ethical principles nursing essay

7 Main Ethical Principles in Nursing + Why They’re Important

Are you a nurse with a genuine desire to give the best care possible to patients and their families and to become a strong member of your nursing team? Maybe you are a nursing student eager to learn as much as possible to help you succeed in nursing. If so, the most important lesson you can learn is how to establish ethical nursing practices. There are several ways to demonstrate strong ethics, and knowing the main ethical principles of nursing is a great place to start. Perhaps you are wondering, "What are the 7 main ethical principles in nursing, and why they are important?” In this article, you will learn about ethical nursing principles and how they apply to you. As you continue reading, you will find an in-depth look at the 7 main ethical principles in nursing, why they’re important, and examples of how they are applied in the four main areas of nursing.

What Exactly is an Ethical Principle in Nursing?

What is the source of ethical principles in nursing, 7 reasons why ethical principles are so important in nursing, how many ethical principles are there in nursing.

1. Accountability 2. Justice 3. Nonmaleficence 4. Autonomy 5. Beneficence 6. Fidelity 7. Veracity

Are There any Conflicting Ethical Principles in Nursing?

What are the 7 main ethical principles in nursing and why they are important, 5 most common challenges you will face while applying the 7 ethical principles in nursing and how to overcome them, challenge #1: knowing where to draw the line between autonomy and beneficence, what is it:, how to overcome:, challenge #2: deciding whether to withhold information or be honest about a patient’s status or prognosis, challenge #3: supporting autonomy related to informed consent, challenge #4: keeping promises when your circumstances change, challenge #5: determining if nonmaleficence overrules a patient’s right to privacy, my final thoughts.

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Ethical Principles in Nursing and Why They Matter

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Nurses experience a unique power dynamic in the workplace. Patients, who are often sick or injured, rely on them for compassion and care, which is why it’s crucial for nurses to adhere to clear ethical principles. Reading about these principles of nursing is a great place to start, as all nurses who have a genuine desire to deliver the best care possible to patients and their families know these ethical principles very well and apply them in their work daily.

Studies have shown that nurses and patients alike benefit when nurses strictly abide by the Code of Ethics. A study published in the Journal of Advanced Nursing found that nurses who consistently followed the Nursing Code of Ethics reported better job satisfaction, which resulted in improved quality of patient care. Another study published in the Journal of Professional Nursing found that adherence to the Nursing Code of Ethics was associated with higher patient satisfaction and better communication between nurses and patients.

What Is the Nursing Code of Ethics?

The Code of Ethics for Nurses with Interpretive Statements (referred to as “the Code”) is an official guide established by the American Nurses Association (ANA) that details nursing responsibilities as they relate to quality of nursing care and the ethical obligations of the profession. Particularly, it governs how nurses behave during the vulnerable moments when patients place their trust, their care, and perhaps even life and death decisions into a nurse’s hands. The Code is revised every decade to keep current with advances in healthcare and technology, greater understanding of global health, inclusivity, and the expansion of nursing into advanced practice roles. While all nurses learn the Code in their nursing education, it’s important to stay up to date on revisions over the years in order to maintain the highest quality of care in an evolving healthcare landscape. The high standards of ethical behavior are necessary because nurses are faced with ethical decisions daily and often walk a line between advocating for patients while also adhering to ethical nursing principles.

4 Ethical Principles in Nursing

Nursing has four overarching ethical principles: autonomy, beneficence, justice, and non-maleficence. These principles provide guidance for nurses to navigate ethical dilemmas and make decisions that promote the well-being of their patients.

• Autonomy acknowledges a patient's right to make their own decisions about their healthcare based on their values and beliefs. Nurses must respect the autonomy of their patients by providing them with the information they need to make informed decisions about their healthcare, by respecting their decisions, and by advocating for their right to informed consent.
• Beneficence requires nurses to always act in the best interest of their patients. Nurses must use their knowledge, skills, and resources to provide high-quality care and promote the well-being of their patients. This may involve actions such as providing comfort and support, administering medication, or collaborating with other healthcare professionals to ensure optimal patient care.
• Justice emphasizes the importance of treating all patients fairly and impartially. Nurses must provide equal care to all patients, regardless of their background, race, gender, or social status. This may involve advocating for the rights of marginalized patients or addressing disparities in healthcare access and outcomes.
• Non-maleficence means "do no harm," which requires nurses to select interventions that are beneficial without causing harm to the patient. Nurses must be knowledgeable about the potential risks and benefits of any interventions they use and must take steps to minimize harm and maximize benefit for their patients. 

