult to imagine that sometimes these principles of ethics can collide. For example, a nurse may find doing no harm is in conflict with a patient’s exercise of autonomy in refusing a lifesaving medication.

The ongoing realities of caring for patients during COVID-19 has also stretched nurses to the limits of autonomy, justice and compassion. However, according to an article in the American Journal of Nursing, an August 2020 survey of 4,000 people (1,000 of whom were nurses) revealed that “the crisis has resulted in some progress within the profession, accelerating changes in attitudes and expectations regarding nurses.”

Specifically, leadership opportunities, professional advancement and influence into decision-making seemed to be higher among those who spent more than half their time caring for COVID-19 patients than those who spent less than half their time caring for COVID-19 patients.

9 provisions of the Code of Ethics for Nurses

In addition to the high-level ethical principles in nursing described above, nurses must abide by a Code of Ethics.

From patient dignity and confidentiality to a safe environment and work setting, nurses are to abide by the nine provisions of the Nursing Code of Ethics, according to the American Nurses Association.

  • Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person.
  • Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population.
  • Provision 3: The nurse promotes, advocates for, and protects the rights, health and safety of the patient.
  • Provision 4: The nurse has authority, accountability and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.
  • Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional growth.
  • Provision 6: The nurse, through individual and collective effort, establishes, maintains and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality healthcare.
  • Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development and the generation of both nursing and health policy.
  • Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy and reduce health disparities.
  • Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession and integrate principles of social justice into nursing and health policy.

The Code of Ethics for Nurses PDF, published by the American Nurses Association, provides greater detail about the provisions.

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