Together, these four ethical principles provide a framework for ethical nursing practice and guide nurses in their practice and the healthcare system as a whole.

9 Provisions for Nurses

In addition to the high-level ethical principles in nursing, nurses must also abide by the Code, which includes nine provisions. The provisions emphasize the importance of treating every person with compassion and respect, which is fundamental to the practice of nursing. By treating patients with dignity, nurses can build trusting relationships with their patients and deliver quality patient care.

• The nurse practices with compassion and respect for every person's inherent dignity, worth, and unique attributes.
• The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
• The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
• 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.
• 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.
• 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.
• 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.
• The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
• 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.

Why Ethical Principles Matter in Nursing

When nurses apply ethical principles in their practice, they contribute to a universal standard for strong nurse-patient relationships, which is essential for collaboration in healthcare facilities and quality patient care. The Code of Ethics helps nurses navigate difficult situations and make decisions that are in the best interest of their patients. By following this compass, nurses can balance the need to provide optimal care with respecting the autonomy of patients, nurturing trust and respect between nurses and their patients.

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Nursing Ethical Principles Application Essay

Introduction, making a decision, ethical principles, personal values and beliefs, self-care strategies.

Nursing ethics, self-advocacy, and professional accountability are three essential principles that guide the practice of nursing professionals. Nurses are held accountable for their actions and conduct to ensure that they operate within the established levels of competence when providing care to patients as well as improve their practice to ensure the provision of high-quality, ethical, and safe care to patients. In this paper, a scenario regarding nurses’ ethical responsibilities will be assessed; it includes a complicated dilemma that could test a nurse’s integrity with regards to catering to a patient’s needs that may go against some of the ethical principles of nursing.

In the scenario, the patient (Mr. Newcomb) diagnosed with a fatal condition asked his nurse to aid in seeing his mistress for the last time. While such a request may not be complicated to arrange, there is one significant ethical barrier – Mr. Newcomb is married, and his wife is always at his bedside, trying to spend as much time with her husband as possible. In such a situation, a nurse has to choose whether to cater to the dying patient’s wish and lie to his wife or to decline the request respectfully.

Despite the fact that the Code of Ethics for Registered Nurses implies support for patients’ decisions even in cases when their families disagree with them, the case of Mr. Newcomb cannot align with this rule since it is not concerned with treatment (CNA, 2017).

A nurse is likely to decline the request by expressing his or her moral obligation of providing ethical care to patients and avoiding deceitful actions that can lead to adverse consequences. However, the nurse must assure the patient that his request would remain between him and the nurse to avoid any complicated situations with his wife: “collect, use, and disclose health information on a need-to-know basis with the highest degree of anonymity possible in the circumstances and in accordance with privacy laws” (CNA, 2017, p. 14).

The knowledge of ethical principles (beneficence, autonomy, non-maleficence, and justice) significantly influenced the decision made in the case of Mr. Newcomb since they guide nursing practice in the context of providing care to patients. If, for instance, Mr. Newcomb asked to administer him more pain relievers while his wife was against it, a nurse would be likely to administer appropriate medication to ease the patient’s pain.

However, the patient’s request was solely personal and went against the general ethical principle of being truthful. This means that Mr. Newcomb’s nurse had more leverage in making the decision of not helping him deceive his wife. It is important to mention that making a solid decision in Mr. Newcomb’s case was hard because the ethical principles of beneficence, autonomy, non-maleficence, and justice did not have a unifying theory to provide a clear guideline on how to act in certain situations (Bishop, n.d.).

For instance, the principle of fairness (treating others equitably and fairly distributing benefits or burdens) can make a nurse more confident in declining Mr. Newcomb’s offer due to the high burden of being responsible for the patient’s cheating behavior. Also, a nurse may harm the patient’s wife by agreeing to the request and thus violate the principle of non-maleficence. However, the principle of autonomy (acknowledging the right to make choices based on personal values and beliefs) suggests that Mr. Newcomb can do whatever he wants, especially due to his severe health condition. Also, the patient could have benefited from seeing his mistress. Despite the fact that the knowledge of the key ethical principles of autonomy, justice, non-maleficence, and beneficence guided the decision, they made the nurse’s considerations even more complicated.

The personal values and beliefs of the nurse in the scenario also contributed to making the decision of not helping Mr. Newcomb see his mistress. Despite the fact that the nurse developed a special bond with the patient, it is essential to understand the value of marriage and the responsibilities it usually brings. Since Mrs. Newcomb is always at her husband’s side and wants to do everything in her power to make him comfortable during his last days, it is disrespectful to consider bringing her husband’s mistress to the hospital.

Strategies for promoting self-care are positive reinforcements that help patients be more conscious of their health situation and thus enhance their autonomy and self-esteem (Bedin, Busanello, Sehnem, da Silva, & Poll, 2014). Three beneficial strategies can include the dissemination of information, patient training, and support networks. Information is essential for helping patients understand their condition, which is especially valuable for those with chronic or fatal diagnoses (Richards, 2012).

Patient training is a strategy that encourages individuals to take action in caring for themselves and be prepared for health prognoses and possible interventions. Lastly, the strategy of support networks is important for self-care because it assesses patients’ needs, available resources, and support mechanisms that could facilitate the improvement of health and contribute to the beneficial self-care strategies that a patient has already implemented.

Bedin, L., Busanello, J., Sehnem, G., da Silva, F., & Poll, M. (2014). Strategies to promote self-esteem, autonomy and self-care practices for people with chronic wounds. Revista Gaúcha de Enfermagem, 53 (3), 1-4.

Bishop, L. (n.d.). Principles – respect, justice, nonmaleficence, beneficence. Web.

CNA. (2017). Code of ethics for registered nurses. Web.

Richards, S. (2012). Putting self-care into practice. Web.

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Nursing ethical considerations.

Lisa M. Haddad ; Robin A. Geiger .

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Last Update: August 14, 2023 .

• Definition/Introduction

Ethical values are essential for any healthcare provider. Ethics comes from the Greek word “ethos,” meaning character. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. [1]  Ethics are moral principles that govern how the person or a group will behave or conduct themselves. The focus pertains to the right and wrong of actions and encompasses the decision-making process of determining the ultimate consequences of those actions. [2]  Each person has their own set of personal ethics and morals. Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them. To practice competently with integrity, nurses, like all healthcare professionals, must have regulation and guidance within the profession. [3]  The American Nurses Association (ANA) has developed the Code of Ethics for this purpose.

• Issues of Concern

The onset of nursing ethics can be traced back to the late 19 century. At that time, it was thought that ethics involved virtues such as physician loyalty, high moral character, and obedience. [3]  Since that early time, the nursing profession has evolved, and nurses are now part of the healthcare team and are patient advocates. The first formal Code of Ethics to guide the nursing profession was developed in the 1950’s. Developed and published by the ANA, it guides nurses in their daily practice and sets primary goals and values for the profession. Its function is to provide a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It provides a nonnegotiable ethical standard and is an expression of nursing’s own understanding of its commitment to society. The Code of Ethics has been revised over time. The current version represents advances in technology, societal changes, expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, and builds and maintains healthy work environments. [3]

The Code of Ethics for Nurses is divided into nine provisions to guide the nurse. The following is a summary of the American Nurses Association Code of Ethics for Nurses: 

Provision 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 

The nurse must have a high level of respect for all individuals, and allow dignity in regards to dealings in care and communication. It's important that patient's families are also treated with respect for their relationship to the patient. Nurses must understand the professional guidelines in communications and work with colleagues and patient families. It's important to understand the proper professional relationship that should be maintained with families and patients. All individuals, whether patients or co-workers have the right to decide on their participation in care and work.

Provision 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

The patient should always be a first and primary concern. The nurse must recognize the need for the patient to include their individual thought into care practices. Any conflict of interest, whether belonging to external organizations, or the nurse's habits or ideals that conflict with the act of being a nurse, should be shared and addressed to not impact patient care. Collaboration with internal and external teams to foster best patient care is a necessity. Understanding professional boundaries and how they relate to patient care outcomes is important.

Provision 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

It is important for the nurse to understand all privacy guidelines with regards to patient care and patient identifiers. Nurses involved in research must understand all aspects of participation including informed consent and full disclosure to the patient of all aspects required to participate in the study. The nurse must understand any institutional standards set in place to review his/her performance; this includes measurements of progress and the need for further review or study to meet performance standards. To become a nurse, competence must be demonstrated in clinical and documentation prowess. Standards of competence will continue at institutions and academic organizations that employ the nurse. If there is witness or recognition of questionable healthcare practice, it is important that the patient is protected by reporting any misconduct or potential safety concern. And finally, the nurse will not provide patient care while under the influence of any substance that may impair thought or action, this includes prescription medication.

Provision 4 . The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.

As a nurse, it's inherent that accountability for all aspects of care aligns with responsible decision making. Use of authority must be professional and about all aspects of individualism and patient, ethical concerns. Nursing decisions must be well thought, planned, and purposefully implemented responsibly. Any delegation of nursing activities or functions must be done with respect for the action and the ultimate results to occur. 

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.

A nurse must also demonstrate care for self as well as others. An ideal nurse, will have self-regard towards healthcare practices and uphold safe practice within the care setting and at home. It's important for a nurse to have a high regard for care as an overall inert ability once the profession is entered. A character becoming a nurse would include integrity. Nurses should be concerned for personal growth in regards to continued learning of the profession. The ability to grow as a nurse with improvements to care, changes or trends in care should be adapted to maintain competence and allow growth of the profession.

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 health care.

As a nursing profession, standards should be outlined within and external to institutions of work that dictate ethical obligations of care and need to report any deviations from appropriateness. It's important to understand safety, quality and environmental considerations that are conducive to best patient care outcomes.

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.

Nurse education should include principles of research, and each nurse should understand how to apply scholarly work and inquiry into practice standards. Nurse committees and board memberships are encouraged to contribute to health policy and professional standards. The ability to maintain professional practice standards should continue, changing and enhancing as developments in practice may over time.

Provision 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 

Through collaboration within the discipline, maintaining the concept that health is a right for all individuals will open the channels of best practice possibilities. The nurse understands the obligation to continue to advance care possibilities by committing to constant learning and preparation. The ability of the nurse to practice in various healthcare settings may include unusual situations that require continued acts of diplomacy and advocacy.

Provision 9. The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Nurses must continue to gather for committees and organize groups where they may share and evaluate values for accuracy and continuation of the profession. It is within these organizations that nurses may join in strength to voice for social justice. There is a need for continued political awareness to maintain the integrity of the nursing profession. The ability of the nurse to contribute to health policy should be shared among the profession, joining nurses throughout the world for a unified voice.

American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring, MD

• Clinical Significance

Ethical values are essential for all healthcare workers. Ethical practice is a foundation for nurses, who deal with ethical issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse's ethical values. Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence.

Each patient has the right to make their own decisions based on their own beliefs and values. [4] . This is known as autonomy. A patient's need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best. A person has a right to refuse medications, treatment, surgery, or other medical interventions regardless of what benefit may come from it. If a patient chooses not to receive a treatment that could potentially provide a benefit, the nurse must respect that choice.

Healthcare workers have a duty to refrain from maltreatment, minimize harm, and promote good towards patients. [4]  This duty of particular treatment describing beneficence. Healthcare workers demonstrate this by providing a balance of benefits against risks to the patient. Assisting patients with tasks that they are unable to perform on their own, keeping side rails up for fall precautions, or providing medications in a quick and timely manner are all examples of beneficence.

All patients have a right to be treated fair and equally by others. Justice involves how people are treated when their interest competes with others. [5] . A current hot topic that addresses this is the lack of healthcare insurance for some. Another example is with patients in rural settings who may not have access to the same healthcare services that are offered in metropolitan areas.

Patients have a right to no harm. Non-maleficence requires that nurses avoid causing harm to patients. [6]  This principle is likely the most difficult to uphold. Where life support is stopped or patients have chosen to stop taking medication that can save their lives, the nurse is put in a morally challenging position.

Nurses should know the Code of Ethics within their profession and be aware and recognize their own integrity and moral character. Nurses should have a basic and clear understanding of key ethical principles. The nursing profession must remain true to patient care while advocating for patient rights to self-identify needs and cultural norms. Ethical considerations in nursing, though challenging, represent a true integration of the art of patient care.

Nurses have a responsibility to themselves, their profession, and their patients to maintain the highest ethical principals. Many organizations have ethics boards in place to review ethical concerns. Nurses at all levels of practice should be involved in ethics review in their targeted specialty area. It is important to advocate for patient care, patient rights, and ethical consideration of practice. Ethics inclusion should begin in nursing school and continue as long as the nurse is practicing.

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Disclosure: Lisa Haddad declares no relevant financial relationships with ineligible companies.

Disclosure: Robin Geiger declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Haddad LM, Geiger RA. Nursing Ethical Considerations. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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